Attention needs to be given to how the child is managing changes and how much care, attention and understanding is being provided. Because children respond to adult expectations such as to not complain and have greater cognitive difficulties to sequence, make sense and express events, distress of children may go unnoticed. Therefore, extra patience is required to give individual attention to listen to children and assess their needs. Assessment takes into account adult reports, though it must be remembered that these may be overoptimistic or skewed. Children tend to express their survival relivings relatively more than adults through actions, emotions and physical manifestations. As well as relivings of anxieties of the actual disaster, children are likely to reflect attachment and protective anxieties and angers and guilts around parents. Assessments in children require skilled reading according to their developmental ages of their behaviors, body language and their expressions in play and drawing. Assessments need to be made of personalised meanings which children are more likely to make of events, such as that they caused them and were punishment, such as for being unlovable. Persistence of the following may require monitoring and possible intervention - physical symptoms, sleep problems and nightmares, clinging, demanding,
regression to earlier behavior, decreased function, overactivity or withdrawal and anxious or aggressive play or acting out in the environment.