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2012

Coping with the Emotional Effects of Exposure to Violence and Trauma

December 18, 2012
kelly Patrick

Patrick Kelly, M.D.

Initially, how might parents best approach their child who has experienced trauma first hand?
The first thing is to see what they have heard and actually know about a violent event. “Do you know what happened in Connecticut? Did you hear about children getting hurt?” Probe what they know and from there ask how the child feels about it. “Is there anything you’re scared of? Worried about?” So you’re opening up their feelings about it but not forcing it on them.

Is there a time when it’s too soon to talk about the child’s traumatic experience?
Following Hurricane Katrina in 2005, researchers found that an aggressive debriefing program soon after the event actually re-traumatized some of the victims. It was more harmful than helpful. My advice would be it’s never too soon to talk about the event, but let the child guide the discussion. If the child says “I don’t want to talk about it” or doesn’t seem ready, don’t force them to talk or think about it.

What is the reasoning behind that?
Children, especially young children, typically don’t fully understand the scope of a traumatic event. For example, they may not comprehend that death is a permanent thing. They may see their friend shot but not fully understand that they may never see their friend again. It’s a very different impact depending on where the child is developmentally. So do we talk about the event or leave it alone for the child to do whatever he or she wants to do with it? There’s no 100 percent answer, it varies by the child.

How so?
For most children, if you shake the bottle it sometimes falls over, but most of the time it goes back to where it was. But everybody is going to have a different frequency in their oscillation when they’re disturbed that way. Some children will have a big internal response but externally look like they’re doing okay. But you have to give them a chance to tell you where they are and respect their decision if they don’t want to talk about it. Parents, in trying to process their own response, sometimes put pressure on the child to process it faster than they’re ready to.

So parents process traumatic events differently than kids?
Yes. Kids are thinking about injuries to themselves or their friends, while parents are thinking about injury to their own children, which is a whole different ballgame. Parents may ask themselves, “What if my child was the victim? Will I ever see my son again?” That fear comes along with being a parent. Children, on the other hand, are more focused on their world.

Are children generally more resilient than adults in dealing with trauma?
Research shows that their resiliency depends a lot on their support network and their relationships with their teachers and parents. Going through a traumatic experience can actually strengthen those bonds and those relationships, so it becomes a tighter web and a coping mechanism for them to fall back on in the future.

Can the experience and how parents react pull them apart, too?
Yes, you can stretch those bonds to the point of breaking. A lot of evidence shows that when a child gets sick, the parents’ relationship can fall apart rather than get stronger, because people respond in different ways. Mom and dad, brothers and sisters are going to have different feelings and emotions, and it’s important to respect each one of those as valid. The key is to be as supportive as possible. Mom and dad can talk about it with each other and make sure they take care of themselves so they can take care of their kids.

What about children who are indirectly exposed to the violent event, through the media or what they hear from friends?
If the child was not directly exposed to the event or did not have any relationship to the event, it’s unlikely to lead to any PTSD-like symptoms. However, the event can still be confusing and disturbing for the child. If the traumatic event happened at a school, the child may not want to go back to school. Many parents, who may have their own reticence about sending their child back to school, don’t really know what to do with this.

So what can they do?
They may want to talk to school officials about safety protocols to reassure themselves a bit about the environment they are putting their child in. They can also set up some sort of safety plan with their child to make them feel more control over their environment. I would advise parents against saying to the child this will never happen at your school, which ignores the way the kid is feeling and brushes it aside as unimportant. But you can say “If something scary happens at school, what are you going to do? You’re going to call mommy on your cell phone, go to your teacher, or go to the principal if you can’t find your teacher.” Parents can give their child an algorithm they can follow, which will make them feel more empowered, safe and secure.

For children who experience trauma first hand, what kind of symptoms should parents watch out for?
In children who experience acute stress we see a conglomeration of symptoms, including elevated anxiety, hypervigilance and withdrawal. They might avoid people or situations that remind them of the event, or they may not play the violent video games they used to enjoy. Some kids will have nightmares and not want to talk about them because they’re so scary. Young kids sometimes don’t know the difference between nightmares and reality. It’s okay for parents to say “It’s a scary dream, it’s over now, you’re safe, do you want to talk about what you were dreaming about?” It’s disturbing to both the parent and the child. The most important thing is to separate the nightmares from reality and open the door to talk about it when the child is ready.

Are these symptoms of post-traumatic stress disorder (PTSD)?
The symptoms of children who are directly exposed to traumatic and violent events, who experience what we call acute stress disorder, may or may not progress to PTSD. Only about 20 percent of people who have an acute stress disorder actually go on to have PTSD. If the child has a pre-existing mental health issue, like an anxiety or depressive disorder, or if he or she experienced a previous trauma, they’re much more likely to have PTSD symptoms in the long run. Then you’re talking about symptoms like recurring thoughts and dreams, decreased interest in activities, psychic numbing and detachment, where they don’t appear to be happy or sad. They’re just sort of flat and absent, they just seem to disappear, which can be some of the scariest signs for parents. This may be a place where the parents aren’t sufficient anymore, where pushing and pushing could make things worse.

So what should parents do in this case?
If you’re worried about your child, just don’t sit there with the worry – take your child to a health professional. I usually say go to your pediatrician first. He or she knows the child pretty well, and because you have an existing relationship you can get in quickly. Pediatricians are experienced in talking to parents about how to talk to their kids. Because they see so many kids they can smell if something is going on, make the referral and guide families in the appropriate direction.

When should you take your child to a mental health professional?
Again, children can be resilient, and most of the time they are okay. I tell the parents to go by the symptoms and not just by the exposure. If the child sees a friend hit by a car, and they’re talking about it and not having symptoms, or having a nightmare once in a while, that’s not necessarily a reason to see a mental health professional. If you see that your child is changing and not going back to who he or she used to be, I would say definitely take the child in for an evaluation. There are mental health centers out there that have child psychiatrists and child therapists who can do an evaluation and give you feedback on the symptoms your child is experiencing.

When should parents be concerned about their child being a potential perpetrator of a violent event?
The parents’ job is to monitor their children for this type of behavior. Do they have an interest in guns, in buying guns? Are they experiencing withdrawal? I’ve always felt that parents have the best radar for their kids, so if they’re nervous about the child they shouldn’t ignore it. But there is something to be said about kids growing up and learning how to be independent adults, and parents need to balance that. Oversight is good but total control maybe not so much. But if you’re worried about your kid, this is something you don’t have to go through alone. There are resources out there. I’d like to consider myself one of them.

For more information, call 410-955-5335.
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