Children’s response to trauma may differ in important ways to those seen in adults. Children may find it hard to understand what has happened. They may be unable to describe how they are feeling and instead express themselves in other ways. The following behaviours may be seen in children following trauma:
1. Reliving the trauma. Repetitive play that re-enacts the trauma, distressing dreams, disorganized or agitated behaviour as well as pre-occupation with other traumatic events.
2. Avoidance and numbing. Social withdrawal and wanting to be alone, loss of interest in significant activities, sense of foreshortened future and a return to ‘babyish’ behaviour.
3. Arousal. Attention and concentration problems, clingy and depedent behaviour, fearfulness and irritability.
4. Associated problems. Aches and pains, bedwetting, general misbehaviour, poor school performance and reduced motivation.
Parental responses are very important in helping children to cope with the aftermath of trauma. It is crucial not to be angry or blame the child. Parents and others can help the recovery process by:
1. Keep communicating. Talk about what is happening and how the child is feeling.
2. Reassure the child that they are safe and will be cared for.
3. List and talk to them about the experience. Honest open discussion is usualy best.
4. Some children will require extra encouragement or special attention, particularly at night and bedtime.
5. Allow expressions of emotions as they are part of the healing process. Support the child and allow them time to work through it.
6. Do things as a family. Make time for rewarding and enjoyable things together.
7. Keep family roles clear. Don’t expect children to take too much responsibility, but equally, do not become too overprotective.
The fllowing information may also be of value:
Facilitate. We attempted to facilitate children’s symbolic expression in play and in art projects by being gently supportively interested and available to observe or join play or to talk with them while they use art and crafts materials. Children who are still unable to play or who can only paint compulsively in black should not be urged upwards to the next symbolic level; a companionable tolerant interested presence may be all it takes for the child to regain capacities for symbolization.
Listen. Some children spontaneously want to talk about what they or their parents and other family members were going through with a sensitive listener from outside the family; others readily appreciate the offer to do so. Here acknowledging the reality of trauma and loss is implicit in simply listening.
Clarify. Children who wish to talk can be helped to make sense of their feelings and to find words to name emotions. Finding words promotes containment, the development of symbolic representation and the capacity for self-regulation. Clarification of affects and events helps toward the restoration of a coherent narrative. We were careful to follow the child’s lead, to avoid probing exploration, responding only to what the child spontaneously introduced, in order to support containment of overwhelming feelings.
Support the capacity to imagine repair, restoration and constructive action. Bob Pynoos (personal communication) described key moments in the crisis intervention after the bombing in Oklahoma City when he helped children to imagine reparative possibilities. When he ended a session with a child who had re-lived the trauma by telling about it or representing it, it could tend to re-traumatize them, unless he ended the session by helping the child imagine some way they might actively contribute to repairing or healing the damage. This worked to restore a sense of safety, agency, and hope. We tried to do this in play as well. We helped younger children to think about how their family and community would take care of them, and encouraged older children to imagine a future in which they would have some agency.
Contextualize feelings. Children could be helped to contextualize their feelings by letting them know that lots of other kids’ were having similar feelings. We understand children’s and parents’ acute stress reactions, intense re-experiencing of the event, nightmares and their frequently reported sense of psychic numbing, as an expectable responses to a horrifying disaster and to traumatic grief. Contextualizing their reactions as a natural response to an extreme situation can help older children.
Support attachment bonds. For children who were ready to do this we supported the child’s identification with or internalization of the attachment to the lost family member by actively facilitating the child’s need to remember and talk about their lost loved one.
The following goals apply to parents:
Contextualize the parents’ reactions, helping them as we did with older children and adolescents to understand that they were not going crazy and that their fears, anxieties and flashbacks were expectable reactions to a severely traumatizing event.
Support the child’s surviving attachment relationships by helping parents to understand the child’s feelings and by facilitating communication between them. We tried to help parents recognize how much their children understood about the events all around them. We tried to help parents, family members and friends to be more accessible by answering children’s questions directly and honestly without providing more information than children needed.
Help parents to make sense of their children’s perplexing and disturbing expressions and behavior in their children. For example, we worked with parents to help them understand and make meaning of the feelings being expressed through children’s repetitive dramatic play, traumatized drawings, dreams or nightmares that parents often had difficulty making sense of and found upsetting. In this way, the adult’s reflective function could be re-engaged.
Help parents understand their children’s experience. Some parents were frightened or became angry with their children for their increased clinginess, tantrums, and aggression. Parents were afraid these reactions were signs of lasting damage and future pathology. It was hard for parents to see these reactions as expectable responses to a situation of great insecurity. Parents’ anxiety or anger in turn made the children more frightened of losing them, and so more demanding or aggressive. We tried to stop this escalating cycle by working with parents to help them understand their children’s experience.
We helped them to answer the questions that children raised both direct and indirect, while protecting children from exposure to adult conversations.
We encouraged families to try to return to ordinary daily life and customary routines as soon as possible.
We encouraged parents to turn off the TV and not expose children to endless repetitions of images.