Mass killings in Europe, the Middle East and Africa, shootings in the USA, and the high level of everyday violence in South Africa... these grotesque acts of violence can affect children as much, if not more, than adults.
But what exactly is trauma, and when does it become post-traumatic stress disorder (PTSD)? How can we help children through trauma and what could happen if children don't get the help they need?
1. First: do no harm
In the first place, our job is to shield our children from trauma where possible. In normal, healthy circumstances, we can:
- Not allow small children to watch the news or documentaries with potentially violent footage, or let newspapers with graphic images lie about;
- Not linger at accident scenes as a passer-by;
- Not talk about gruesome events in front of smaller children, who may not understand the context and become fearful but unable to communicate that to you;
- Not let your kids watch movies rated for older audiences;
- Fast-forward in children’s movies when your small child expresses fear instead of just switching off – it’s useful to show them the resolution and happy ending. Stories are often useful tools for children to explore themes of good and evil in a safe environment.
- Protect your child and avoid exposure to physical violence, if possible.
Every child is different and may be sensitive to different stimuli. Two children of the same age may react completely differently to the same movie, for instance. Parents should try to be aware of each child’s threshold and err on the side of caution.
We should also teach our kids the vocabulory to express their emotions and encourage them to share their feelings, by listening and acknowledging what they say, without brushing it off. If they tell us they’re sad that their teacher is leaving and we respond with, "There are kids with bigger problems", your child may feel less inclined to share their feelings when they’re experiencing real trauma.
2. Identify when your child is experiencing trauma
Daphne* was 10 when their school outing took them to the Police Museum in Pretoria. The images she saw haunted her for years and she became anxious and tearful at any cue that reminded her of crime or police.
Thobela* was 4 when he saw a seething mob chasing a family friend with pangas. His mom immediately sent him indoors. The man was killed in front of their house and although Thobela didn’t see a thing, he heard it all.
Ben* was 14 when his alcoholic dad killed all his pet bunnies in a fury, because Ben had asked for money to feed them.
Cindy* was sexually abused and at the age of 7 she saw her dad kill her mother in a domestic dispute.
Nandi* was 4 when she saw a man sleeping rough next to the road. She thought he was dead and became very distressed that everybody, including her and her dad, just walked past him, but she was too small to verbalise it.
When is a child likely to experience trauma?
Some traumatic events seem less serious than others, but they can nonetheless have negative effects. The way a child responds may depend on different factors, such as:
- whether it was an one-off event or long-term exposure to stress and trauma;
- how severe the event was;
- how close to the event he or she was;
- whether the child has had a history of trauma including the death of the mom or dad, abuse, neglect or physical separation;
- the child's personality;
- a history of psychiatric illness;
- the child’s age;
- and whether the child had access to support resources afterwards.
How to recognise trauma in a child:
It is normal to experience symptoms like flashbacks, nightmares, clinginess, being withdrawn, regression, unexplained tummy or headaches and anger outbursts, and in older children, being tired all the time, rebelliousness or poor academic performance, for weeks after a traumatic event. But when these continue beyond 4 to 6 weeks and interfere with the child’s day-to-day life, it’s best to get your child to a doctor, who could assess your child for post-traumatic stress disorder (PTSD).
3. Respond appropriately
When you suspect your child may be traumatised after an event, don’t ignore it and hope it goes away. Talk to your child, however difficult it may be for you.
You may have seen this beautiful interview with a dad and his small son by French TV show Le Petit Journal that went viral after the Paris attacks in 2016.
The dad chose his words carefully, allowing the boy to voice his concerns, then reassured him that there are good things in the world.
The US Child Welfare Information Gateway offers the following advice to help your child through trauma:
Identify and be sensitive about your child’s triggers. Try to avoid things that remind your child about the event, at least until they’re better.
Be there. In person and emotionally available, without being pushy. Let you child know that when they’re ready to talk or just need a hug, you’re there for them.
Stay calm. Even when your child throw a tantrum or gets very upset, stay reassuring and keep your voice low.
Point out all the good in the world. At every public emergency, there are emergency personnel and volunteers getting stuck in to help victims. Help your child to see generosity, goodwill and love in other people.
Listen. Let them express their feelings when they want to. Don’t judge, don’t avoid the topic, and don’t take it personally.
Answer their questions. Discuss what had happened, state the facts, don't lie but don't be overly graphic either, ask the child how he or she feels about it, if they’re scared, what they’re scared about. Then respond reassuringly and age-appropriately.
Tell them it was not their fault. Children often take the blame for events outside of their control, and often don’t express that shame. Reassure the child, for instance, that their dog didn’t pass away because they forgot to brush it the previous day.
Help your child to relax. Do yoga together, meditate, pray, listen to calming music, massage her, and have a positive mantra to encourage them.
Let them feel safe. Reassure small ones that you'll do everything in your power to protect them. Discuss physical safety measures with older children and help them to feel emotionally safe with you. If you're a spiritual family, you may discuss getting security and comfort from a Greater Power.
Have a predictable routine. It helps the child to feel safe if they know when to expect meals, bathtime and bedtime, for instance. Pre-empt a change in routine by warning your child what will happen.
Don’t rush. People don’t heal overnight and some may heal quicker than others.
Let the child feel in control of their life. Give them age-appropriate choices to build their confidence.
Build self-esteem. Having a positive experience such as learning a new skill or joining a new group can help kids to recover.
Set boundaries but avoid smacking. After a violent trauma experience, this could increase a child’s panic and slow healing.
Let them write about it. Older children can keep a journal in which they pour out their feelings, their fears, and anything unresolved from the past that bubbled up again.
Help the victims. This absolutely depends on the kind of event and the age of the child. But taking blankets and toys to victims of floods or fires could help your child to feel more connected with the world again and build confidence.
Get external help. If your child’s trauma symptoms don’t let up after 4 to 6 weeks, take him to a doctor, who may refer you to a psychologist.
So when is it PTSD?
Post-traumatic stress disorder (PTSD) may develop when the child is unable to process the shock of the trauma in a reasonably amount of time and the symptoms continue to interfere with daily life and academic performance.
Children are more prone to developing PTSD than adults, as their brains are still in development. Local studies revealed that as much as 20% of young people and clinic patients in South Africa had been diagnosed with PTSD, while various US studies pin the figure to between 25% and 33%.
"Traumas with the highest risk for psychopathology are severe, unpredictable or uncontrollable," says Dr Eileen Thomas, a psychiatrist affiliated to Akeso Psychiatric Clinics. "PTSD risk is also increased by the cumulative effect of multiple, severe, uncontrollable traumas."
A child may display PTSD symptoms in the following ways:
- The shocking event is re-experienced, which may present in repetitive play around aspects of the trauma; re-enactment or constant talking about it; scary but vague dreams; and a psychological or physical response to triggers.
- Avoidance of thoughts, feelings, conversations, activities, people and/or places associated with the trauma; a feeling of detachment; loss of interest in food or certain activities or inability to feel emotions; feelings of excessive guilt or shame; depression or anxiety; or inability to recall important details of the event.
- Heightened responses such as anger outbursts, being disorganised or agitated, risky behaviour, being overly jumpy, concentration problems, insomnia and always being on high alert.
Also read on Health24: Post-traumatic stress disorder
Dr Eileen Thomas says that a diagnostic criteria set for PTSD in children 6 years and younger has now been developed for use in preschool children, which will help to diagnose and treat smaller children.
How can PTSD be treated in children?
If left untreated or unrecognised, PTSD may lead to long-term problems such as anxiety and depressive disorders, insomnia, addiction, behavioural problems, and in worst cases, ultimately also result in suicidal thoughts. In fact, children exposed to trauma are sometimes diagnosed with ADHD, anxiety, depression or OCD, isolating the symptoms of PTSD instead of going to the root of the problem. "Getting a PTSD-diagnosis can usefully bring together many seemingly unrelated symptoms," says Dr Thomas.
"For any psychiatric disorder, the earlier treatment is initiated, the better the outcome," stresses Dr Thomas. "Treatment should be sought from either a psychiatrist or a clinical psychologist, preferably one with experience in treating trauma-related disorders."
Over the past decade, she says, great results have been achieved with both psychological and medical treatment. "Research findings are still unsettled on which approach is best, but most international guidelines advocate use of either or both." But she points out that treatment strategies should always tailored to the individual. "What may be effective for one person may be ineffective for another," she explains.
Dr Thomas does warn against the old-fashioned approach of debriefing, saying it is an outdated intervention which may in fact increase distress. This old approach offered a single session to everyone exposed to the trauma, shortly after exposure, for instance in a war situation, without first evaluating or diagnosing PTSD.
Instead, the treatment most widely recognised as effective these days is cognitive behavioural therapy (CBT). There are a wide variety of approaches, including Multi-Modality Trauma Treatment (MMTT) , Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), Stanford Cue-Centered Therapy (SCCT), Seeking Safety, Trauma Affect Regulation: A Guide for Education and Therapy (TARGET), and the Prolonged Exposure (PE) protocol. This article in Psychology Today explains the different approaches.
Other treatment options include play, music, art and drama therapy, and Eye Movement Desensitisation and Reprocessing (EMDR) therapy.
For many individuals, PTSD is chronic, but symptoms can fluctuate and may worsen during stressful times. "Recovery, also known as remission of symptoms, is an attainable goal," says Dr Thomas. "Affected individuals can lead productive, meaningful lives."
What about you?
It’s important for the parents to seek help too. Your child’s trauma could trigger some unresolved trauma in your own life. And those parents who have been exposed to higher levels of physical and sexual violence in their lives may not even realise what an impact these events may have on their children, or they may feel traumatised and helpless themselves. Small babies also experience trauma, and get confused and frightened by the trauma of those around them, even if they don't understand what had happened. So do get help so you're in a better position to offer support to your children.
Consider the environment in which South African children are growing up – our high rate of road accidents, family violence and crime – and it's not difficult to see that our younger generation needs support. Recognising and effectively treating trauma in our children could help the live full lives and realise their potential.
Where to find help:
- To find a registered counsellor, ask your doctor or find a therapist online.
- FAMSA can also help, for a nominal fee. Call their national office for your nearest branch: 011 975 7106/7 or visit FAMSA's website.
- Your local church may have registered counsellors.
Sources: Health24, Psychology Today, Child Welfare Information Gateway, Child Trauma Academy, Greater Good: Berkley University of California, a 2016 study on the effects of the Fukushima Nuclear Disaster.