Helping Children Cope With Traumatic Events

We live in a time of horrific, senseless violence and catastrophic natural and accidental disasters. Acts of terrorism, shootings in our schools and communities, hurricanes, wildfires, chemical and oil spills, and pollution of our water supplies seem to be in the news all the time.

While these events affect all rational, caring people, children are especially vulnerable to emotional distress when they are exposed to them. They do not even have to witness these events firsthand. 

I recall, as a small child in the early 1950s, channel surfing (the few channels we had at that time) early one morning. Unsupervised by adults, I came upon newsreels of Nazi concentration camps. Multitudes of lifeless bodies being bulldozed into burial ditches, gas chambers, and cremation ovens, the emaciated survivors barely alive.

As a child, these frightening images haunted me, kept secret from adults who could have provided some explanation, reassurance, and comfort. I saw these images again as a young adult in the film Judgment at Nuremberg, when I was better equipped to process them, understand them in a moral context, mourn the loss, compartmentalize the feelings, and resolve to try to make the world a better place.

Violence perpetrated against children is particularly abhorrent to empathic, caring adults—especially parents, first responders, and other adult protectors and caregivers such as those providing emotional first aid. As adults, being prepared to prevent or mitigate children’s trauma can help us function more effectively when children need support. Having knowledge and skills to provide empathic support is critical when traumatic events happen.

Characteristics of traumatic events

Traumatic events are generally perceived as causing extreme physical or psychological pain (Carlson, 1997), producing “feelings of helplessness, powerlessness, and entrapment,” and often occurring suddenly and without warning (APA, 2000).

The effects of trauma tend to be heightened by sudden, unpredictable crises since there is little time to prepare or adapt to generated problems (Carlson, 1997; Saylor et al., 1997). An anticipated terminal illness is generally less traumatic than a sudden or accidental death with witnesses.

Examples of traumatic events include:

• Sudden or accidental death of a family member or friend
• Death of a teacher or classmate
• Suicide of a meaningful person
• Natural or accidental disasters
• Sexual abuse or molestation
• Acts of violence, shootings, or terrorism

Common grief reactions: resilience is the norm

The course of traumatic stress in children and adolescents is variable and their reactions are related to unique factors, including psychological, familial, social, academic, and environmental. The death of a family member can evoke intense, painful emotions not previously experienced by a young person, who may feel lonely, unable to control emotions, and unsure of how to express confused feelings.

A supportive environment, stable adult figures, and early intervention can be helpful for grieving and traumatized youth. Caplan (1970) recognized the importance of social support and positive interpersonal relationships to help individuals develop greater resiliency when dealing with adversity.

Bereavement is an important aspect of life and a normal reaction when a loved one dies. The experience of grief may include thoughts, emotions, and physical and behavioral components.

Mourning is the expression of grief reflecting cultural traditions mediated by comforting rituals and ceremonies.

Bonanno’s (2009) model identified three main patterns among adults:

1. Prolonged grief, the first pattern, is enduring grief that never seems to lessen over many years or a lifetime.
2. Recovery, the second pattern, involves intense suffering over a shorter period of time, usually not over a year. While grieving continues, there is a gradual return to normal emotional functioning.
3. Resilience is the third and most common pattern, in which a person experiences acute grief for a few days or weeks, but then manages the pain, adjusts to the reality of the loss, and moves on, meeting the demands of life.  

These patterns appear both cross-culturally and after other traumatic events, with resilience more common than expected.

Complicated grief reactions or traumatic grief

Complicated grief has been defined as a “pattern of adaptation to bereavement” with symptoms exceeding responses considered typical and adaptive (Lobb et al., 2010).

While sadness and other intense reactions to loss are considered normal, children experiencing traumatic grief generally have stronger emotions and intrusive memories about death or the traumatizing event. Those experiencing complicated grief often have significant difficulty adjusting to their loss or the distressing experience. They feel more loneliness than those with more typical symptoms, struggle with daily functioning, and are at a higher risk for suicide.

Studies of psychological consequences of bereavement have shown that sudden, unexpected, and untimely deaths are more likely to create problems than those that have been anticipated and prepared for. Other factors that contribute to complicated or traumatic grief include witnessing violence, deaths for which someone is culpable (murder, suicide), and those in which no body is recovered.

Child vulnerability to emotional trauma

Children are considered especially vulnerable after traumatic events (Heath et al., 2009). The death of a parent or caregiver has an especially significant effect on children’s daily functioning and support systems (Worden, 2009). Children’s reactions may include intrusive thoughts and fears, intense sadness, regressive behaviors, increased clinging to adults, and need for reassurance of personal safety.

Caregivers must be alert for both overt and subtle signs of traumatic stress in children. It is sometimes difficult to recognize when young children are psychologically traumatized. A child can be traumatized without witnessing or being in proximity to the incident. After hearing or reading about an event, a child’s imagination or experiences with media or game portrayals of violence can fill in the blanks, vividly constructing an incident that was not directly observed (Roth, 2015).

Television, the Internet, and social media can make it difficult to minimize children’s exposure to traumatic events. Children are sensitive to repeated portrayals of violence and harmful images. Their access to words and pictures should be monitored and limited by responsible adults (Eth, 2002; Singer et al., 2004). When images of the space shuttle Challenger exploding in flight, or airplanes crashing into the World Trade Center were repeatedly shown on afternoon television, children were terrified by each exposure. Parents and schools can help children cope with disturbing visuals by honest reassurance of safety, explaining how people are working to protect them, and by educating them about how to manage news coverage (Roth, 2015).

Promoting children’s resilience and recovery

Promoting resilience in children at home and in school begins before a traumatic incident or death occurs. It starts with a supportive home and school climate that’s responsive to needs and feelings. If a death or traumatic event is anticipated, children can be prepared for what to expect, for a funeral, for reassurance and self-expression.

While the norm is resilience and recovery, evaluation of risk for emotional trauma can help identify those in need and match the appropriate intervention with their degree of severity.

Triage to assess degree of risk for psychological trauma reactions considers the interaction of the nature and circumstances of the incident with personal risk factors (Brock et al., 2009).

Evaluation of risk for psychological trauma

1. Nature and circumstances of the traumatic event
   • Predictability, intensity, consequences of the event:
     • Was the event sudden or expected?
     • Were there fatalities?
     • Loss of property?
   • Duration of exposure: Was the event lengthy and/or repeated?
2. Personal risk factors
   • Physical proximity to the event:
     • Was it at school?
     • At home?
     • Witnesses?
   • Emotional proximity:
     • Close relationship?
     • Family?
     • Friends?
   • Internal personal vulnerability:
     • Poor emotional regulation?
     • History of trauma, loss, (death, divorce), or mental illness?
   • External personal vulnerability: Family and/or social support systems?
   • Perception of threat: Continuing perception of risk?
   • Early and enduring warning signs:
     • Maladaptive coping?
     • Symptoms of PTSD?

Evaluation of risk determines types of intervention needed or not needed by affected individuals. Those who are minimally affected and have support systems may not need structured intervention. Moderately affected individuals will need a different level of intervention than those who are severely affected. Source: Adapted from Brock et al. (2009).

When adults support children and adolescents coping with emotional trauma and death, they can model, practice, and teach the principles of resilience. They can teach young people about the grieving process and normalize fearful reactions. Adults can model personal qualities and facilitate strategies that manage stress, promote recovery, and encourage connections with families and other social support systems (Demaria & Schonfeld, 2014). A source of comfort is demonstrating that when bad things happen, children are not alone.

Early intervention to mitigate psychological trauma

Engaging children to cope with trauma involves perceptive listening to learn their needs. Recovery can be facilitated through honest reassurance of security, reuniting with primary caregivers and social support systems (family, school, faith, community), self-expression, stress management strategies, and psychological first aid for those needing it.

Psychological first aid: guidelines for approaching children in distress

• Initiate contact without intruding or interrupting.
• Offer practical assistance (water, food, blankets).
• Ask simple, respectful questions about how you can help, without making assumptions about their need.
• Be present in a supportive way, understanding that not everyone affected will want or need to talk with you.
• Speak calmly, with patience, responsiveness, and sensitivity.
• Listen carefully, trying to understand what they want to communicate and how you can help (children may express needs through behaviors, play, or drawing).
• Reinforce personal strengths and positive coping strategies.
• Give accurate, age-appropriate information that addresses immediate goals.
• If ready, initiate simple problem solving addressing stated concerns. Source: Adapted from Brymer et al. (2012).

Tips for parents to help children cope with traumatic events

• Have a talking time to hear thoughts and feelings your child wants to share. Understand your child’s perspective to correct false beliefs. Don’t force. Follow your child’s cues.
• Explain in a direct, age-appropriate way what happened and answer questions honestly. Avoid unnecessary or disturbing details. Assure reasonably that you will be there to care for your child.
• Be prepared to discuss difficult subjects raised by your child. Look for cues indicating their need to be reassured, to better understand, or to talk about some details and feelings repeatedly. It’s OK to say there are things we don’t know.
• Be aware that you and your child may be in different places in the way you are each dealing with the traumatic event. For example, you may reach a stage of anger or acceptance, while your child remains in a state of grief and sorrow.
• Correct clearly and directly any false assumptions your child may have about a death, such as guilt or magical thinking that his/her thoughts or actions caused it.
• Be prepared to deal with the topic of death whenever your child brings it up, reassuring your child over a long period of time.
• Do not let your child watch disturbing pictures on television or the Internet. Minimize trauma exposure. Spend time with your child away from television and media.
• Reestablish your child’s daily routines—especially bedtime.
• Family religious or spiritual beliefs can be integrated into thoughts, discussions, and ways of finding meaning and coping with trauma.
• Let your child write a letter, draw, or in some way express sympathy for those grieving. Older children may find comfort in writing their thoughts and feelings. Teenagers often benefit from guided peer support, or engaging in life-affirming activities.
• Expect your child to show an increased need for physical contact and an increased fear that something will happen to you or other loved ones. Expect more ‘childish’ behavior, sadness, clinging, anger, or playfulness.
• Grief reactions are normal, but if your child continues to experience severe distress or has difficulty with normal functioning, seek help from professional resources in your school or community. Source: Adapted from Raundalen & Dyregrov (2004).

Tips for parents to help teenagers cope with traumatic events

Adolescents may mask feelings of pain and grief with the misleading image of a ‘cool’ or strong façade. Hidden reactions can appear long after the traumatic event.

• Be a listener. Reflect genuine concern without giving advice.
• Communicate that grieving may last longer than expected, although the intensity usually subsides over time. Encourage and allow healthy expression of grief.
• Do not avoid talking about a person or people who died or the event for fear it might reawaken the pain. Usually, teenagers want to talk, but in a manner and a time they select. Follow their lead.
• Times of grief are not times to make changes or important decisions. Try to keep the situation as normal as possible.
• Watch for trouble signs in adolescents. The need to appear competent may prevent teenagers from reaching out to others for help.
• While most grief reactions are normal and temporary responses to trauma, it is imperative that suicidal thinking be treated seriously, and that help is sought (Erbacher et al., 2015).
• Referral should be considered if trouble signs are especially severe and intense over an extended period, or if there are striking changes in usual behavior. Trouble signs include:
  • Withdrawal and isolation
  • Physical complaints (headache, stomach pain, insomnia)
  • Emotional concerns (depression, sadness, anxiety, suicidal thoughts, confusion)
  • Antisocial behavior (stealing, acting out, aggression, alcohol or substance abuse)
  • School problems (avoidance, disruptive behavior, academic failure)
• The power of the peer group is often evident when dealing with teenage grief. Adolescents may form networks of support, leaning on each other during difficult times. Encourage helpful, cooperative, life-affirming activities.
• Less frequently, the peer group can be a catalyst for further tragedy. After a suicide, caregivers must be vigilant to prevent suicide contagion, clusters, or pacts that signal the danger of further suicides among those most at risk.
• While most teens support each other moving toward recovery, some may succumb to contagion, breeding copycats. This emphasizes the need for triage, psychoeducation, open discussion, constructive actions to empower, and when necessary, monitoring and referral for more intensive treatment. Source: Adapted from Responding to Critical Incidents: A Resource Guide for Schools. British Columbia Ministry of Education (1998).

The need for follow-up

When a traumatic incident occurs, there are generally many resources providing psychological first aid, triage, interventions, and attention for those most in need during the first few days and weeks.

After that initial response, in the weeks and months that follow, attention may be minimal, or nonexistent. Even those most at risk may begin to feel that continuing to request help is an imposition—they should “get over it” and move on. The reality is that for those severely affected by trauma, the need for monitoring and possibly therapeutic treatment could extend for years.

For most, healing and recovery is a natural, spontaneous process with minimal support needed. For the typically small percentage most seriously affected by a traumatic incident or death—often family, friends, witnesses, first responders, and vulnerable populations—it is essential to monitor them after the event and as anniversary dates approach. Long-term follow-up is especially important after a severely traumatic or violent incident such as a school shooting or death by suicide.

Healing does not proceed in a constant, linear progression. Rather, it is a gradual journey, with ups, downs, and occasional setbacks on the road to a better place. Most approaches engaging children to cope with traumatic events involve perceptive listening and learning about their needs. This facilitates developmentally appropriate movement toward self-expression, support systems, stress management, problem solving, and recovery. (Roth, 2015)

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (DSM-IV-TR) (4^th ed).  Washington, D.C.:  APA.

Bonanno, G. A. (2009). The other side of sadness: What the new science of bereavement tells us about life after loss. New York, NY: Basic Books.

Brock, S.E., Nickerson, A.B., Reeves, M.A., Jimerson, S.R., Lieberman, R.A., & Feinberg, T.A. (2009). School crisis prevention and intervention: The PREPaRE model. Bethesda, MD:  National Association of School Psychologists.

Brymer, M. J., Pynoos, R. S., Vivrette, R. L., & Taylor, M. A. (2012). Providing school crisis interventions.  In S. E. Brock & S. R. Jimerson (Eds.)  Best practices in school crisis prevention and intervention (pp. 317–336; 2^nd ed.).  Bethesda, MD:  National Association of School Psychologists.

Caplan, G. (1970). The theory and practice of mental health consultation.  New York: Basic Books.   

Carlson, E.B. (1997). Trauma assessments:  A clinician’s guide.  New York: Guilford Press.

Demaria, T. & Schonfeld, D. J. (2013/2014, December/January). Do it now: Short-term responses to traumatic events.  Phi Delta Kappan, 95(4), 13–17.

Erbacher, T.A., Singer, J.B., & Poland, S. (2015). Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention, and postvention. New York: Routledge.

Eth, S. (2002). Television viewing as risk factor. Psychiatry, 65, 301–303. 

Heath, M.A., Nickerson, A.B., Annandale, N., Kemple, A., & Dean, B. (2009). Strengthening cultural sensitivity in children’s disaster mental health services. School Psychology International, 30, 347–373.

Lobb. E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. K. B., & Davies, A. (2010).  Predictors of complicated grief: A systematic review of empirical studies. Death Studies, 34, 673–698. 

Raundalen, M. & Dyregrov, A. (2004). Terror: How to talk to children. Center for Crisis Psychology, Bergen, Norway.

Roth, J.C. (2015). School crisis response: Reflections of a team leader. Wilmington, DE: Hickory Run Press.

Saylor, C.F., Belter, R., & Stokes, S.J. (1997). Children and families coping with disaster. In S.A. Wolchik & I.N. Sandler (Eds.). Handbook of children’s coping: Linking theory and intervention (pp. 361–383). New York, NY:  Plenum.

Singer, M.I., Flannery, D.J., Guo, S., Miller, D., & Leibbrandt, S. (2004). Exposure to
violence, parental monitoring, and television viewing as contributors to children’s psychological trauma. Journal of Community Psychology, 32, 489–504.

Worden, J.W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner. (4^th ed.). New York, NY: Springer Publishing Company.

About the author

A Nationally Certified School Psychologist, Jeffrey C. Roth joined the Brandywine School District in Delaware where he initiated Operation Cooperation, a school-wide approach to conflict resolution. He wrote a middle school crisis manual, helped initiate and lead the district Crisis Response Team, and was named School Psychologist of the Year by the Delaware Association of School Psychologists. He coordinated school psychologists, developed Instructional Support and Positive Behavior Support teams, and a social skills program for students with social challenges. He also developed a program of self-directed professional development for school psychologists and attended workshops in the PREPaRE Model, Critical Incident Stress Management, CPI’s Nonviolent Crisis Intervention^® training, and Red Cross Disaster Mental Health. He is an American Red Cross Disaster Mental Health volunteer.

Dr. Roth received his undergraduate degree in psychology at Temple University. After serving in the Air Force, he practiced social work and returned to graduate school at Temple, where he earned his doctorate. During graduate school, Dr. Roth worked as a recreational therapist at St. Christopher’s Hospital for Children and taught graduate courses at Arcadia University. He is a licensed psychologist in Delaware, and currently an adjunct professor and advisor in the special education graduate program at Wilmington University. He co-developed a mentoring program for new school psychologists for the state Department of Education. Dr. Roth is author of School Crisis Response: Reflections of a Team Leader.