CHILDREN S RESPONSES TO TRAUMA REFERENCE CHART

Transcription

1 CHILDREN S RESPONSES TO TRAUMA REFERENCE CHART Children s responses to disaster vary with the age of the child. These responses are considered normal if they are of brief (under 2 weeks) duration. *Although these responses are considered normal, should they continue even for several days help should be sought. *Any suicidal verbalization indicates a need for professional help Enuresis = Involuntary discharge of urine. Encopresis = Involuntary discharge of the bowels. Childr 1.DOC 1

2 PRESCHOOL THROUGH SECOND GRADE. Response to trauma Helplessness & passivity Generalized fear. Cognitive confusion (e.g. do not understand that the danger is over) Difficulty identifying what is bothering them Lack of verbalization selective mutism, repetitive nonverbal traumatic play, unvoiced questions. Attributing magical qualities to traumatic reminders. Sleep disturbances (night terrors & nightmares; fear of going to sleep; fear of being alone, especially at nights.) Anxious attachments (e.g., clinging to parents) Regressive symptoms (thumb sucking, enuresis, regressive speech.) Anxieties related to incomplete understanding about death; fantasies of fixing up the dead; expectations that a dead person will return. Provide support, rest, comfort, food & opportunity to play or draw. Reestablish adult protective shield. Give repeated, concrete clarification. Provide emotional labels for common reactions. Help to verbalize general feelings & complaints. Separate what happened from physical reminders such as the place where the trauma occurred. Encourage them to let their parent know. Provide consistent care taking (e.g. assurance of being picked up from school.) Tolerate regressive symptoms in a time limited manner. Give explanations about the physical reality of death. 2

3 THIRD THROUGH FIFTH GRADE Response to Trauma Preoccupation with their own actions during the event; issues of responsibility & guilt. Specific fears triggered by traumatic reminders. Retelling & replaying of the event (traumatic play) Fear of being overwhelmed by their feelings (of crying, of being angry.) Impaired concentration & learning. Sleep disturbances (bad dreams; fear of sleeping alone.) Concerns about their own & others safety. Altered & inconsistent behavior (e.g. unusually aggressive or reckless behavior, inhibitions.) Somatic complaints. Hesitation to disturb parent with own anxieties. Concern for other victims & their families Feeling disturbed, confused & frightened by their grief responses; fear of ghosts. Help to express their secretive imaginings about the event. Help to identify & articulate traumatic reminders & anxieties; encourage them not to generalize. Permit them to talk & act it out; address distortions, & acknowledge normality of feelings & reactions. Encourage expressions of fear, anger, sadness, in your supportive presence. Encourage to let teachers know when thoughts & feelings interfere with learning. Support them in reporting dreams; provide information about why we have bad dreams. Help to share worries; reassure with realistic information. Help to cope with the challenge to their own impulse control (e.g. acknowledge, "It must be hard to feel so angry." Help identify the physical sensations they felt during the event & link when possible. Offer to meet with children & parent(s), to help children let parents know how they are feeling. Encourage constructive activities on behalf of the injured or deceased. Help to retain positive memories as they work through the more intrusive traumatic memories. 3

4 ADOLESCENTS (SIXTH GRADE & UP.) Response to trauma Detachment, shame, guilt. Self consciousness about their fears, sense of vulnerability; fear of being labeled abnormal. Post traumatic acting out behavior (e.g., drug use, delinquent behavior, sexual acting out.) Life threatening reenactment, Self destructive or accident prone behavior. Abrupt shifts in interpersonal relationships. Desires & plans to take revenge. Radical changes in life s attitudes which influence identity formation. Premature entrance into adulthood (e.g., leaving school or getting married) or reluctance to leave home. Encourage discussion of the event, feelings about it, & realistic expectations of what could have been done. Help them understand the adult nature of these feelings. Encourage peer understanding & support. Help to understand the acting out behavior as an effort to numb their responses to, or to voice their anger over the event. Address the impulse toward reckless behavior in the acute aftermath; link it to the challenge to impulse control associated with violence. Discuss the expectable strain on relationships with family & peers. Elicit their actual plans of revenge; address the realistic consequences of these actions; encourage constructive alternatives that lesson the traumatic sense of helplessness. Link attitude changes to the events impact. Encourage postponing radical decisions in order to allow time allow time to work through their responses to the event & to grieve. FAMILY Pynoos & Nader also suggest how "" may be administered to children in the family. These suggestions might be mailed to families or sent home with the students. 1. Give children special & directed support by keeping things fairly structured & adjusting for fears, especially at bedtime. 2. Help reestablish a sense of safety by assuring that the house is locked & that the child knows the parents whereabouts at all times. This may mean transporting to & from school for awhile. 3. Offer reassurance when traumatic reminders include thinking, feeling or behavior. 4. Validate the expression of all feelings by tolerating them & not dismissing them. Predict And Prepare. Preparation for handling deaths at school, before a trauma happens, is essential. It is the only way to assure rapid & sensitive handling of deaths invading the psychological sanctity of schools. 4

5 Mental health professionals might be engaged to teach small group techniques to teachers so that student groups could be quickly organized with skilled leaders if a tragedy occurs. In service training programs for teachers on handling grief & loss should be elevated to necessity rather than choice. Teachers can learn how to use art, musical expression, poetry & storytelling as expressive outlets for grieving or traumatized children. Today s "typical American family" includes family disintegration, & multiple & compound losses. Death can tip the scale to a position that stressed children find impossible to comprehend & accommodate. Schools must be prepared to play a larger role in substituting for values, structure & solidarity which may be lacking in the nuclear family. Childr 1.DOC 5