Helping Kids Deal With the Trauma of Terrorism and War

Adapted from the National Institute of Mental Health by ]]>Marjorie Montemayor, MA]]> November 2005

child looking down The tragedy of September 11, 2001 was traumatic for us all. And now the war in Iraq and the horrors of Hurricane Katrina have brought additional anxieties, even when we're not on the battlegrounds or in the hurricane-stricken area. For our children, these traumatic events and the emotions they are feeling can be confusing as well. The National Institute of Mental Health offers the following advice on helping your children to cope during these difficult times.

Emotional Trauma

Psychiatric trauma, or emotional harm, is essentially a normal response to an extreme event. It involves the creation of emotional memories about the distressful event that are stored in structures deep within the brain. In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm. But even second-hand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or a disaster, even if only through graphic media reports, should be watched for signs of emotional distress.

How Children and Adolescents React to Trauma

Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Some youngsters are more vulnerable to trauma than others, for reasons scientists don't fully understand. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary according to age.

Five Years Old and Younger

For children five years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions, and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (called regressive behaviors), such as thumb sucking, bedwetting, and fear of darkness. Children in this age group tend to be strongly affected by their parents' reactions to the traumatic event.

Six to Eleven Years Old

Children 6 to 11 years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age. Also the child may complain of stomachaches or other bodily symptoms that have no medical basis. Schoolwork often suffers. ]]>Depression]]>, ]]>anxiety]]>, feelings of guilt, and emotional numbing or "flatness" are often present as well.

Twelve to Seventeen Years Old

Adolescents 12 to 17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, ]]>substance abuse]]>, problems with peers, and antisocial behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. The adolescents may feel extreme guilt over their failure to prevent injury or loss of life. They may harbor revenge fantasies that interfere with recovery from the trauma.

How to Help Children and Adolescents Deal With Trauma

Early intervention to help children and adolescents who have suffered trauma from violence or a disaster is critical. Parents, teachers, and mental health professionals can do a great deal to help these youngsters recover.

Tips for Parents

After violence or a disaster occurs, the family is the first-line resource for helping. Here are things that parents and other caring adults can do:

Explain the episode of violence or disaster as well as you are able.
Encourage the children to express their feelings and listen without passing judgment. Help younger children learn to use words that express their feelings. However, do not force discussion of the traumatic event.
Let children and adolescents know that it is normal to feel upset after something bad happens.
Allow time for the youngsters to experience and talk about their feelings. At home, however, a gradual return to routine can be reassuring to the child.
If your children are fearful, reassure them that you love them and will take care of them. Stay together as a family as much as possible.
If behavior at bedtime is a problem, give the child extra time and reassurance. Let him or her sleep with a light on or in your room for a limited time, if necessary.
Reassure children and adolescents that the traumatic event was not their fault.
Do not criticize regressive behavior or shame the child with words like "babyish."
Allow children to cry or be sad. Don't expect them to be brave or tough.
Encourage children and adolescents to feel in control. Let them make some decisions about meals, what to wear, etc.
Take care of yourself so you can take care of the children.
Overexposure to media coverage of war, violence, and terrorism can be harmful to children of all ages. Therefore, you should limit your child's exposure to media coverage of these disturbing events.

Tips for Teachers and School Administrators

When violence or disaster affects a whole school or community, teachers and school administrators can play a major role in the healing process. Here are things educators can do:

If possible, give yourself a bit of time to come to terms with the event before you attempt to reassure the children. This may not be possible in the case of a violent episode that occurs at school, but sometimes in a natural disaster there will be several days before schools reopen. Teachers can take the time to prepare themselves emotionally.
Don't try to rush back to ordinary school routines too soon. Give the children or adolescents time to talk over the traumatic event and express their feelings about it.
Respect the preferences of children who do not want to participate in class discussions about the traumatic event. Do not force discussion or repeatedly bring up the catastrophic event. This may re-traumatize children.
Hold in-school sessions with entire classes, with smaller groups of students, or with individual students. These sessions can be very useful in letting students know that their fears and concerns are normal reactions. Many counties and school districts have teams that will go into schools to hold such sessions after a disaster or episode of violence. Involve mental health professionals in these activities, if possible.
Offer art and play therapy for young children in school.
Be sensitive to cultural differences among the children. In some cultures, for example, it is not acceptable to express negative emotions. Also, the child who is reluctant to make eye contact with a teacher may not be depressed, but may simply be exhibiting behavior appropriate to his or her culture.
Encourage children to develop coping and problem-solving skills and age-appropriate methods for managing anxiety.
Hold meetings for parents to discuss the traumatic event, their children's response to it, and how they and you can help. Involve mental health professionals in these meetings if possible.

Most children and adolescents, if given support, will recover almost completely from the fear and anxiety caused by a traumatic experience within a few weeks. However, some children and adolescents will need more help perhaps over a longer period of time in order to heal. Grief over the loss of a loved one, teacher, friend, or pet may take months to resolve, and may be reawakened by reminders such as media reports or the anniversary of the death.

In the immediate aftermath of a traumatic event, and in the weeks following, it is important to identify the youngsters who are in need of more intensive support and therapy because of profound grief or some other extreme emotion.

Children and adolescents who may require the help of a mental health professional include those who show avoidance behavior. Avoidance behavior may be shown as resisting to go places that remind the child of the traumatic event, as well as emotional numbing, a lack of feeling toward the event.

Youngsters who have more common reactions, such as reliving the trauma in the form of nightmares, may respond well to supportive reassurance from parents and teachers.

RESOURCES:

American Counseling Association
http://www.counseling.org

National Institute of Mental Health
http://www.nimh.nih.gov

National Mental Health Association
http://www.nmha.org

CANADIAN RESOURCES:

Canadian Mental Health Association
]]> http://www.ontario.cmha.ca/index.asp]]>

Canadian Psychological Association
]]> http://www.cpa.ca/cpasite/home.asp]]>

References:

American Academy of Pediatrics website. Available at: http://www.aap.org/terrorism .
Accessed on April 3, 2003.

Helping children and adolescents cope with violence and disasters. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/violence.cfm .

Last reviewed February 2008 by ]]> Theodor B. Rais, MD]]>

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.