Children's memory for trauma and positive experiences

Daily-level associations between posttraumatic stress disorder symptoms and reactions to retrieving positive autobiographical memories

Trauma survivors with posttraumatic stress disorder (PTSD) report difficulties accessing and describing positive memories. To understand these patterns, we examined daily-level relations of PTSD symptoms with affective, cognitive (dwelling/rumination; pushing memory out of one's mind; suppression; avoidance; distraction; thinking about something else; remembering negative or positive memories/events; negative or positive thoughts; accepting or disapproving memory; reinterpreting memory), and behavioral (using alcohol/drugs; smoking cigarettes; cravings for or seeking out cigarettes/alcohol/drugs; craving, seeking out, or consuming large amounts of food; dissociation; engaging in risky behaviors; sharing memories; interference with ongoing task; arousal) reactions to retrieving positive memories. Eighty-eight trauma survivors (Mage= 39.89 years; 59.1% female) completed 7 daily measures of PTSD and reactions to retrieving positive memories. Days with more PTSD severity were associated with higher odds of same-day suppression, avoidance, distraction, thinking about something else, smoking cigarettes, craving substances, craving, seeking out, or consuming large amounts of food, dissociation, remembering negative memories/events/thoughts, engaging in risky behaviors, interference with ongoing tasks, and arousal (ORs=1.10-1.22); and greater negative affect (β = 0.27). Supplemental lagged analyses indicated some associations between previous-day reactions to positive memory retrieval and next-day PTSD severity and vice versa. Trauma survivors with PTSD symptoms report negative and avoidance-oriented reactions to retrieving positive memories.

Study protocol and rationale for a pilot randomized clinical trial comparing processing of positive memories technique with supportive counseling for PTSD

BACKGROUND

Research indicates that positive memories have a role in posttraumatic stress disorder's (PTSD) symptomatology and treatment. Following treatment development guidelines, a novel PTSD intervention - Processing of Positive Memories Technique (PPMT) - was developed and subsequently examined for its effects and feasibility in pilot studies. Extending this research, the proposed pilot randomized clinical trial with PPMT and Supportive Counseling (SC) arms will examine PPMT's effects on PTSD severity and biomarkers of stress systems' dysregulation (awakening salivary alpha amylase [sAA] and cortisol concentrations); examine mechanistic targets (affect) underlying PPMT's effects; and refine PPMT. We hypothesize that the PPMT arm will report greater decreases in PTSD severity and greater decreases in awakening sAA/cortisol ratio compared to the SC arm; and that improved affect (more positive affect and less negative affect) will mediate associations between intervention arm and changes in PTSD severity.

METHODS

We will recruit 70 individuals aged 18-65 years with PTSD. They will be randomized to 5 weekly therapy sessions of PPMT or SC, and will be assessed at baseline, weekly during treatment, 1-week post-treatment, and 3-months post-treatment. Primary outcomes are past-week PTSD severity, past-week positive and negative affect levels, and feedback data on PPMT's feasibility, format, and content. The secondary outcome is the awakening sAA/cortisol ratio. Statistical analyses include mixed-effect models and within-subjects cross-lag longitudinal mediation analyses.

CONCLUSION

Study results will advance knowledge of trauma interventions by examining effects and feasibility of a novel PTSD intervention, and by elucidating potential mechanisms underlying PPMT's effects. Clinical Trials #: NCT05523453.

Do positive memory characteristics influence daily-level trajectories of posttraumatic stress disorder symptoms? an exploratory daily diary study

BACKGROUND AND OBJECTIVES

Evidence links posttraumatic stress disorder (PTSD) with positive memory characteristics. To extend this research, we utilized daily diary data to examine (1) concurrent/lagged associations between daily PTSD symptom severity and positive memory vividness/accessibility; and (2) associations between baseline-assessed positive memory characteristics and changes in PTSD symptom severity over time.

DESIGN AND METHODS

A sample of 238 trauma-exposed participants (Mage = 21.19 years; 86% women) completed baseline and 10 daily measures of PTSD symptoms and positive memory characteristics. Multilevel models covaried for gender, number of trauma types, and number of completed surveys.

RESULTS

Days with greater PTSD symptom severity than an individual's average associated with less vividness (b = -0.02, p < .001) and accessibility (b = -0.02, p < .001) of the positive memory on the same day. Days with greater positive memory vividness (b = -1.06, p < .001) and accessibility (b = -0.93, p < .001) than an individual's average associated with less PTSD symptom severity on the same day. There were no significant lagged associations between these constructs. There were significant interactions between baseline-assessed psychological distance and time (b = -0.04, p  = .042) and between baseline-assessed visual perspective and time (b = 0.05, p = .023) on PTSD symptom severity across days.

CONCLUSIONS

Findings inform positive memory intervention targets for PTSD and provide impetus for longitudinal investigations on their inter-relations.

Investigating features that contribute to evaluations of intrusiveness for thoughts and memories

What makes a thought feel intrusive? One possibility is that traumatic experiences are the primary cause of intrusive thoughts and memories. Another possibility is that experiences of intrusiveness arise from the features involved with re-experiencing. We investigated several features that may lead a thought to feel intrusive: task-congruence, repetition, and affective content. In Experiment 1, participants listened to popular song clips expected to become stuck in one's head. In Experiment 2, participants were cued to recall their own autobiographical memories. We found that both songs and autobiographical memories replaying mentally felt more intrusive when they were incongruent with the current task, cued repeatedly, and had negative emotional content. Additionally, even liked songs and positive autobiographical memories were evaluated as highly intrusive under some conditions. Based on these findings, we argue that intrusiveness is not limited to traumatic thoughts, but rather is a context-dependent evaluation influenced by a variety of features.

An Examination of the Synergy of Age and PTSD on Narrative Coherence in Child Sexual Abuse Testimony

In a criminal proceeding, a witness is considered as reliable if he/she can recall in narrative form the events, chronologically ordered, with salient contextual (place and time) details, and essential evaluations for the definition of meanings. This study aimed to confirm the effects of age and PTSD on narrative coherence and to investigate the moderating role of age on the association between PTSD and narrative coherence. Narrative coherence was analyzed in 92 allegations of children (M = 10.3; range: 4-17), who were victims of sexual abuse. Thirty-five children presented the symptoms for a diagnosis of PTSD. Each deposition has been codified through the Narrative Coherence Coding Scheme, a coding scheme based on the three independent dimensions (context, chronology, and theme). Correlation analysis indicated the positive associations between age and context, chronology, and theme; and the negative associations between PTSD symptoms and context, chronology, and theme. Predictive effect of PTSD became less and less significant with increasing age. This study could underline the importance of age and PTSD (and their synergy) in legal testimony of children who have been sexually abused.

Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood

OBJECTIVE

To examine the association between developmental timing of initial exposure to racial discrimination and cardiovascular health conditions.

DESIGN

Using data from the 1995 Detroit Area Study, logistic and negative binomial regression models were used to assess the association between timing of initial exposure to racial/ethnic discrimination, classified as early childhood (0-7), childhood (8-12), adolescence (13-19), and adulthood (>19), on physician-diagnosed cardiovascular health conditions during adulthood. Each analysis adjusted for age, gender, race/ethnicity, income, education, marital status, health-related behaviors, and pre-existing health conditions.

RESULTS

Of the 1,106 participants in the final sample, 520 identified as White and 586 identified as Black. Over half (64%) of the sample experienced at least one major cardiovascular health event at the time of the study, with 39% reporting two or more events. Results from logistic regression models showed that initial exposure to racial discrimination during early childhood was associated with a 2.96 (95%CI:1.15, 7.83) times greater odds of having any cardiovascular-related health condition later in life compared to individuals who reported no discrimination. Results from negative binomial regression models demonstrated that individuals who reported initial exposure to racial discrimination during early childhood and adolescence had a CVD incidence rate that was 1.63 (95%CI:1.11, 2.38) and 1.37 (95%CI:1.10, 1.69) times higher than individuals who reported no discrimination.

CONCLUSION

Initial exposure to racial discrimination in early childhood and adolescence may increase the risk of cardiovascular conditions later in life. Clinicians and researchers should consider racial discrimination during childhood as a possible risk factor for illness and disease.

Moderating effects of dysregulation and fear of positive emotions on the relationship between posttraumatic stress disorder symptoms and positive memory count

OBJECTIVES

We examined moderating effects of positive emotion dysregulation and fear of positive emotions in the relation between posttraumatic stress disorder (PTSD) severity and positive memory count.

METHOD

Participants were 205 trauma-exposed community individuals (Mage  = 35.44; 61.50% female).

RESULTS

Moderation analyses indicated interaction effects of PTSD severity with nonacceptance of positive emotions (b = -0.01, p = .002) and difficulties with goal-directed behaviors when experiencing positive emotions (b = -0.01, p = .006) on positive memory count.

CONCLUSIONS

Greater PTSD severity was associated with more specific positive memories when individuals reported less nonacceptance of positive emotions and fewer difficulties engaging in goal-directed behaviors in the context of positive emotions. Greater PTSD severity was associated with fewer specific positive memories when individuals reported greater nonacceptance of positive emotions and greater difficulties engaging in goal-directed behaviors in the context of positive emotions. Results support addressing positive emotion dysregulation in memory-focused interventions for PTSD.

Examining relations of polytraumatization typologies with positive memory count and phenomenology

Background and Objectives: Most individuals experience multiple potentially traumatizing events (PTEs); hence, it is important to consider count and types of PTEs (polytraumatization) in relation to post-trauma health. Notably, no research has examined polytraumatization typologies in relation to positive memory count and phenomenology. We examined (1) latent subgroupings of individuals based on PTE endorsements; and (2) relation of the optimal latent class solution to positive memory count and phenomenology. Design: Participants were 203 trauma-exposed adults (Mage  = 35.40; 61.10% females); we used PTEs endorsed on the Life Events Checklist for DSM-5 as indicators for analyses. Results: Latent class analyses indicated a three-class solution differing in quantity and quality of PTE types: Low Experience, Predominant Interpersonal PTEs, and Predominant Non-Interpersonal PTEs. Further, more positive memories predicted membership in the Low Experience vs. other classes; greater sensory details of a positive memory predicted membership in the Low Experience vs. the Predominant Interpersonal PTEs Classes; and greater accessibility of a positive memory predicted membership in the Predominant Interpersonal PTEs vs. the Predominant Non-Interpersonal PTEs Classes. Conclusions: Results indicated three meaningful subgroups endorsing differing levels/types of PTEs; count, sensory details, and accessibility of positive memories, pending further investigation, may differentiate these subgroups.

Relation between PTSD symptom clusters and positive memory characteristics: A network perspective

Positive memory characteristics relate to posttraumatic stress disorder (PTSD) severity. We utilized a network approach to examine relations between PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive memory characteristics (count, accessibility, valence, vividness, coherence, time perspective, sensory details). We identified differential relations between PTSD clusters and positive memory characteristics, and central/bridging symptoms. Participants were an Amazon Mechanical Turk-recruited sample of 206 individuals (M_age = 35.36; 61.20% females). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD clusters and six nodes representing positive memory characteristics. Regarding cross-community relations, AAR (highest node strength) was negatively associated with positive memory count, valence, coherence, and accessibility; avoidance was positively and negatively associated with positive memory vividness and count respectively. The NACM-AAR and intrusion-avoidance edges were significantly stronger than most edges. From the PTSD community, AAR and avoidance had the highest bridge strength and bridge expected influence respectively; from the positive memory community, coherence and vividness had the highest bridge strength and bridge expected influence respectively. Results indicate the potential pivotal role of AAR, avoidance, coherence, and vividness in the PTSD-positive memory relation, which renders them assessment/treatment targets pending further investigation.

Investigating linguistic coherence relations in child sexual abuse: A comparison of PTSD and non-PTSD children

Background

Language is the most common way to communicate internal states and emotions into a narrative form. Studies on the use of language provide a useful understanding of how people process an event and interpret it.

Objective

The aim of this study was to investigate the effects of PTSD on the narrative coherence of children's reports of sexual abuse.

Participants and setting

Narrative coherence was analyzed within a group of 89 allegations of children (M = 10; range: 4–16), who were victims of sexual abuse. Thirty-seven children presented the symptoms for a diagnosis of PTSD.

Method

Linguistic Inquiry Word Count (LIWC) was employed and narrative coherence was analyzed through some linguistic markers (first-person singular pronouns, conjunctions, and cognitive words).

Results

Results illustrated the effects of PTSD on the narrative coherence, in terms of first-person singular pronouns, conjunctions, and cognitive processes. Indeed, compared with traumatic narratives of children without PTSD, traumatic narratives of children with PTSD contained a greater number of first-person singular pronouns (M_PTSD = 1.45 versus M_no-PTSD = 1.12) and a smaller number of conjunctions (M_PTSD = .37 versus M_non-PTSD = .67), cognitive (M_PTSD = 2.93 versus M_non-PTSD = 3.76) and insight words (M_PTSD = 2.29 versus M_non-PTSD = 3.09). Regression analyses were used to examine if age and PTSD were predictors of the narrative coherence, suggesting the effects of PTSD in predicting the use of the first-person singular pronouns and the conjunctions.

Conclusion

This study could underline the importance of considering the PTSD in legal testimony of children who have been sexually abused.

Recalling a Devastating Tornado: Qualities of Child Recollections and Associations with Mental Health Symptoms

Trauma recollections often contain trauma-related cognitive and emotional processing. Research examining indicators of such processing in children's trauma recollections and their association with mental health symptoms is limited. Fifty 8 to 12-year-old children provided two open-ended recollections about (1) challenging/"bad" things and (2) positive/ "good" things that happened to them 1-year post experiencing an EF-5 tornado. Children completed exposure and mental health symptom measures (PTSD, anxiety, depression). Transcripts were coded for indicators of processing: coherence, positive and negative emotion terms, and resolutions. Age, gender, SES, family tornado-related discussion frequency, verbal ability, tornado-specific psychotherapy receipt, and exposure were controlled. Coherence and positive emotion were positively associated and resolutions were negatively associated with mental health symptoms when children discussed the "bad" things. Children's processing and mental health symptoms were unrelated when children discussed the "good" things. The measured indicators of children's processing may reflect children's meaning-making efforts and have implications for adjustment.

Comparing Children's Memories for Negative Versus Positive Events in the Context of Posttraumatic Stress Symptoms

How well children remember negative events is not fully understood. Previous research has failed to simultaneously test memory and perceptions of memory for both negative and positive events. Children (n = 38, 7-17 years) recruited from a hospital following accidental injury were tested for their memory of an injury-producing accident (negative event) and a positive event (unexpectedly receiving a $50 gift voucher). Objective accuracy of memory, memory quality characteristics (e.g., how coherently the event was recalled), children's judgments of their memory (meta-cognitive), and posttraumatic stress (PTS) symptoms were assessed 2 months post-injury. Children's memories for their experiences were verified using witness/parent reports. Memory quality characteristics of children's free recollection were coded with a previously used standardized system. Overall, children showed high levels of accuracy for both events, with little degradation over time. High PTS children showed little evidence of deficits in coherence or organization in their narratives relative to low PTS children. Although in some instances high PTS children judged their memory quality to be poor compared to low PTS children, this depended on how this was assessed (e.g., self-report questionnaire vs. coded narratives). In terms of limitations, it is unclear whether the findings will generalize for memories of repeated events. Witness verification of the accident details itself could be prone to error. In conclusion, the findings are broadly supportive of the proposal made by theorists who argue that trauma memories are recalled no less accurately than other distinctive memories. The role of meta-cognitive elements of children's memory and reporting in PTS is less clear.

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M=10years; SD=3.7; range: 4-17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.

Developmentally Sensitive Forensic Interviewing of Preschool Children: Some Guidelines Drawn From Basic Psychological Research

Interviewing preschool children who are victims or witnesses of crime to ensure accuracy and completeness of their recall is no easy task. Rising up to the challenge, a large number of empirical psychological studies related to interviewing young children have been conducted in the past decades. Most of these studies were applied research, simulating circumstances of real forensic interviews. It is believed, however, that more basic research could also be informative. The present article thus selectively reviews more basic psychological research in the areas of memory development, language development, and conceptual development as they relate to the forensic interviewing of preschool children. Based on characteristics of preschool children’s development in these areas, some useful guidelines are generated for forensic interviewers. Recommendations for future research are also made.

Traumagedächtnis bei Kindern mit Posttraumatischer Belastungsstörung

Das Gedächtnis spielt eine wichtige Rolle bei der Entstehung und Behandlung von Posttraumatischer Belastungsstörung (PTBS). Die vorliegende Überblicksarbeit beschäftigt sich mit der Frage nach dem empirischen Nachweis von traumabezogenen Gedächtnisstörungen im Kindesalter. Die bisherigen Untersuchungen zeigen ein heterogenes Bild. Es gibt Hinweise auf eine Beeinträchtigung der Hirnreifungsprozesse sowie der Erinnerungsqualität bei Kindern und Jugendlichen mit PTBS. Jedoch im Gegensatz zu Befunden im Erwachsenenalter wiesen traumatisierte Kinder ein größeres Hippocampusvolumen im Vergleich zur Kontrollgruppe auf. Die Zusammenschau der Befunde macht den großen Bedarf an weiterführenden Untersuchungen deutlich.

The cognitive impact of sexual abuse and PTSD in children: a neuropsychological study

Sexual abuse is known to have an impact on both child and adult mental health, but the neuropsychological basis of this effect is still largely unknown. This study compared neuropsychological test results from a group of 76 children, 13 of them sexual abuse victims with symptoms of post-traumatic stress disorder, 26 victims of sexual abuse who showed no symptoms post-traumatic stress disorder, and 37 controls. The groups were matched by age, sex, socioeconomic status, and educational level. Child sexual abuse was associated with reduced ability to inhibit automatic responses measured by the Stroop test regardless of post-traumatic stress disorder status. These findings indicate possible attentional inhibition difficulties in child victims of sexual abuse, which may help explain psychopathology associated with the experience.

The veridicality of children's reports of parenting: a review of factors contributing to parent-child discrepancies

Child informants routinely participate in forensic and social service investigations and are often a critical source of information. However, across research domains high levels of discrepancy between parents' reports and children's reports have been documented, which has led researchers to question children's abilities to provide accurate information about others' behavior. To date research examining parent-child discrepancies has focused on discrepancies in reports of child behavior. The aim of the present review is to examine children's abilities to provide veridical accounts of parental behaviors, drawing on developmental and clinical research to delineate factors likely to enhance or impede accuracy. Among the factors examined, age appears to have the strongest influence on the accuracy of children's reports in general. A clear distinction also emerged in the literature between children's abilities to report objective data versus information regarding abstract concepts. Although available evidence provides mixed support for the veridicality of children's reports of parenting, factors that influence children's accuracy have generally been overlooked. Namely, researchers have largely failed to discriminate between assessment of child-rearing behaviors and children's perceptions of those behaviors. The present review proposes that such failure likely accounts for a notable portion of parent-child discrepancies in reports of parenting.

The coherence of memories for trauma: evidence from posttraumatic stress disorder

Participants with posttraumatic stress disorder (PTSD) and participants with a trauma but without PTSD wrote narratives of their trauma and, for comparison, of the most-important and the happiest events that occurred within a year of their trauma. They then rated these three events on coherence. Based on participants' self-ratings and on naïve-observer scorings of the participants' narratives, memories of traumas were not more incoherent than the comparison memories in participants in general or in participants with PTSD. This study comprehensively assesses narrative coherence using a full two (PTSD or not) by two (traumatic event or not) design. The results are counter to most prevalent theoretical views of memory for trauma.

Assessing children's exposure to intimate partner violence

Child exposure to intimate partner violence (IPV) is widely acknowledged as a threat to the psycho-social and academic well-being of children. Unfortunately, as reflected in the literature, the specific link between such exposure and childhood outcomes is ambiguous. Based on a review of the literature, this article suggests that this state of affairs is due, in part, to the manner with which exposure to IPV is operationally defined. After reviewing the dominant strategies for operationally defining exposure to IPV and the problems associated with those strategies, this article reports original data contrasting three measures derived from maternal reports, three measures derived from child reports, and the limited concordance among those different indices of exposure to IPV. The implications of these findings for research on child outcomes and the clinical assessment of children who might have been exposed to IPV are discussed.

Bullying among school children in postwar bosnia and herzegovina: cross-sectional study

AIM

To compare the prevalence and characteristics of bullying between two towns in Bosnia and Herzegovina-Stolac, which was exposed to firearm conflict during the 1992-1995 war in Bosnia and Herzegovina, and Posusje, which was outside of the active combat zone.

METHODS

In this cross-sectional study, we included 484 primary school pupils attending 4th-8th grade of elementary school, 217 (44.8%) of them from Stolac and 267 (55.2%) from Posusje. The pupils were interviewed using a standardized questionnaire on the experience of bullying.

RESULTS

Every sixth pupil (16.4%) experienced at least one form of bullying almost every day, while 34 (7.0%) pupils constantly bullied other children. Sixth-eighth graders were more often bullies than 4th-5th graders (P=0.044). Girls were most often victims was of bullying, while boys were most often bullies (P=0.036). The expected difference in bullying between the two towns was not observed, except for older pupils in Posusje, who were more violent than their peers in Stolac (P=0.044). Among the analyzed variables of sex, age, town, and school achievement, only male sex was significant predictor of bullying (P=0.010), increasing the relative risk by 3.005 times.

CONCLUSION

Bullying among primary school pupils did not differ between areas that experienced war activities in 1992-1995. Our results could be useful in the introduction of specific prevention measures against bullying in postwar situation.

Are memories for sexually traumatic events "special"? A within-subjects investigation of trauma and memory in a clinical sample

According to a long-standing clinical tradition, sexually traumatic experiences are processed and recalled differently from other experiences, often leading to memory impairment. In this study, we compared the characteristics of traumatic memories for sexual violence and two other types of emotional experiences. N=44 women recruited from a local sexual trauma agency were asked to recall and describe three autobiographical events: sexual abuse/assault, a non-sexual trauma, and a positive emotional event. The characteristics of the three memory types were compared on both subjective and objective measures. Further, the potential influences of level of traumatic impact and dissociation were assessed. Results indicated that memories for sexual trauma were not impaired or fragmented relative to other memories. Instead, memories for sexual trauma were associated with a remarkably high level of vividness, detail, and sensory components. Further, high levels of traumatic impact were not associated with memory impairment. Implications for the ongoing traumatic memory debate are discussed.

Pleasantness bias in flashbulb memories: positive and negative flashbulb memories of the fall of the Berlin Wall among East and West Germans

Flashbulb memories for the fall of the Berlin Wall were examined among 103 East and West Germans who considered the event as either highly positive or highly negative. The participants in the positive group rated their memories higher on measures of reliving and sensory imagery, whereas their memory for facts was less accurate than that of the participants in the negative group. The participants in the negative group had higher ratings on amount of consequences but had talked less about the event and considered it less central to their personal and national identity than did the participants in the positive group. In both groups, rehearsal and the centrality of the memory to the person's identity and life story correlated positively with memory qualities. The results suggest that positive and negative emotions have different effects on the processing and long-term retention of flashbulb memories.

What can subjective forgetting tell us about memory for childhood trauma?

In the present study, we examined the prevalence and predictors of subjective forgetting (i.e., self-reported amnesia) of child sexual abuse (CSA). Adults who, as children, were involved as victims in legal prosecutions were questioned about their CSA experiences, which had been documented in the 1980s, and about lost and recovered memory of those experiences. Males and individuals who experienced more severe abuse were more likely to report forgetting. The majority of individuals attributed their forgetting to active attempts to avoid thinking about the abuse. In contrast, when predictors of subjective forgetting were used to predict objective memory of abuse, more severe abuse and more extended legal involvement were associated with fewer memory errors. The differences between subjective and objective memory underscore the risks of using subjective measures to assess lost memory of abuse.

The aftermath of disaster: Children in crisis

This article uses examples from the terrorist attacks on the World Trade Center and the hurricane disasters of Katrina and Rita to illustrate the impact of crisis in the lives of children and adolescents. The author reviews children's responses to loss and crisis. Therapeutic approaches that facilitate integration of crisis and loss are provided, including illustrations of self-care, comfort strategies, and developmental, traditional, and nontraditional methods.