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ABSTRACT: The effects of disasters may predispose
many adolescents to psychological stress, which can
interfere with their growth and development and
disrupt their intrapsychic homeostasis. This may lead
to negative long-term health outcomes and hamper
normal development. Many nurses view traumatic events
involving children, including adolescents, as the most
PATRICIA A. CRANE, MSN, RNC, CRNP, AND PAUL T. CLEMENTS, PhD, APRN-BC, DF-IAFN
JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 43, NO. 8
frequent and stressful critical incidents. There is a need to
address psychological emergency preparedness for mass
disasters with the development of protocols and practice
guidelines. Assessing and managing physical injuries may
take priority in emergencies, but incorporating rapid,
cost-effective mental health assessments for children and
adolescents is essential.
31
 C
oupled with developmen-
tal transitions, the effects
of disasters may predispose
many children and adolescents
to psychological stress, which can
interfere with growth and devel-
opment and disrupt intrapsychic
homeostasis. This may lead to nega-
tive long-term health outcomes and
hamper normal development (Vigil
& Clements, 2003). In addition, 1
in 10 children younger than age 18
has a mental illness severe enough
to cause some level of impairment,
and less than 1 in 5 receives the
necessary treatment (U.S. Depart-
ment of Health and Human Servic-
es, 2001). It is clear that, in the con-
temporary era of war and terrorism,
children and adolescents are dispro-
portionately at risk for exposure to
threats from chemical, biological,
and physical weapons.
A disaster is defined as a spatial-
ly concentrated event with rapid
onset that creates severe danger
and destruction, as it disrupts the
community’s ability to meet its
needs (DeRanieri, Clements, &
Henry, 2002; Vitaliano, Maiuro,
Bolton, & Armsden, 1987). While
the classic study on the effects of
disasters is more than 50 years old
(Lindemann, 1979), during the
past 20 years there has been grow-
ing interest in the psychological
consequences for children and
adolescents of mass disasters, such
as floods, hurricanes, earthquakes,
wildfires, arson, nuclear events,
sniper attacks, war, and the explo-
sion of the space shuttle Challenger
(Barenbaum, Vladislav, & Schwab-
Stone, 2004; Yule, 1999).
The manifestation of posttrau-
ma symptomatology in adolescents
may go unrecognized by health
care providers (Bernardo, 2001;
Burgess, Hartman, & Clements,
1995; Clements & Burgess, 2002).
Many nurses view traumatic events
involving children and adolescents
as the most frequent and stressful
critical incidents. Thus, psycho-
logical emergency preparedness for
32
mass disasters need to be addressed
with the development of protocols
and practice guidelines (Ursano et
al., 1999). Assessing and managing
physical injuries may take priority
in emergencies, but incorporating
rapid, cost-effective mental health
assessments for children and adoles-
cents is essential.
PURPOSE
Normal developmental transi-
tions inherent in adolescence are
rarely straightforward. Adolescents
who experience disasters are par-
ticularly vulnerable to the effects
as they progress through the dis-
quieting journey of self-discovery,
with shifting repertoires of coping
skills. Health care providers need
to plan assessment guidelines for
risk screening the most-vulnerable
adolescents, provide anticipatory
guidance, and identify the need
for consultation with and referral
to community resources. School
health care providers in adminis-
trative roles, nurses, and advanced
practice clinicians in school-based
clinics can initiate assessment, carry
it out in a safe setting, normalize the
experience, and minimize the stig-
ma related to potential treatment.
In addition, school accessibility is
considered an advantage by feder-
ally funded disaster mental health
programs (Pfefferbaum, 2002).
In this article, we review the ad-
olescent developmental transition
process as it relates to the psycho-
logical effects of disasters, and pro-
vide a brief literature review of stud-
ies involving children younger than
age 18. Features of disaster-related
diagnoses set forth in the Diagnostic
and Statistical Manual of Mental Dis-
orders, fourth edition, text revision
(DSM-IV-TR) (American Psy-
chiatric Association [APA], 2000)
were used. Implications for practice
and realistic, developmentally ap-
propriate suggestions for health care
providers working with adolescents
who witness or experience traumat-
ic events are reviewed.
LITERATURE REVIEW
Following disasters, aware-
ness of who may be at highest risk
for posttraumatic stress disorder
(PTSD) can help focus the earliest
and most vigorous screening and
treatment efforts to prevent devel-
opment of PTSD. An important
connection exists between PTSD,
physical symptoms, other psychi-
atric disorders, and increased rates
of suicide (Mitchell, Sakraida, &
Kameg, 2002). In addition, the di-
saster may have an adverse effect on
adolescents’ subsequent develop-
ment (Goenjian et al., 1996). Only
during the past 15 years have clini-
cians come to realize that children
and adolescents do not merely re-
spond to transient stress, but may be
disabled by it. However, what may
be different from adult survivors
are the ways in which children and
adolescents think about the event,
express their fears, and attempt to
cope (Clements & Burgess, 2002).
In the past, data on children
and adolescents following disasters
and trauma were limited because
they were provided not by the chil-
dren themselves, but by parents
and teachers, who may have been
coping with their own emotional
adjustment and grief (Yule, 1999).
Often, parents underestimate the
severity of distress and are not aware
of feelings their children internalize
(Stoppelbein & Greening, 2000).
Parents may not be fully aware of
children’s emotional experiences
or may be in denial because they
blame themselves. In addition, chil-
dren and adolescents may not want
to further upset their parents and so
do not disclose their distress (Korol,
Green, & Gleser, 1999).
Some researchers question the
usefulness of the DSM-IV-TR
(APA, 2000) criteria in diagnos-
ing PTSD in adolescents because
manifestation of symptom clusters
vary and are more often expressed
in behavioral terms than cognitive
expressions. Experts also claim that
research focusing on categorization
AUGUST 2005
of PTSD symptoms for adolescents
in general is lacking (Anthony,
Lonigan, & Hecht, 1999). Poten-
tial age-related differences in the
expression of PTSD must be ad-
dressed because the diagnosis was
developed for adults following war.
In reality, many of these adult war
veterans may have been in late ad-
olescent development in their late
teens and early 20s.
McCloskey and Walker (2000)
examined psychopathology in 337
children exposed to chronic abuse
and single-event trauma. Single-
event trauma is more likely to result
in PTSD when caused by an acci-
dent, natural disaster, or interper-
sonal trauma that involved a threat
to a person’s life. The researchers
reported that children ages 6 to
12 may develop PTSD symptoms
whether they are witnesses to
(21%) or targets of (38%) a violent
stressor (McCloskey & Walker,
2000). The likelihood increases to
100% when children experience
both. The death or illness of a fam-
ily member or friend was found to
be the strongest predictor of PTSD.
The study also found high correla-
tions between the PTSD symptoms
reported by children and other
forms of psychopathology, such as
JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 43, NO. 8
phobias, separation anxiety, op-
position disorder, and depression,
reported by the parents and chil-
dren long after the trauma occurred
(McCloskey & Walker, 2000).
Anthony et al. (1999) described
symptom categories in child and ad-
olescent victims (n = 5,446) follow-
ing a hurricane, and the dimensions
of PTSD closely resembled those of
adult veterans studied 20 years af-
ter their trauma by King and King
in 1994 (as cited in Anthony et
al., 1999). Data from the child and
adolescent studies was synthesized
with the veteran data. Anthony et
al. (1999) concluded that children’s
PTSD dimensions are stable and not
qualitatively different across ages at
time of exposure, type of trauma,
years after trauma, and means of
measurement. In addition, their
characterization of PTSD included
the following symptom clusters:
● Intrusive phenomena, cou-
pled with active avoidance of nega-
tive experiences.
● Emotional numbing, along
with passive avoidance of emotion-
ally unrewarding activities.
● Increased arousal.
This structure was stable for
late childhood and early and late
adolescence; yet, the quantity or
severity of symptoms consistently
increased with younger age. This
led Anthony et al. (1999) to re-
port that postdisaster disturbance
severity is on a continuum, with
the youngest individuals being the
most vulnerable. They challenged
the categorization of the DSM-IV
symptom clusters, claiming the ac-
tive and passive avoidance strategies
belong in different PTSD symptom
clusters. This indicates there may
be different risk factors and predic-
tors that respond to different types
of treatment strategies for children
and adolescents.
Stoppelbein and Greening
(2000) compared emotional adjust-
ment of children and adolescents
who lost a parent (n = 39), experi-
enced a tornado disaster (n = 69),
and were coping with academic
stress (n = 118). Up to 1 year af-
ter a death experience, unresolved
adjustment was more appropri-
ately conceptualized as PTSD if
there had been a severe threat to
life, death of a family member, or
long-term family disruption. One
year later, parentally bereaved chil-
dren had significantly more PTSD
symptoms (23%) than those who
experienced the tornado (3%) or
those living with the daily academ-
33
 ic stressor (3%) (Stoppelbein &
Greening, 2000). The ability of the
surviving parent to provide a stable
environment affected children’s ad-
justment. Children whose parents
scored high on the PTSD measures
were at greater risk for PTSD, indi-
cating there may be a genetic pre-
disposition for reacting to stress in a
certain way (Stoppelbein & Green-
ing, 2000).
DSM-IV-TR DIAGNOSES
The continuum of anxiety dis-
orders is defined and accompanied
by diagnostic criteria within the
DSM-IV-TR (APA, 2000). These
disorders range from adjustment
disorders to PTSD, the most severe
state of anxiety. Adjustment dis-
order may be experienced acutely
during the first few months after
the trauma. Integration of the trau-
matic event is typically completed
with brief psychotherapeutic sup-
port and intervention. Diagnosis of
PTSD officially recognizes the trau-
matic experience and its long-last-
ing effects, but other variables and
interactions may increase the like-
lihood of mental health problems.
Therefore, health care providers
and people who work with children
and adolescents need to be aware of
the full spectrum of psychiatric dis-
orders and who is most at risk, in-
cluding those in close proximity to
the disaster or who experience the
injury or death of a loved one due
to the disaster, those with acute or
chronic exposure to other horrific
experiences, or those who express
a sense of intense helplessness (Mc-
Closkey & Walker, 2000; Stoddard
& Saxe, 2001).
Adjustment Disorder
Diagnosis of adjustment disor-
der is based on the development
of emotional and behavioral symp-
toms seen within 3 months of the
disaster. Clinically significant find-
ings include marked distress in
excess of what would be expected
from exposure to a stressor, and sig-
34
nificant impairment in social or oc-
cupational functioning. This could
include academic function with
children and adolescents. The trau-
ma or disturbance is not another
disorder classified as Axis I or II in
the DSM-IV-TR (APA, 2000), nor
should the symptoms be confused
with bereavement. Symptoms usu-
ally begin at any time from within
days of to a few months after the
disaster and do not persist beyond
6 months after the event has termi-
nated. When the stressor persists,
the adjustment disorder may also
persist, or progress to a more severe
disorder. Children are more likely
to experience adjustment disorder,
and the risk increases with the ex-
istence of a comorbid psychiatric
condition.
Stress Disorders
Stress disorders differ from ad-
justment disorders in that they
follow a witnessed or experienced
stressor (e.g., terrorist acts, natural
disasters, military combat, sexual
assault, physical attacks, robberies)
that evokes fear, helplessness, and
horror (APA, 2000). In addition,
stress disorders are characterized
by a specific constellation of symp-
toms—persistent reexperiencing
of the event, avoidance of or in-
creased arousal to stimuli associated
with the event, and dissociation
or a numbing response. According
to the DSM-IV-TR (APA, 2000),
disorganized and agitated behav-
ior may be seen in children. These
symptoms are typically noticed
when they cause significant impair-
ment in social interactions, occupa-
tional performance or attendance,
or other important areas of daily
function.
The stress disorders are cat-
egorized in relation to onset and
duration of symptoms. In acute
stress disorder, symptoms are seen
within 2 days to 4 weeks following
the traumatic event, and last up
to 3 months. If symptoms last 3 or
more months, the designated term
AUGUST 2005
is chronic stress disorder. Delayed
onset is the occurrence of trauma-
related symptoms 6 or more months
after the event.
RISK FACTORS
Gender
Girls are more likely to be diag-
nosed with an adjustment disorder,
the prevalence of which is reported
as 2% to 8% in community samples
of children and as high as 50% in
populations that have experienced
a specific stressor, such as a disaster
(Jones, Frary, Cunningham, Wed-
dle, & Kaiser, 2001). Data on gen-
der differences in PTSD following
disaster are conflicting, with some
researchers proposing that women
are more likely to exhibit symptoms
because they are socialized to do so,
and others reporting similarities in
responses between men and women
(Jones et al., 2001).
Following a hurricane in Ha-
waii, children (n = 4,528) who ex-
perienced the greatest devastation
to their communities manifested
enduring psychological symptoms
2 years after the event (Chemtaub,
Nakashima, & Hamada, 2002).
Girls, younger children, those of
lower socioeconomic status, those
who panicked at the time of the
event, and those who feared for
the physical safety of their families
and themselves were found to be
most vulnerable at the 2-year mea-
surement point (Chemtaub et al.,
2002).
Race
Race has been found to play a
mediating role in children’s symp-
toms after trauma, but with mixed
results. For example, some research-
ers have found Caucasian youth to
be more likely to develop PTSD,
while others have found this to be
true for African American youth
(Jones et al., 2001). Further cloud-
ing the issue is that race is often
poorly defined because of the ex-
clusion of ethnicity, acculturation,
socioeconomic status, values, and
JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 43, NO. 8
beliefs (Jones et al., 2001). Some
researchers maintain that stress
from disasters and war is expressed
similarly in all cultures and that
Western therapeutic techniques
and programs are valid and useful
(Barenbaum et al., 2004). Alterna-
tively, it has been proposed that ex-
pansion of the understanding of the
expression of posttrauma symptom-
atology is needed, and that distress
of this nature cannot be homoge-
neously addressed but is defined by
the social, cultural, and political sit-
uation of each person (Barenbaum
et al., 2004).
Preexisting Psychopathology
Stoddard and Saxe (2001) re-
ported that children with preexist-
ing psychopathology are at greater
risk for developing PTSD or exac-
erbating the psychopathology in
any post-injury phase. This is more
likely when the cause of injury is
related to an uncontrollable, fear-
inducing event, such as a disaster.
McCloskey and Walker (2000)
indicated that adolescents are more
at risk if they have been diagnosed
with psychiatric disorders or have
witnessed familial homicide, com-
munity violence, or war.
Mild-to-moderate PTSD symp-
toms were reported in 28% of chil-
dren 1 year after an earthquake
(Asarnow et al., 1999). Risk was
associated with resource loss, per-
ceived stress, preexisting anxiety
disorder, and increased use of cogni-
tive coping strategies (Asarnow et
al., 1999). Asarnow et al. (1999)
hypothesized that children with
preexisting anxiety disorder have
more extreme subjective appraisals
of the event that preclude their use
of reappraisal mechanisms and their
ability to sustain comfort from reas-
surance and safety efforts.
ADOLESCENT
DEVELOPMENT
Adolescent development is a
transitional process through which
the individuals are evolving, with
ultimate task attainment not being
complete at a specific age (Bloch,
1995). The process is described as an
urge to complete development re-
lated to physical, physiological, and
intellectual growth, accompanied
by a need for parenting, which en-
ables self-confidence (Bloch, 1995).
Parental relationships and pleasing
parents is important. Adolescents
must remain reality oriented and
adapt to their increasing capacities
as they experiment and adjust, to
balance a sense of security, integra-
tion of their sexuality, aggression,
and new cognitive abilities, in ad-
dition to coping with parental con-
flicts (Bloch, 1995). In short, they
must learn how to control their
impulses, while coping with their
environment. Disruption of fam-
ily stability and support following a
disaster challenges adolescents’ pro-
gression through this transition.
Adolescents also formalize their
moral code and understanding of
family and societal rules during
this time. Tragedy and trauma can
present adolescents with conflict in
direct violation of what they have
learned, confounding their abil-
ity to understand societal norms of
interpersonal safety and respect for
the value of life. The critical foun-
dation for personal mastery may be
disrupted and lead to confusion and
misunderstanding about appropri-
ate roles and expectations.
Adolescents’ fears and anxiet-
ies are most likely shared with their
peers, making the schools and or-
ganizations where they gather ideal
places for initiating assessment. A
traumatic experience can challenge
adolescents’ feelings of safety and
security at a time when a key devel-
opmental task is moving out into
the world.
IMPLICATIONS FOR
CLINICIANS
Assessment following disasters
requires a complementary evalu-
ation to provide holistic manage-
ment and should include assess-
35
 ment for vulnerability to PTSD,
dissociation, and traumatic grief,
because they are each associated
with different risk factors (Laor et
al., 2002). In addition, clinicians
may find the following consider-
ations helpful for assessment of
adolescents following disasters.
Perception of the Event
Clinicians should consider
adolescents’ perception or under-
standing of the event, which may
be related to their cognitive abil-
ity, the location of the disaster, or
the severity of damage they wit-
nessed. Those experiencing the
most devastating exposure can
be expected to be the most symp-
tomatic over time. Maturity level
may be assessed through a brief
interview with the adolescents,
their friends or families, or school
personnel regarding the adoles-
cents’ responsibilities at home,
work, and school. This informs
health care providers about the
adolescents’ coping skills and how
well they may adapt. However, re-
gressive behaviors are not unusual
for adolescents of all ages follow-
ing trauma.
SELECTED DISASTER-RELATED
RESOURCES
American Academy of Child
and Adolescent Psychiatry
http://www.aacap.org/
Emergency Medical Services for Children
http://www.ems-c.org/
Federal Emergency Management
Agency for Kids
http://www.fema.gov/kids/
National Institute of Mental Health
“Helping Children and Adolescents Cope
with Violence and Disasters”
http://www.nimh.nih.gov/publicat/violence.cfm
Terrorist Attacks and Children: A National
Center for PTSD Fact Sheet
http://www.ncptsd.va.gov/facts/disasters/
fs_children_disaster.html
36
When verbal information is
limited, school files may provide
needed information regarding the
adolescents’ home address, as well
as their proximity to the point of
maximum destruction and whether
they witnessed death and terror due
to the disaster, experiences more
likely to cause immediate behavior
changes and long-term distress. Al-
ternatively, surviving a disaster may
make adolescents feel immortal and
lead to increased risk-taking behav-
ior and recklessness.
Individual Vulnerabilities
Vulnerabilities can be described
as medical conditions, developmen-
tal challenges, or mental health his-
tory (e.g., depression) that can put
some adolescents more at risk (Mc-
Nally, Bryant, & Ehlers, 2003). Ad-
olescents with a medical diagnosis
that they perceive as limiting are at
greater risk for experiencing worse
psychological outcomes, particular-
ly if they are maladjusted or in the
process of adjusting to the preexist-
ing condition. Stoddard and Saxe
(2001) found worse psychiatric out-
comes in children who were more
severely injured. For example, an
adolescent who is mobile with the
use of crutches or a wheelchair may
experience greater fear and anxiety,
feel they are more of a burden, or
believe they are less helpful follow-
ing an event that limits activity or
their ability to participate.
Adolescents with developmen-
tal challenges may reside in special
housing or go to special schools.
Their cognitive understanding of
tragic events may be limited and
may make it difficult to explain a
disaster, when their stability of rou-
tine is altered, home life disrupted,
and support staff or family unavail-
able. Adolescents with past experi-
ences of trauma may have received
ineffective treatment in the past
and may require immediate psychi-
atric treatment. In addition, adoles-
cents with psychiatric diagnoses are
at high risk for developing adjust-
ment disorders and PTSD. If stabili-
zation of their psychiatric condition
requires medication, special care is
needed to maintain therapy.
Psychological Coping Skills
Adolescents’ adaptive strategies
following disasters are related to
their psychological, physical, cogni-
tive, and moral development. The
process becomes more complex with
the development of reasoning abil-
ity in later adolescence when their
array of coping strategies expands.
In addition, their coping strategies
change with the passage of time,
amount of exposure, and success
they experience coping with a va-
riety of situations. Therefore their
maturity, the timing of the event,
individual differences (e.g., those
found in different cultures), and
the meaning of the event influence
adolescents’ coping abilities.
Severe psychological stress dur-
ing adolescent transition is reported
by less than 20% of this population
(Hauser & Bowlds, 1990). How-
ever, compounding stressors can
lead to potential maladaptive cop-
ing and negative outcomes (Hauser
& Bowlds, 1990). In addition, due
to their immature cognitive coping
skills, adolescents may indulge in
more avoidance coping, which may
lead to poorer outcomes and adjust-
ment, substance abuse, or depres-
sion (Asarnow et al., 1999).
Social Support
Social support has a powerful
influence on stress resistance and
reflects the family environment, as
well as other social networks. Strong
attachments and a stable home life
may lead to greater resilience. Ado-
lescents may experience the death
of family members and peers due
to the disaster or not know where
their loved ones are for an extended
period of time. The burden of loss
following disasters, along with de-
velopmental transitions, may have
devastating effects on adolescents’
development and health, particu-
AUGUST 2005
larly if the individual’s vulnerabili-
ties include a damaged social sup-
port system.
SUGGESTIONS FOR
PRACTICE
Recommendations for mental
health services were put forth by
the National Center for Disaster
Preparedness at a 2003 national
consensus conference. The ex-
perts suggested that disaster mental
health protocols and considerations
for children and adolescents be in-
tegrated into every phase of disaster
planning and response. Develop-
ment and improvement in the part-
nerships between mental health,
medical, and disaster management
professionals is recommended. A
continuum of care for disaster men-
tal health that addresses preven-
tion, acute interventions, and long-
term risk, vulnerability, and positive
coping across the life span, from in-
fancy to age 21, should be designed
and promoted (National Center for
Disaster Preparedness, 2003).
For adolescents who are exposed
to a disaster, caring and sensitive
clinicians may serve as a buffer
against stress disorders (McNally
et al., 2003). It is critical to vali-
date the adolescents’ feelings and
acknowledge the severity of the
event, and to promote normal ado-
lescent activities with peer groups.
Smoyak (2004), citing McNally et
al.’s work, noted that evidence re-
lated to the efficacy of psychologi-
cal debriefing for preventing PTSD
is not convincing; in fact, some
evidence suggests it may hamper
recovery (McNally et al., 2003).
Thus, assessment for individual
vulnerabilities and adaptive coping
methods may be vital in the initial
interaction with adolescents.
Following a traumatic event,
adolescents may be overwhelmed
by emotions, as well as practical
matters. Their concentration and
comprehension may be impaired,
and it may help to provide practi-
cal, verbal or printed educational
JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 43, NO. 8
K E Y P O I N T S
1. Vulnerabilities, such as physical and psychiatric mental health conditions, may
place adolescents in developmental transition at higher risk for long-term
negative effects following disasters.
2. Holistic assessment of adolescents most at risk should take priority following
disasters.
3. Adaptive coping skills and social support may reduce the likelihood of
adolescents’ developing negative effects.
4. Sensitive, caring clinicians may be the most effective remedy for adolescents
who witness or experience traumatic events.
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information about issues such as event. Severe posttrauma symp-
financial resources and safety. toms experienced a week or two
Shock, numbness, disbelief, and after the event are thought to be
overt denial can be typical reactions a strong indicator that treatment is
after a disaster, and encouraging ad- necessary (McNally et al., 2003).
olescents to talk about the event is A more common reaction among
beneficial for many. Talking about adolescents is confusion about
the event can help explore their why they are still upset about the
feelings and experiences at the time events. Trauma-related symptoms
of the event and help connect to are typical for the first year follow-
current thoughts, feelings, and fears. ing the event, especially around
Telling the story helps adolescents the 1-year anniversary of the event.
begin to understand the trauma Symptoms may continue into the
they have experienced. Clinicians second year and still be considered
should reassure the adolescents that normal.
recovery may entail becoming up- If, at any point in the continuum
set or angry and crying (Clements, of recovery, PTSD or related symp-
2001). toms are disruptive to adolescents’
It is possible for adolescents to routine activities of daily living,
be affected mentally, emotionally, medical or mental health interven-
physically, and spiritually, and the tion may be required. Using drugs
adolescents and their family mem- or alcohol and engaging in violence
bers may need to be informed of this are not a normal part of the recov-
as they begin to confront the reali- ery process. Adolescents displaying
ties of the event. However, trauma such behavior should be referred
and the related coping responses immediately for further assessment
may vary among family members, and possible intervention.
and no particular response is “bad.” Adolescents and their family
While some people may cry openly, members should be informed that
others may not allow themselves they cannot define the effects of
to cry; this does not mean either the event for one another. Each
person is doing anything wrong person will determine their own
(Barenbaum et al., 2004; Clements, meaning of the event. The effects
2001). of an event are not the same, even
Just as with adolescent devel- when friends or family experienced
opment, no established timetable a similar event. Most survivors find
exists for adjusting to a traumatic themselves repeating the story of
37

the event many times. Through
this repetition, the exploration and
identification of what the event
means to them marks the begin-
ning of healing and recovery.
SUMMARY
Following disasters, adolescents’
perceptions, vulnerabilities, and
internal and external resources
must be assessed before initiation
of treatment. Adjustment and
stress disorders are likely to be ex-
perienced after disasters or other
traumatic events. An understand-
ing of assessment criteria and care
guidelines that consider where ad-
olescents are in the developmental
process and their individual char-
acteristics is instrumental in the
prevention, early detection, and
management of subsequent health
problems. Sensitive and caring
clinicians can incorporate sugges-
tions for practice into protocols
and care guidelines that may help
adolescents progress through re-
covery following disasters or trau-
matic events.
REFERENCES
American Psychiatric Association. (2000).
Diagnostic and statistical manual of mental
disorders (4th ed., Text Rev.). Washing-
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Ms. Crane is a faculty member,
Graduate Forensic Nursing Program,
Duquesne University School of Nursing,
and a doctoral student, University of
Pittsburgh School of Nursing, Pittsburgh,
Pennsylvania; and Dr. Clements is Assis-
tant Professor, Old Dominion University,
Norfolk, Virginia.
The authors disclose that they have
no significant financial interests in any
product or class of products discussed
directly or indirectly in this activity,
including research support.
Address correspondence to Patricia
A. Crane, MSN, RNC, CRNP, Faculty,
Graduate Forensic Nursing Program,
Room 529 Fisher Hall, Duquesne
University School of Nursing, Pittsburgh,
PA 15282; e-mail: cranep@duq.edu.
AUGUST 2005
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permission.