Research
Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do
For Parents of Children Exposed to Violence or Disaster
Violence or disasters can cause trauma in young people. Trauma is hurt or harm. It can be hurt to a person?s body. It can be harm to a person?s mind.
The National Institute of Mental Health (NIMH) works to help children who experience trauma. Other Federal agencies also provide help.
Parents and family members play important roles.
They help children who experience violence or disaster. They help children cope with trauma. They help protect children from further trauma. They help children get medical care and counseling. They also help young people avoid or overcome emotional problems. These problems can result from trauma.
This fact sheet provides steps parents can take. It gives information on:
? Coping with Trauma after violence and disasters
? What is Trauma?
? Helping Young Trauma Survivors
? How Parents Can Help
? Help for all people in the First Days and Weeks
? How Children React to Trauma
o Children under 5
o Children Age 6-11
o Adolescents Ages 12-17
? More about Trauma and Stress
? Additional Resources
Coping with Trauma After Violence and Disasters
Disasters cause major damage. Hurricanes Katrina and Rita were examples. They occurred in 2005. Many homes were destroyed. Whole communities were damaged. Many survivors were displaced. There were also many deaths.
Trauma is also caused by major acts of violence. The September 11, 2001 terrorist attacks were examples. Another example was the 1999 shootings at Columbine High School in Colorado. The Oklahoma City bombing in 1995 was also an example. These acts claim lives. They also threaten our sense of security.
Beyond these events, children face many other traumas. Each year, they are injured. They see others harmed by violence. They suffer sexual abuse. They lose loved ones. Or, they witness other tragic events.
Children are very sensitive. They struggle to make sense of trauma. They also respond differently to traumas. They may have emotional reactions. They may hurt deeply. They may find it hard to recover from frightening experiences. They need support. Adult helpers can provide this support. This may help children resolve emotional problems.
What is Trauma?
There are two types of trauma ? physical and mental. Physical trauma includes the body?s response to serious injury and threat. Mental trauma includes frightening thoughts and painful feelings. They are the mind?s response to serious injury. Mental trauma can produce strong feelings. It can also produce extreme behavior; such as intense fear or helplessness, withdrawal or detachment, lack of concentration, irritability, sleep disturbance, aggression, hyper vigilance (intensely watching for more distressing events), or flashbacks (sense that event is reoccurring).
A response could be fear. It could be fear that a loved one will be hurt or killed. It is believed that more direct exposures to traumatic events causes greater harm. For instance, in a school shooting, an injured student will probably be more severely affected emotionally than a student who was in another part of the building. However, second-hand exposure to violence can also be traumatic. This includes witnessing violence such as seeing or hearing about death and destruction after a building is bombed or a plane crashes.
Helping Young Trauma Survivors
Helping children begins at the scene of the event. It may need to continue for weeks or months. Most children recover within a few weeks. Some need help longer. Grief (a deep emotional response to loss) may take months to resolve. It could be for a loved one or a teacher. It could be for a friend or pet. Grief may be re-experienced or worsened by news reports or the event?s anniversary.
Some children may need help from a mental health professional. Some people may seek other kinds of help. They may turn to religious leaders. They may turn to community leaders.
Identify children who need the most support. Help them obtain it. Monitor their healing.
Identify Children Who:
? Refuse to go places that remind them of the event
? Seem numb emotionally
? Show little reaction to the event
? Behave dangerously
These children may need extra help.
In general adult helpers should:
? Attend to children
o Listen to them
o Accept/ do not argue about their feelings
o Help them cope with the reality of their experiences
? Reduce effects of other sources of stress including:
o Frequent moving or changes in place of residence
o Long periods away from family and friends
o Pressures at school
o Transportation problems
o Fighting within the family
o Being hungry
? Monitor healing
o It takes time
o Do not ignore severe reactions
o Attend to sudden changes in behaviors, speech, language use, or in emotional/feeling states
? Remind children that adults:
o Love them
o Support them
o Will be with them when possible
How Parents Can Help:
After violence or a disaster parents and family should:
? Identify and address their own feelings ? this will allow them to help others
? Explain to children what happened
? Let children know:
o You love them
o The event was not their fault
o You will take care of them, but only if you can; be honest
o It?s okay for them to feel upset
? DO:
o Allow children to cry
o Allow sadness
o Let children talk about feelings
o Let them write about feelings
o Let them draw pictures
? DON?T:
o Expect children to be brave or tough
o Make children discuss the event before they are ready
o Get angry if children show strong emotions
o Get upset if they begin:
§ Bed-wetting
§ Acting out
§ Thumb-sucking
? If children have trouble sleeping:
o Give them extra attention
o Let them sleep with a light on
o Let them sleep in your room (for a short time)
? Try to keep normal routines (such routines may not be normal for some children):
o Bed-time stories
o Eating dinner together
o Watching TV together
o Reading books, exercising, playing games
? If you can?t keep normal routines, make new ones together
? Help children feel in control:
o Let them choose meals, if possible
o Let them pick out clothes, if possible
o Let them make some decisions for themselves, when possible.
Help for all people in the First Days and Weeks
Key steps after a disaster can help adults cope. Adults can then provide better care for children. Create an environment of safety. Be calm. Be hopeful. Be friendly, even if people are difficult. Connect to others. Listen to their stories. But, listen only if they want to share. Encourage respect for adult decision-making.
In general help people:
? Get food
? Get a safe place to live
? Get help from a doctor or nurse if hurt
? Contact loved ones or friends
? Keep children with parents or relatives
? Become aware of available help
? Become aware of where to get help
? Understand what happened
? Understand what is being done
? Move towards meeting their own needs
Avoid certain things:
? Don?t force people to tell their stories
? Don?t probe for personal details.
? Do not Say:
o ?Everything will be OK.?
o ?At least you survived.?
o What you think people should feel
o How people should have acted
o People suffered for personal behaviors or beliefs
o Negative things about available help
? Don?t make promises that you can?t keep
o (Ex: ?You will go home soon.?)
How Children React to Trauma
Children?s reactions to trauma can be immediate. Reactions may also appear much later. Reactions differ in severity. They also cover a range of behaviors. People from different cultures may have their own ways of reacting. Other reactions vary according to age.
One common response is loss of trust. Another is fear of the event reoccurring. Some children are more vulnerable to trauma?s effects. Children with existing mental health problems may be more affected. Children who have experienced other traumatic events may be more affected.
Children Age 5 and Under
Children under five can react in a number of ways:
? Facial expressions of fear
? Clinging to parent or caregiver
? Crying or screaming
? Whimpering or trembling
? Moving aimlessly
? Becoming immobile
? Returning to behaviors common to being younger
o Thumb sucking
o Bedwetting
o Being afraid of the dark.
Young children?s reactions are strongly influenced by parent reactions to the event.
Children Age 6 to 11
Children between six and 11 have a range of reactions. They may:
? Isolate themselves
? Become quiet around friends, family, and teachers
? Have nightmares or other sleep problems
? Become irritable or disruptive
? Have outbursts of anger
? Start fights
? Be unable to concentrate
? Refuse to go to school
? Complain of unfounded physical problems
? Develop unfounded fears
? Become depressed
? Become filled with guilt
? Feel numb emotionally
? Do poorly with school and homework.
Adolescents Age 12 to 17
Children between 12 and 17 have various reactions:
? Flashbacks to the traumatic event (flashbacks are the mind reliving the event)
? Avoiding reminders of the event
? Drug, alcohol, tobacco use and abuse
? Antisocial behavior i.e. disruptive, disrespectful, or destructive behavior
? Physical complaints
? Nightmares or other sleep problems
? Isolation or confusion
? Depression
? Suicidal thoughts.
Adolescents may feel guilty about the event. They may feel guilt for not preventing injury or deaths. They may also have thoughts of revenge.
More About Trauma and Stress
Some children will have prolonged problems after a traumatic event. These may include grief, depression, anxiety and post-traumatic stress disorder (PTSD). Children may show a range of symptoms:
? Re-experiencing the event
o Through play
o Through trauma-specific nightmares/ dreams
o In flashbacks and unwanted memories
o By distress over events that remind them of the trauma
? Avoidance of reminders of the event
? Lack of responsiveness
? Lack of interest in things that used to interest them
? A sense of having ?no future?
? Increased sleep disturbances
? Irritability
? Poor concentration
? Be easily startled
? Behavior from earlier life stages.
Children experience trauma differently. It is difficult to tell how many will develop mental health problems. Some trauma survivors get better with only good support. Others need counseling by a mental health professional.
If, after a month in a safe environment:
? Children are not able to perform normal routines
? New symptoms develop
Then, contact a health professional.
Some people are more sensitive to trauma. Factors that may influence how someone may respond include:
? Being directly involved in the trauma, especially as a victim
? Severe and/or prolonged exposure to the event
? Personal history of prior trauma
? Family or personal history of mental illness and severe behavioral problems
? Lack of social support
? Lack of caring family and friends
? On-going life stressors such as moving to a new home, or new school, divorce, job change, financial troubles.
Some symptoms may require immediate attention. Contact a mental health professional if these symptoms occur:
? Flashbacks
? Racing heart and sweating
? Being easily startled
? Being emotionally numb
? Being very sad or depressed
? Thoughts or actions to end life
Additional Resources
Individuals and organizations can obtain publications about stress and anxiety disorders, including Post Traumatic Stress Disorder (PTSD), from NIMH. Call the information service at 1-866-615-6464 (toll-free) or 1-866-415-8051 (TTY toll-free). Information is also online at http://www.nimh.nih.gov/healthinformation/anxietymenu.cfm.
The list below includes other government agencies that may have additional information on helping children and adolescents cope with violence and disasters:
1) Center for Mental Health Services
Emergency Services and Disaster Relief Branch
5600 Fishers Lane, Room 17C-20
Rockville, MD 20857
Email: ken@mentalhealth.org
Web site: http://mentalhealth.samhsa.gov/publications/allpubs/KEN95-0011/default.asp
2) U.S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202
Phone: 1-800-USA-LEARN
TTY: 1-800-437-0833
Email: customerservice@inet.ed.gov
Web site: https://www.ed.gov
3) U.S. Department of Justice
950 Pennsylvania Avenue, NW
Washington, DC 20530-0001
Email: AskDOJ@usdoj.gov
Web site: http://www.usdoj.gov
4) Federal Emergency Management Agency
(Information for children and adolescents)
P.O. Box 2012
Jessup, MD 20794-2012
Phone: 1-800-480-2520
Web site: http://www.fema.gov/kids
5) National Center for Post Traumatic Stress Disorder
Phone: (802) 296-6300
Email: ncptsd@ncptsd.org
Web site: http://www.ncptsd.va.gov/
6) Uniformed Services University of the Health Sciences
Center for the Study of Traumatic Stress
4301 Jones Bridge Road
Bethesda, Maryland 20814
Web site: http://www.centerforthestudyoftraumaticstress.org/factsheets.shtml
7) National Child Traumatic Stress Network
905 W. Main Street
Suite 25-B
Durham, NC 27701
Phone: (919) 682-1552
Fax: (919) 667-9578
Email: info@nctsn.org
Web site: http://www.nctsn.org
NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:
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? NIMH does not provide specific medical advice or treatment recommendations or referrals; these materials may not be used in a manner that has the appearance of such information.
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If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or at nimhinfo@nih.gov.
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