Trauma: Children

Trauma Information for Parents

(Taken from Using EMDR with children, by Ricky Groenewald)

Children who experience a trauma (such as a car accident) have reactions that may include denial, fear, anger, guilt, sadness, and confusion. These reactions are part of the normal recovery process.

You can help your child by showing acceptance of her feelings, reassuring her that she is safe now, and by being consistent with your discipline and expectations, so that she will feel secure. You may observe some of the following behaviours:

1. Sleep disturbance . Your child may sleep fitfully, talk in sleep, have nightmares, scream, cry out, etc. When he wakens, he may need consoling and reassurance. Even though he may not recall what he was dreaming, he was probably remembering and recalling the accident. This is normal, and how our minds resolve traumatic events.
   
   Reassure your child that he is safe; tell him that he just had a bad dream about the accident, but it's all over now. In the child's waking hours, encourage him to talk about the accident- tell the story over and over. If he doesn't remember, you can talk to him about it and tell him what happened.
   
   It's important to talk about this to help normalize it. Many parents do not know this and are afraid to make their child think about it as it is unpleasant. However, then the child is left to deal with his memories all alone. Get him to share it with you even it is hard for you to hear.
   
   
2. Guilt . Some children think they have been bad and that is why the accident happened. Most children feel guilty about something they have done or thought about. Though unrelated, they think the accident is punishment. Tell your child that she is not a bad person, that she is not being punished. Reinforce this often.
   
   
3. Acting younger . Some children become frightened and afraid to be alone. Some children regress- act younger than their age. This is normal. Give your child and reassurance, but do not change drastically how you treat him. Understand that he feels ill and may be younger acting, but do not let him ‘get away' with behaviours you normally would not tolerate. Otherwise your child will get the message that you believe something is wrong with him.
   
   
4. Fear . Some children will continue to be afraid of things they associate with the accident, e.g., cars, the driver of the car. Gently, together, in small steps, increase their exposure to these things. Talk about each step along the way.
   
   
5. Your feelings . Sometimes parents will feel guilty and responsible. Remember it is not your fault either. Parents can never watch their children at all times. Do not spend your energy feeling guilty and trying to make it up to your child. This is the time to be focusing on your child's feelings, and helping her recover. If your feelings persist, and get in the way of helping your child, seek the support of another adult or professional.

Children's Reactions Following Trauma/ Disaster and Guidelines for Assisting them

Compiled by Robin H. Gurwitch, Ph.D., Jane F. Silovsky, Ph.D.,Shelli Schultz, Ph.D., Michelle Kees, Ph.D., & Sarah Burlingame, B.A. Department of Pediatrics, University of Oklahoma Health Sciences Centre

PRE-SCHOOL STUDENTS

Reactions to Trauma

1. Feelings of anxiety, fears, and worries about safety of self and others (more clingy to teacher or parent)
2. Worries about recurrence of violence
3. Increased levels of distress (whiny, irritable, more moody)
4. Changes in behaviour:
   

   Increased activity level Decreased concentration / attention Withdrawal Angry outbursts Aggression Absenteeism

5. Increased somatic complaints (e.g. headaches, stomachaches, aches, pains)
6. Changes in school performance
7. Recreating event (e.g. talking repeatedly about it, ‘playing' the event)
8. Increased sensitivity to sounds (e.g. sirens, planes, thunder, backfires, loud noises)
9. Statements and questions about death and dying
10. In addition, at home parents may see:
    

    Changes in sleep Changes in appetite Withdrawal Lack of interest in usual activities Increased negative behaviours (e.g. defiance) or emotions (e.g. sadness, fears, anger, worries) Regression in behaviours (e.g. baby talk, bedwetting, tantrums) Hate or anger statements

How Parents of pre-school children can help

Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to let your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events- even when you think they are not listening, they often are.

Maintain the family routines, particularly around sleeping, eating, and extracurricular activities (e.g. sports, church, dance). Be sure the bedtime routine includes safely tucking them in at night. Young children may want a night light again. Make sure your child is receiving a balanced diet and enough rest.

Avoid unnecessary separations from important caregivers.

Expect temporary regression in your child's behaviors. Do not panic, as your child is likely to return to previous functioning with time and support.

Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc.

Increase patience with your child and with yourself. Give your family time to cope. Find ways to emphasize to your children that you love them.

How teachers of Pre-school children can help

• Reinforce ideas of safety and security. This may be needed multiple times, particularly in response to changes, loud sounds, or other events that may remind the children of the tragedy. After any classroom discussion of the event, end the discussion with a focus on the current safety and a calming activity, such as taking deep breaths, working together on an art project, or holding hands and singing a quiet song.
• Maintain a predictable class schedule and rules to provide support and consistency for the children.
• Listen to and tolerate your students' retelling of the events, as well as playing out the events. Schedule specific times for discussion and play during the school day to allow for opportunities to express their thoughts and feelings about the tragedy; however, set limits on scary or hurtful play.
• Encourage students to talk about confusing feelings, worries, daydreams and disruptions of concentration by accepting the feelings, listening carefully, and reminding students that these are normal reactions (any of these feelings are okay) following a scary event. Information focused on safety will be important. A review of school safety rules may also be helpful.
• Some students may express hate towards a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help students to separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates or other people they might know (e.g. all people of Arab decent).
• Young children will process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults. Try to respond in a calm manner, answering the questions in simple, direct terms and helping the student's transition back to their activity.
• Use simple, direct terms to describe what has happened. Avoid terms designed to ‘soften' the information, which inadvertently further confuses children. For example, use the term ‘died', rather than ‘went to sleep'.
• Students may misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.
• Students may ask the same types of questions repeatedly, which can be confusing and/or frustrating for teachers. Understand that students may need to hear the information multiple times before being able to integrate and understand it. Give the students time to cope with fears.
• Expect some angry outbursts from students. Try to catch students before they ‘act out', by taking them aside, and helping them calm down and regain control of their behaviour.
• Do classroom activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting cans.
• Encourage some distraction times, which would include doing school work that does not require a high level of new learning, as well as enjoyable activities.
• Expect some brief, temporary declines in the students' school performance. Consider reducing homework as the nation heals and the national routine is stabilized (parents back to work etc.).
• Provide reassurance to the students that feelings will get smaller and easier to handle over time.
• Expect and understand students' regression (acting younger) and other difficult behaviours that are not typical of the students.
• Protect students from re-exposure to frightening situations and reminders of the trauma. This includes limiting teacher-to-teacher conversations about the events in front of students.
• Maintain communication with other students, school personnel, and parents to monitor how the students are coping with the demands of school, home, and community activities.
• Remain aware of your own reactions to students' trauma. It is okay to express emotions to your students, such as “I am feeling sad about what happened”. However, if you are feeling overwhelmed with emotion, it is important to take care of yourself and seek support from other teachers and staff.

PRIMARY SCHOOL STUDENTS

Reactions to trauma

1. Feelings of anxiety, worries, and fears about safety of self and others.
2. Worries about recurrence or consequences such as war, as well as worries about school violence.
3. Changes in behaviour:
   

   Decreased attention and/or concentration Increase in hyperactivity Changes in academic performance Irritability with friends, teachers, events Ange r outbursts and/or aggression Withdrawal Absenteeism

4. Increased somatic complaints (e.g. headaches, stomach aches, chest pains)
5. Discomfort with feelings, particularly those associated with revenge.
6. Increased likelihood to discuss the gruesome details
7. Repeated discussions of event
8. Increased sensitivity to sounds (e.g. sirens, planes, thunder, backfires, loud noises)
9. Negative impact on issues of trust and perceptions of others, particularly those that are ‘different'
10. Repetitive thoughts and comments about death and dying
11. In addition, at home parents may see:
    

    Changes in sleep or appetite Withdrawal Lack of interest in usual activities (e.g. after-school activities, time with friends) Increased negative behaviours (e.g. defiance) or emotions (e.g. sadness, fears, anger, worries) Hate or anger statements Denial of impact

How parents of Primary School students can help

• Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to let your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events- even when you think they are not listening, they often are.
• Maintain the family routines, particularly around sleeping, eating, and extracurricular activities (e.g. sports, church, dance). Make sure your child is receiving a balanced diet and enough rest. Extra time with friends who are supportive and meaningful to him/her may be needed.
• Avoid unnecessary separation from important caregivers.
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc. Some primary school students benefit from writing their thoughts and feelings in a journal.
• Address acting-out behaviour involving aggression or self-destructive activities quickly and firmly with limit-setting. If the behaviour is severe or persists, seek professional help.
• Increase patience with your child and yourself. Give your family time to cope. Find ways to emphasize to the children that you love them.

How teachers of Primary School students can help

• Reinforce ideas of safety and security. This may be needed multiple times, particularly in response to changes/loud sounds/or other events that may remind the students of the tragedy. After any classroom discussion of the event, end the discussion with a focus on their current safety and a calming activity, such as taking deep breaths, working together on an art project, or having a moment of quiet reflection.
• Listen to, and tolerate, your students' retelling of events, as well as playing out the events. Maintain a predictable class schedule and rules to provide consistency and support for the students. Schedule specific times for discussion during the school day to allow for opportunities to express their thoughts and feelings about the tragedy. This may need to be done in multiple classes; however, set limits on scary or hurtful talk (e.g. specific threats of retribution).
• Encourage the students to talk about confusing feelings, worries, daydreams and disruptions of concentration by accepting the feelings, listening carefully, and reminding the students that these are normal reactions (any of these feelings are okay) following a scary event. Discuss students' perceptions of media descriptions of the event. Information focused on safety will be important. Review of school rules may also be helpful.
• Some students may express hate towards a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help students to separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates or other people they might know (e.g. all people of Arab decent).
• Students will often process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults, including questions that have gruesome details or focus on death. Try to respond in a calm manner, answering the questions in simple, direct terms and helping the student's transition back to their activity.
• Use simple, direct terms to describe what has happened. Avoid terms designed to ‘soften' the information, which inadvertently further confuses children. For example, use the term ‘died', rather than ‘went to sleep'.
• Students may misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.
• Students may ask the same types of questions repeatedly, which can be confusing and/or frustrating for teachers. Understand that students may need to hear the information multiple times before being able to integrate and understand it. Give the students time to cope with fears.
• Expect some angry outbursts from students. Try to catch students before they ‘act out', by taking them aside, and helping them calm down and regain control of their behaviour. In addition, redirect students who are being irritable with each other which could escalate to direct conflict.
• Do classroom activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting cans.
• Encourage some distraction times, which would include doing schoolwork that does not require a high level of new learning, as well as enjoyable activities. Help students do activities that allow them to experience mastery and build self-esteem.
• Expect some brief, temporary declines in the students' school performance. Consider suspending standardized testing and classroom testing for the rest of the week. Also, consider reducing homework as the nation heals and the national routine is stabilized (parents back to work etc.).
• Provide reassurance to the students that feelings will get smaller and easier to handle over time.
• Protect students from re-exposure to frightening situations and reminders of the trauma. This includes limiting teacher-to-teacher conversations about the event in front of the students.
• Maintain communication with other teachers, school personnel, and parents to monitor how the students are coping with the demands of school, home, and community activities. Should difficulties coping with the event persist and interfere with the students' functioning, consider seeking help from a mental health professional. In addition to helping those who are clearly angry or depressed, monitor students who are withdrawn or isolated from others.