Ethan, the boy whom law enforcement officials have identified only by his first name, was rescued Monday when the FBI stormed the shelter and killed his kidnapper, Jimmy Lee Dykes, in a shootout. Ethan, who was not physically harmed, was taken to a hospital and reunited with family. He had his sixth birthday Wednesday.
"He's old enough that he will remember this. If he were 2 or 3, it might be another matter. But if you think of something really bad that happened when you were 5 or 6, you can remember those things," said Nadine Kaslow, a family therapist and psychiatry professor at Emory University in Atlanta.
She said he will need to be evaluated for nightmares and lingering signs of fear or trauma, like aggression.
"The most important thing for him is going to be to connect with the therapist and have a safe place to go," said Kaslow, the president-elect of the American Psychological Association.
Katie Beers was kidnapped in 1992 as a 9-year-old and kept in an underground bunker in suburban New York for 17 days before her captor surrendered and showed police where she was hidden.
She credited her foster family with giving her a loving home life and structure, noting the best decision they made was to keep her out of the public spotlight.
"In my experience, not being in the public eye helped out tremendously," she said.
Beers ended 20 years of silence last month, when she released a book co-written a television reporter who covered her kidnapping: "Buried Memories: Katie Beers' Story"
The boy's aunt and grandmother - with whom Ethan and his mother have lived - said they are intent on protecting him from the media spotlight and helping him return to as normal a life as possible.
"I just want him to be all right," aunt Debra Cook told The Associated Press in an interview this week.
Kaslow, the psychiatrist, said family support and friendship will be key.
Authorities have said boy has Asperger's syndrome and attention deficit hyperactivity disorder, and Ethan's medical condition and any past difficulties in his short life could make recovery from the hostage ordeal even tougher, said Dr. Niranjan Karnik, an assistant psychiatry professor at the University of Chicago.
"This incident has probably put him at more risk for having difficulties later on," he said. "He could be more susceptible to depressive episodes ... and anxiety."
But young children often can recover from traumatic episodes faster than adults, he said.
"Kids in this age range typically do remarkably well ... in the face of a terrible thing. In a way, kids have more of that bounce-back that adults do. Things don't gel as hard in kids as they do in adults," said Karnik.
While only a town of 2,300 people, Midland City is less than 10 miles away from Dothan, which has the largest medical infrastructure in southeast Alabama. Aside from two hospitals in the city, patients also can receive treatment through a state-affiliated mental health center in Dothan, said Alabama Mental Health Commissioner Jim Reddoch.
Angie Bradley is clinical director for SpectraCare Health Systems, a state contractor which provides mental health services in the area that includes Midland City. While declining comment on Ethan or whether workers have treated him, she said the nonprofit organization provides a "myriad" of services for children in a rural, five-county area.
"We have psychiatrists, therapists, case managers who work with children in their home," she said.
A neighborhood friend described Ethan as being friendly and playful before the hostage drama, and authorities said they were able to provide him with toy cars, crayons and coloring books during the standoff. Kaslow said those descriptions were signs of normal behavior that could help him recover.
Authorities said the standoff began a week ago Tuesday when Dykes boarded a bus full of children and gunned down driver Charles Albert Poland Jr. as he sought to protect the 21 children on board. According to officials, the gunman then seized the boy, and fled with his hostage to the nearby bunker.
Authorities said Thursday that Dykes was shot multiple times during the shootout with FBI agents and his body has been taken to a state lab for an autopsy.
The FBI said it was still at the bunker but hoped to be done soon so residents could get back to their homes.
"We came in as uninvited guests and the entire community has welcomed us like neighbors who have known each other for a long time. We will never be able to thank them enough," said Steve Richardson, head of the FBI's office in Mobile.
Officials hope to eventually throw an event to celebrate Ethan's birthday and recovery, but family members of the boy told AP they were not yet ready.
Associated Press writer Frank Eltman in Mineola, N.Y., contributed to this report.