beyondblue Board Director, Associate Professor Brett McDermott is an expert in emotional trauma in children following large scale disasters. He conducted research into the impact of disasters on children's mental health following the Sydney bushfires in 1994, the Canberra bushfires in 2003 and Cyclone Larry in 2006.

How are children and adolescents who have been directly involved in the bushfires likely to be affected?

We know from past research into bushfires that there are several types of mental health symptoms children and adolescents are likely to experience. These can be grouped into:

• types of anxiety
• and types of mood symptoms.

The usual anxiety symptoms are consistent with Post Traumatic Stress Disorder (PTSD), or a phobic or fearful response of the events. With PTSD, the symptoms usually occur in the early days after the disaster and it's called 're-experiencing'. Young people may feel as if it's still happening or that it's happening again. They might see some reminder like smoke or a blackened car or something on the TV and it comes back as if they're experiencing the event again.

Young people can also have nightmares, or during the day time, have very intrusive frightening flashbacks. At the same time, in the early phase, their body can tell them it's anxious - by fast pulse rate, breathing heavily, sweating or being incredibly tense and being vigilant - looking around for danger or startling easily.

After a month or two, often in response to those other symptoms, the body and the mind controls these symptoms by pushing them out of the mind. Some people do that so well that they can feel numb or detached and feel as if they don't have emotions anymore.

Phobic symptoms are more direct fearful responses to something related to the bushfire. It could be that roaring furnace noise, the wind or the smell of smoke. The minute people get these, they feel incredibly panicky and might want to run away and want to avoid it or they may be paralysed with fear.

The grief or mood symptoms are a bit different. The young person may:

• feel low mood,sad or depressed
• lose the pleasure response
• have body responses to lower mood like loss of appetite or weight.

People can also have more direct grief feelings such as:

• an incredible intense pining for a loved one
• an incredible intense piningfor very significant possessions
• grief at the loss of a pet.

Unfortunately, some people who have had extreme exposure or experiences can feel all of these symptoms and have a complex presentation.

How are children who are not directly involved going to be affected?

If you're not involved it doesn't mean you're out of the woods.

For instance, we know from our experience of the 2004 Boxing Day tsunami and the September 11 terrorist attacks that some people, especially younger children, were traumatised by media images of the frightening event, especially when the media coverage is so intense. Younger children might not realise that the bushfire is over if they keep seeing images of it for several weeks. They might feel people are losing their lives over a period of weeks and the fires have not been put out yet. A very young child can have trouble processing the information and can get traumatised.

Older adolescents can get very strong feelings of empathy and grief watching and seeing what's happened to other families and children. There's also something called survivor guilt where someone may feel if they had been there to help, then a friend may be alive, may not have been burnt or their house may have remained intact. So some adolescents can feel very guilty that they didn't help, even if they weren't there.

What can parents do to help their children?

There are three things parents can do.

1. The first one is about routines. Children understand and respond to routines. Routines are built into our daily lives. It might be getting out of bed in the morning, having their school lunch made and going off to school. Now even if have been evacuated and displaced, there will be a local school for children to attend and the family can get into a routine. It's very containing. It says very strongly, 'we're alive and we're going to get on with life and these are the normal things we do'. Even if people are evacuated and displaced and even though it sounds impossible, it's a good idea to think about the family routine and see if they can get back into it.

2. The second one is for children to see their parents coping. This is something that settles children down emotionally. Although the parents may be experiencing significant loss, grief and anxiety, they need to try for their children to model positive, effective coping. Clearly, for some parents this is going to be very difficult, but any steps they can take towards "seeming to be coping" in front of their children will send a strong message of, 'This is what we need to do... we need to think about the future, recovery and getting on our feet.'

3. Thirdly, there is an old tale that talking about traumatic events can stir people up. There is no evidence this is true and most therapists and counsellors will say that talking about the event is helpful. Children and adolescents will be thinking about the bushfires, so you may as well talk about it. The important things to remember if you're talking about a traumatic event are:

• be very measured and matter a fact
• stick to the facts
• and correct any misconceptions or catastrophic thinking.

If a child thinks there are 7000 houses destroyed, that's wrong and you need to correct that.

Allowing some expression of emotion is very good and normalising. If the child needs to cry or be distressed, that's very normal. Parents should allow that and then talk about it. If children talk about their feelings draw numerous bushfire pictures or write bushfire journal entries, it is less likely they will have nightmares.

So the three things parents can do are to emphasise and return to family routines, look to how they're coping themselves and allow and encourage children to talk about their feelings.

What signs indicate a child may need professional help?

There are early signs and later signs. The early signs relate to the degree of distress. Everyone has some degree of distress and that is completely understandable. If the child has a very high level of distress that causes impairment in their daily living - problems eating, sleeping, pacing in an agitated fashion, these are worrying signs. If they are extremely hyper-vigilant for danger, if they startle very easily, if they suddenly break down and become distressed for no obvious reason, have a lot of nightmares, if any reminder brings them back and they feel it's happening again - these are worrying signs.

There is one specific group that is correlated with later problems and that is children who truly thought they were going to die during the bushfires. We know as a child, if you think you are going to die, your probability of PTSD is four or five times higher than other children.

The other risk group is people who have complicated experiences, such as fearing they would die, as well as having lost a loved one, or their pets have been killed and they have experienced significant loss of possessions. Loss of a loved one puts that person at very high risk of bereavement as well as PTSD.

After two monthsr so, some parents say their child has had a personality change. This is a significant warning sign. The child may have become quieter, more withdrawn, won't go outside, and is very fearful of anything that involves even a small amount of risk. Those individuals may have numbing and detachment anxiety symptoms and if they do, they need some sort of intervention.

Where can parents go for help?

Australia is very fortunate in that we have layers of helping professionals and the General Practitioner is always a fantastic resource to go to in the first instance. We also have very good coverage in our schools in terms of nurses and guidance officers. They will be very aware of post-bushfire disaster mental health symptoms; they'll be very skilled at picking those up. The school counsellors can give direct assistance and also have links into child and adolescent mental health services (CAMHS). Victoria has excellent CAMHS services, which provide a range of professionals such as psychologists, social workers, psychiatrists and these workers are very skilled at interventions for anxiety, depression and PTSD.

For more information on depression, anxiety, post-traumatic stress disorder and related mental health disorders call the beyondblue info line on 1300 22 4636 or log onto www.beyondblue.org.au