The world has been shocked by the terrible tragedy in Newtown, Conn., where a shooting in a primary school has resulted in the loss of 20 young children and six adults, in addition to the shooter and his mother. Our thoughts and hearts go out to their families, friends, and community, as well as to the professionals involved.
In the wake of a disaster of horrific impact and proportions, be it human-made or the result of catastrophic forces of nature (as climate change has brought all too frequently in recent times), many wonder about children's responses to traumatic events and how best to support them. In addition, many children who themselves were not directly affected will be exposed to relentless media footage, potentially propagating distress and calling for helpful responses by parents, relatives and teachers.
How do children respond to trauma?
Children's immediate reactions vary widely. Some children are visibly frightened, agitated or upset, while other children are more withdrawn, or on the contrary, can come across as very composed. In the latter instance, it is difficult for adults to judge to what extent a child has been affected.
Most children directly exposed or living in the impacted community will show stress reactions in the weeks following the traumatic event. Common reactions include nightmares, repetitive intrusive thoughts about what happened, avoidance of places or people related to the event, concentration difficulties, separation anxiety, heightened vigilance, irritability, and guilty feelings. In addition, the children involved in the shooting, in this case, will be mourning the loss of friends and teachers. For some young children, this will be the first time that they are confronted with death and its irrevocability.
Children will respond differently according to their age and capacity to put their experience into words. The National Child Traumatic Stress Network has depicted age-related responses, which vary from preschool children to adolescents. Younger children may behave in ways even more childlike than their years (called regression), with less control over their feelings or behavior or even control over their toilet functions. Older children may show their fearfulness with worries, withdrawal or physical problems like stomach pain and headaches.
An excellent summary for parents on the impact of a violent event such as the Newtown shootings is also available from the National Child Traumatic Stress Network. Also helpful is "After the Injury," which can be useful for families of injured and traumatized children; it provides clear descriptions and short videos explaining post-traumatic stress reactions and their development over time, as well as a simple checklist that can assist parents in monitoring their child's stress reaction.
What can we do to support children in the direct aftermath of a traumatic event?
An international consortium of trauma experts has identified the five essential actions to direct us in what we can all do to help survivors after a mass trauma. These actions apply to both children and adults:
1. Promote a sense of safety. Make sure survivors feel as comfortable as possible, and reassure them that they are safe now (provided that they are really safe).2. Promote calming. For survivors who are overwhelmed by emotions, help them learn to breathe slowly -- with an emphasis on breathing out -- and to be aware of their body and surroundings.3. Promote a sense of self and community effectiveness. Survivors need to be helped to return to taking control over their own lives and decision making. Taking up normal routines as soon as possible is a fundamental rule of post-disaster responses.4. Promote connectedness. Social support is one of the most robust predictors of recovery. Help children and families turn to those they care for and trust to receive both emotional and practical support.5. Instill hope. Most people, children and adults are resilient and will eventually recover from a traumatic event. Survivors who feel confident about their capacity to recover are more likely to experience a good outcome.
Based on these five essential actions, the National Center for PTSD and the NCTSN have developed and supported the use of Psychological First Aid (PFA) by mental health professionals and first responders.
How you can you talk about the shooting with children who were not there
With the extraordinary high levels of media coverage of this shooting, we expect that many children throughout the U.S. and internationally will become aware of this tragedy. Parents, teachers and other responsible adults will surely encounter questions about safety, even the meaning of death. Responding starts with letting children know that they are safe.
For example, young children may have difficulty understanding that repeated television coverage is not a new shooting. For this reason alone, you will want to limit children's media exposure and answer their questions in an open and honest manner, without using frightening language. For young children, it may be helpful to explain death with analogies -- for example, as if they recently broke a toy that could not be fixed. The National Association for School Psychologists has a well-done brochure about talking with children about violence.
Effective treatments for long-term post-traumatic stress
The gravity of the tragedy in Newtown, Conn., indicates that a significant number of directly exposed children will experience significant post-traumatic stress reactions in the months after the shootings. Some may develop post-traumatic stress disorder (PTSD). Cognitive behavioral therapy (CBT) is a well-know therapy for children (and adults), and there is good evidence of its beneficial effects.
The tragedy in Newtown, and its predecessor violent events, should be a further wake-up call for efforts to reduce the risk of future devastation produced by these events. While there is balm for the grief, fear and psychological wounds of the survivors, there is no remedy for their losses. We must attend to the survivors and gather the resolve to take the steps needed to identify those who are at risk to perpetrate these awful acts and to reduce their access to the weapons of destruction by which they wreck their havoc.
Eva Alisic, Ph.D., who co-wrote this article, is with Monash Injury Research Institute, Australia, the National Psychotrauma Center for Children and Youth, The Netherlands, and is a member of the International Society for Traumatic Stress Studies. She blogs at www.trauma-recovery.net.
Dr. Sederer's book for families who have a member with a mental illness, The Family Guide to Mental Health Care, will be published by WW Norton in the spring of 2013.
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
Visit Dr. Sederer's website for questions you want answered, commentaries, movie and book reviews, and stories.
Originally published in the Huffington Post on December 16, 2012.
