Traumatic life experiences challenge a person's normal coping efforts. For children and adolescents, traumatic experiences include such things as fires, and medical procedures. It can be traumatic for children to witness or experience violent crimes (e.g., kidnapping, break-in, attacks, and school shootings) or vehicle accidents such as automobile and plane crashes. Witnessing assault, rape, or murder of a parent can also be traumatic for children.
What is the range of responses?
There is a wide range of responses to catastrophic events. Some children and teenagers experience temporary worries and fears that get better quickly. Others experience long-term problems such as fear, depression, withdrawal, anger, haunting memories, avoiding reminders of the event, regressive behaviour (acting younger than their actual age), worrying about themselves and others dying or being hurt, and irritability. Reactions can occur immediately after the event or weeks later.
Children who have had traumatic experiences may have difficulty sleeping or have nightmares. They may avoid activities, situations, thoughts, or conversations that may be related to the traumatic events, even if other people don't perceive them as related (for example, a child who was eating corn flakes on the morning of a terrible event may not want to eat corn flakes). They may play in ways that repeat something from their traumatic experiences (for example, twirling or hiding under things after exposure to a tornado).
They may recreate aspects of the traumatic experience in their behaviour (for example a child who was exposed to a fire may set fires). They may not want to be with people as much as before. They may avoid school, have trouble with schoolwork, or feel unable to pay attention. They may not want to play as much, avoid certain kinds of play, or lose interest in things they once enjoyed. They may be sad or seem to have less emotion or feel guilty about things they did or did not do related to the traumatic experience.
Young children (age five and younger) may experience new fears such as separation anxiety or fear of strangers or animals. They may act younger or lose a skill they have already mastered (such as toilet training).
Primary school-aged children (ages six to 11) may get parts of the traumatic experience confused or out of order when recalling the memory. They may complain of body symptoms that have no medical cause (such as stomach aches). They may stare into space or seem "spacey," or startle easily.
Adolescents (ages 12 to 18) may experience visual, auditory, or bodily flashbacks of the events, have unwanted distressing thoughts or images of the events, demonstrate impulsive and aggressive behaviours, or use alcohol or drugs to try to feel better. They may feel depressed or have suicidal thoughts.
What can adults do to help?
- Let the child know it is normal to feel upset when something bad or scary happens.
- Encourage the child to express feelings and thoughts, without making judgments.
- Protect the child or adolescent from further exposure to traumatic events, as much as possible.
- Return to normal routines as much as possible.
- As the child's most important routine, school can be a major healing environment. Educate school personnel about the child's needs. Reassure the child that it was not his or her fault and that adults will try to take care of him or her.
- Allow the child to feel sad and/or cry.
- Give the child a sense of control and choice by offering reasonable options about daily activities (choosing meals, clothes, etc.).
- If the child regresses (or starts to do things he or she did when younger), adults can help by being supportive, remembering that it is a common response to trauma, and not criticising the behaviour.
Adults can be most helpful if they take care of themselves and get help for their own distress, since children and adolescents may respond to adults' feelings and reactions.
When to seek help
Most children and adolescents will recover within a few weeks with such support. However, some children may require more help. Responsible adults who are concerned about their child's reaction to a very stressful event may want to consider seeking the help of a mental health professional who is trained in helping children with traumatic responses or post-traumatic stress disorder. Therapies can be individual, group, or family sessions that include talking, drawing, and writing about the event. In some cases medication can be helpful.
A family doctor, clergy person, local community organisation or social work association may be helpful in providing a referral to a counsellor or therapist with experience in treating children affected by traumatic stress.