This year's hurricane season has just begun, and already it is producing a new surge of anxiety in Gulf Coast children.
Children at a day-care center in Gautier, Miss., ask their caregivers every day: "Did you watch the Weather Channel? What does the Weather Channel say?" In a New Orleans trailer park, a 12-year-old boy who spent five days outside the convention center after Hurricane Katrina and saw a woman in a wheelchair slowly die pleads with his mother to buy a car so they can escape the next big one. An 8-year-old girl is convinced that another hurricane will hit New Orleans -- she is even sure it will be on June 15 and a Category 8 (a rating that doesn't exist).
Ten months after Katrina, its emotional effect on children is proving to be long and lasting. Two studies of children affected by the hurricane have found high rates of depression, anxiety, behavioral problems and post-traumatic stress disorder.
A Louisiana State University mental health screening of nearly 5,000 children in schools and temporary housing in the state found that 96 percent saw hurricane damage to their homes or neighborhoods, 22 percent had relatives or friends who were injured, 14 percent had relatives or friends who died, and 35 percent lost pets. Thirty-four percent were separated from their primary caregivers at some point; 9 percent still are.
The concern for the Katrina children is not just the immediate trauma from the storm, but that so much of their lives remains disrupted.
'Trauma has not yet ended'
A report prepared for Congress last November estimated that 189,000 children were dislocated by Katrina; about 110,000 still do not live where they did nine months ago. Some children have attended as many as nine schools since August. Those who have returned to school in New Orleans often do not attend the same schools with the same students or teachers as before.
"Disasters like Oklahoma City and 9/11 were time-limited," said Irwin Redlener, director of Columbia University's National Center for Disaster Preparedness and president of the Children's Health Fund, an advocacy group and care provider for medically underserved children. "The children who were affected psychologically could go to a place of normalcy. The difference here is not only the scope of devastation but the prolonged dislocation with an uncertain timeline. The trauma has not yet ended."
Justyn Green, 12, and his brother Jaleel, 8, spent six days at the Louisiana Superdome in New Orleans with their mother and father -- hot, hungry, thirsty, dirty and frightened. They heard gunfire and saw dead people. They got out at one point, only to be forced to return when police in a nearby town turned away thousands of evacuees at gunpoint. When they finally boarded a bus to leave -- after enduring a line so long they could barely stand -- they thought the horror was over, but it wasn't. The bus flipped over near Opelousas, and their father was killed.
The boys "didn't say a word" at the Superdome, said their mother, Joy Green. "They looked so lost and scared. There was no security at all. You were on your own."
The boys still don't talk much. In their ranch-style brick home in Algiers, which in the end suffered no storm damage, they sit at the kitchen table and draw pictures. They have been drawing for months, encouraged by a psychiatrist as a way to express themselves and describe their experiences.
"At first, they drew a lot of coffins," said the psychiatrist, Barbara Hamm. "Now they draw the Dome and men with guns." She and their mother attribute their obsession with guns and what they call "Army men" to having guns pointed at them and to their perception of the military men in the Superdome as menacing rather than protective.
The boys' 17-year-old brother, James, who was named after their father, evacuated to Arkansas with friends. Although he didn't experience the horrors of the Superdome, he has dropped out of school and won't go for counseling with his mother and siblings. "He won't talk about it, so I'm not sure what's going on with him," Joy Green said. "He did say one time that he shouldn't have told us to evacuate. He said, 'If I hadn't have told you to go, Daddy would still be alive.' "
'Afraid of the sky'
Many children are having difficulties adjusting after Katrina. The screening by LSU found that more than 30 percent of them showed symptoms of depression or post-traumatic stress disorder.
In a study by Columbia University and the Children's Health Fund of 665 displaced families, nearly half of the parents reported that at least one child in their household had emotional or behavioral difficulties that were not present before the hurricane. Symptoms involve feeling sad or depressed, being nervous or afraid, and having problems sleeping or getting along with others. Compared with children surveyed in Louisiana in 2003, Katrina's victims were more than twice as likely to have behavioral or conduct problems; the same was true of depression and anxiety, the survey found.
Patterns are beginning to emerge. "The younger children lack the cognitive ability to grasp the idea of a once-in-a-hundred-year storm," said Elmore Rigamer, a psychiatrist who is medical director of Catholic Charities Archdiocese of New Orleans. "For them, if it happened once, the world is an unsafe place."
Elementary and middle school children can be both more withdrawn and more aggressive, and their anxiety often comes out in physical symptoms such as headaches and stomachaches. Rigamer described a 6-year-old boy from hurricane-devastated St. Bernard Parish. "He's a meticulous boy who'd started to collect stamps and toy soldiers. Now, they're all gone," she said. "His mother brought him to me because he's punching kids at school, he quit learning to read and he's hoarding food."
Rainy days frighten the weather-obsessed children at Gautier Academy Child Development Center in Gautier, near Pascagoula. "When it's cloudy, they don't want to go outside," said Cynthia Matthews, the academy's owner. "It's as if they're afraid of the sky."
Teenagers seem affected most by social isolation. Joy Osofsky, an LSU professor of pediatrics and psychiatry, said that when she worked with a group of young people in a shelter in rural Louisiana about a week after the storm, she expected to hear stories of terrible experiences; some of them had been in the Superdome or were rescued from rooftops.
"Some talked about that, but what they talked about more was missing friends," she said. "They used to be in constant touch by e-mail or cellphones, and they felt very isolated."
The older children, while suffering, often show strength, said Howard Osofsky, chairman of LSU's psychiatry department, who with his wife is leading the university's screening of Katrina children.
"One reason our clinicians work around the clock and are so dedicated is how inspiring these kids can be. They really do have symptoms of mental distress," he said. "Yet when you ask their first concerns, so many say they want to help their parents or help in the rebuilding."
Younger children can be especially resilient, Joy Osofsky said. "If their parents are able to give them support and stability, most will bounce back and do what children do -- play," she said.
Focus on families
For this reason, experts say that efforts to help Katrina children should focus not just on them but on their families. A number of charities and nonprofit organizations have established or are raising money for programs such as free family mental health screening, trauma counseling in schools, and summer programs for children who have fallen behind in school or who live in Federal Emergency Management Agency trailer parks, which have no playgrounds.
Some advocates, including the Children's Health Fund, have called on the federal government to allocate $100 million to send a force of pediatricians, family doctors, specially trained mental health workers and mobile medical vans to the Gulf Coast. The Children's Defense Fund, another advocacy group, likewise is calling for emergency health and mental health services.
For parents, their children's well-being has become one of their biggest concerns in trying to return to a normal life.
Joy Green hasn't yet returned to her job at the Zatarain's plant, which packages rice, because of her worries about her three sons. "I can't hardly focus. It's depressing. The only thing that keeps me going are my kids," she said. "I'm afraid for them."