Helping our traumatised children

2008-03-05 00:00

The epidemic of crime in this country affects almost everyone no matter what their age, race or socio-economic background. With this scourge has come another pandemic, perhaps more destructive and certainly more subtle than the first: anxiety. This too affects almost everyone, not least, our children.

“Life in South Africa is not safe. People in all communities know that it’s not a question of if they’ll be the victim of a crime, but when. The more insecurity there is, the more anxiety there is, so we live with generally high levels of stress and anxiety, and children are not exempt,” says Dr Beverley Killian, head of the School of Psychology’s Child and Family Centre (CFC) at the University of KwaZulu-Natal (Pietermaritzburg).

The centre trains postgraduate psychology students. As part of their training, the students provide psychological assessments and psychotherapy for a negotiable charge for people from local communities.

“Many [children] are anxious because of the underlying expectation that they will soon be victims of crime. The CFC is swamped with requests to help children who have experienced crime and have various acute anxiety disorders. We even have a waiting list. Many children have suffered robbery, hijacking, rape and even ‘bicycle-jacking’. Others experience repeated trauma like sexual abuse or exposure to domestic violence.”

In his book on trauma, local psychologist Clive Willows defines it as an event that “causes someone to experience emotional and psychological damage or pain. It is expressed through thoughts, feelings and behaviour.”

After experiencing a trauma, it is normal for people to have a traumatic stress response. They can feel a range of emotions including horror, fear, helplessness, anger, guilt or sadness. They may keep re-experiencing the trauma in flashbacks, try to avoid and deny the incident or be in a state of constant arousal marked by conditions like agitation and restlessness. To recover from trauma, people first need to feel safe again and then deal with what happened and their feelings about it.

Signs of crime-related anxiety in children can include:

• not wanting to sleep in their own bed;

• resuming immature or baby-like behaviour such as bed-wetting or thumb sucking;

• clinginess;

• repeatedly checking security like locked doors and asking for them to be checked;

• unwillingness to play outside;

• the need for quiet inside so that sounds outside can be heard;

• shock responses to loud noises;

• hyper arousal or living in a state of constant heightened awareness or tension; and

• panic attacks.

Says Killian: “Helping children to feel safe again after a traumatic event like a robbery includes not only practical things like repairing damage and improving security, but also ritual actions to show that safety has been restored. This could be moving furniture, a cleansing ritual or a prayer. This helps children to regain their sense of personal equilibrium.

“The way parents respond to a traumatic incident is critical to their children’s ability to recover. If they model coping behaviour their children will also cope. If they ‘fall apart’ they could inhibit their children’s ability to recover. If they try to deny the trauma their children may believe it must have been their fault and could be doubly traumatised.

“The CFC provides supportive therapy for children affected by crime and post-trauma debriefing for their families. Depending on their age, therapy can be counselling or art or play therapy. It usually takes about three to six sessions for children to understand that the incident was not their fault. They talk, play or draw their story until they are able to put aside the event and free up the psychic energy they need to get on with life. For many children, gaining mastery over a trauma involves describing, drawing or acting out in fantasy punishment for the perpetrator.”

Willows stresses that this disempowering of the perpetrators of crime is central to recovery. “Criminals have power over their victims for the duration of a crime, but victims do not have to let them retain that power for the rest of their lives. Traumatic life events like crime destroy people’s trust in themselves and in life. To recover they need to regain that trust and gaining a sense of mastery over the traumatic event and the perpetrators helps them do that.”

Killian says that many children in less privileged communities learn to live with high levels of anxiety caused by insecurity and fear of crime. “They learn to put up with difficulties such as sexual harassment, family violence or rape, perhaps even repeated trauma. However, the damage this does to children is huge. It inhibits them from reaching their full potential as functioning individuals.

“Unresolved trauma and distress could be a major contributor to the violence in our society, such that we have a self-perpetuating cycle of negative interpersonal interactions and a lack of appropriate conflict resolution strategies.”

Grace Naidoo, deputy principal of Orient Heights Primary School in Raisethorpe, says that children at the school are definitely conscious of crime as “they live in the middle of it. Many of our pupils come from informal settlements like Wattville and Copesville, and have to walk home. Some of them have been mugged.

“If pupils experience an incident like that, we refer them for counselling to the Psychological Services of the KwaZulu-Natal Department of Education’s Service Delivery Support Services. However, they service several schools, so sometimes we ask professional volunteers from the community to help. We are fortunate to have two psychologists and a doctor who assist, and at no charge.”

Naidoo adds that some children come from dysfunctional homes where they experience trauma like family violence. “It is not only disadvantaged homes where this occurs, but also very privileged homes. We are required by law to report incidents to the Child Protection Unit and we arrange for the children to get help, and sometimes also the family.”

The school also runs a programme to help pupils be aware of potential dangers and learn to take care of themselves. For example, the South African Police Services talks to them about safety awareness.

Jill Bailey, school counsellor at Linpark High School in Blackridge, says: “I cannot say for certain that there is more crime-related stress. However, some children do come from communities where they know the perpetrators of crime, but keep quiet because there can be consequences for reporting it.

“Despite all of us living with crime and the anxiety that this can cause, what strikes me about the children in our school is their resilience, courage and personal strength. They also do seek help when their coping mechanisms are under pressure. It is important for young people to have options, so the contact details of counselling and other services are being posted in all the classrooms. This gives them choices that extend beyond the school building and the school day.”

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is diagnosed only if the symptoms of a traumatic stress response persist and interfere with an individual’s functioning after at least a month.

PTSD is not inevitable and most people who experience a trauma do not develop it. People who are continuously exposed to trauma or the risk of injury are most prone to PTSD, for example emergency workers, soldiers and civilians in conflict zones. The symptoms are similar to the symptoms of acute anxiety disorder and are characterised by re-experiencing, avoidance and hyper-arousal.

Treatment for PTSD involves psychotherapy, often accompanied by medication. People who are treated for PTSD usually respond well. If not treated, it can lead to dysfunctional behaviour and clinical depression is a common consequence.

Controlled studies in the United States show that, depending on the nature of the event, 15% to 90% of children exposed to traumatic events develop PTSD. Universally, the rate of children who develop PTSD after traumatic events is higher than adults.

There is growing recognition that children are more vulnerable to traumatic experiences than adults. The recovery rate is very low among children with PTSD who are not treated. Children with this condition are also sometimes misdiagnosed and treated incorrectly because the health professional concerned is not aware of on-going trauma like domestic violence or abuse. The symptoms can also look like other disorders like attention deficit hyperactivity disorder (ADHD) or depression.

— Healing from Trauma, The Family Workshop, 2003; Trauma and Terror in Childhood, 2000, Child Trauma Academy, Houston, Texas.

How can parents help anxious children?

• Make your home environment as secure as you can and normalise the safety precautions your family needs to take, such as keeping gates and doors locked.

• Establish and maintain routines for your children and restore them quickly after a traumatic incident because routine and familiarity are important to children’s sense of security.

• Teach your children to do what they can to look after themselves, for example do not walk anywhere alone, do not accept lifts or gifts from strangers, etc.

• Be careful of what your children read and watch — crime stories in the media can increase anxiety.

• Do not feed their anxiety by complaining constantly about crime in front of them.

• Encourage them to talk with their friends about taking care of each other.

• Teach them to report things that worry them and keep on reporting them until someone in authority responds, such as a stranger who hangs around the school gate.

• Most importantly, build your children’s self-esteem so that they value themselves and want to take care of themselves.

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