| Following
exposure to crisis events (such as natural disasters,
acts of violence, and the death of a friend
or family member) it is not unusual for children
to display symptoms of acute distress (such
as shock, crying, anger, confusion, fear, sadness,
grief, and pessimism). In most cases these reactions
are temporary and gradually lessen in the days
and weeks following the event. However, there
are instances where these reactions are part
of more severe emotional trauma. How adults
react to a crisis can have a significant effect
on how traumatized children become. It is very
important that adults remain calm and reassuring
to the extent possible. This handout describes
how to identify severely traumatized children
so as to better ensure they get timely access
to the professional counseling they will require.
Exposure to a traumatic event alone is not
necessarily sufficient to seriously traumatize
a child. Rather, it is a consequence of how
the child experienced the crisis that results
in severe emotional distress. It is helpful
for adults to understand both the risk factors
involved and the specific reactions to the traumatic
event that signal the need for referral to a
mental health professional.
The Child’s Trauma Experience
How traumatic an event is for a given child
is the result of an interaction between the
event and the child’s personal crisis
experiences. Quite simply, if a child views
the event as threatening, then the greater is
the likelihood that the child will be traumatized.
These threat perceptions are determined and
influenced by (1) the nature of the crisis event
itself, (2) crisis exposure, (3) relationships
with crisis victims, (4) adult reactions to
the trauma, and (5) a variety of individual/personal
vulnerability factors.
1. Crisis event. Some traumatic events are
more threatening than are others. Severe emotional
trauma is more likely to occur following events
that are intentional human caused acts of aggression
(vs. accidents or natural disasters); and/or
those that occur suddenly and unexpectedly,
have particularly devastating consequences (e.g.,
involve fatalities), have relatively long durations,
and are intense.
2. Exposure. The closer a child is to the
location of a crisis event, and the longer their
exposure, the greater the likelihood of the
child viewing the even as personally threatening.
Thus children who are physically closer to a
terrorist attack, a school shooting, or a natural
disaster are at greater risk than are children
who were far away for the traumatic event.
3. Relationships. Having relationships with
the victims of a crisis (i.e., those who were
killed, injured, and/or threatened) is associated
with an increase chance of viewing the event
as threatening. The stronger the child’s
relationships with the victims, the greater
the likelihood of severe distress. Children
who lost a caregiver or immediate family member
are most at risk.
4. Adult reactions. Particularly among younger
children threat perceptions are influenced by
adult behaviors and reactions to the crisis
event. Events that initially are not viewed
as threatening and/or frightening may become
so after observing the panic reactions of parents
or teachers. Sensationalized media reports can
also influence how frightening a child views
an event to be.
5. Individual vulnerability. Personal experiences
and characteristics can also influence how crisis
event threat perceptions. These include:
a. Family factors. Children who are not
living with their families, have been exposed
to family violence, have a family history
of mental illness, and/or have caregivers
who are severely distressed by the disaster
are more likely themselves to be severely
distressed.
b. Social factors. Children who must face
a disaster without supportive and nurturing
friends or relatives suffer more than those
who have at lease one source of such support.
c. Mental health. The child who had mental
health problems (such as depression or anxiety
disorders) before experiencing a traumatic
event will be more likely to be severely distressed
by a traumatic event.
d. Developmental level. Although young children,
in some respects, may be protected from the
emotional impact of traumatic events (because
they don’t recognize the threat), once
they perceive a situation as threatening,
younger children are more likely to experience
severe stress reactions than are older children
and adolescents.
e. Previous trauma experience. Children
who have experienced previous threatening
and/or frightening events are more likely
to experience severe reactions to a subsequent
disaster event severe psychological distress.
Symptoms of Severe Emotional Trauma
The presence of the risk factors described above
will signal the need to be more vigilant for
the symptoms of severe emotional trauma. While
some initial symptoms are to be expected following
a crisis event, there are several reactions
that signal the need for referral to a mental
health professional.
1. Acute initial reactions. Severe reactions
during the crisis (e.g., become hysterical or
panic).
2. Increased arousal. Difficulty falling or
staying asleep, being irritable or quick to
anger, having difficulty concentrating, and
easily startling.
3. Avoidance of crisis reminders and a lack
of emotion. Avoiding all activities that serve
as reminders of the trauma, withdrawal from
other people, difficulty feeling positive emotions.
4. Maladaptive coping. Potentially harmful
coping behaviors (e.g., drug or alcohol use,
severe aggression).
These reactions are especially concerning if
they interfere with daily functioning (e.g.,
result in the child not being able to play with
friends, go to school, etc.) and are long lasting
(i.e., do not begin to lessen a week or more
following the event).
It is important to note that symptoms can
be delayed, particularly in the case of ongoing
or extended trauma experiences such as war or
loss of home and community as the result of
a disaster. Additionally, experiencing a traumatic
event can put children at higher risk for severe
trauma reaction to a future crisis.
Know the Signs and Get Help if Necessary
Parents and other significant adults can help
reduce potentially severe psychological effects
of a traumatic event by being observant of children
who might be at greater risk and getting them
help immediately. The mental health service
providers who are part of the school system—school
psychologists, social workers and counselors—can
help teachers, administrators and parents identify
children in need of extra help and can also
help identify appropriate referral resources
in the community. Distinguishing “normal”
from extreme reactions to trauma requires training
and any concern about a child should be referred
to a mental health professional.
For further information about the signs and
symptoms of severe emotional trauma in children
and adolescents, please refer to the National
Center for PTSD.
Adapted from School Crisis Prevention and
Intervention: The PREPaRE Model by S. E. Brock
et al. (2009), National Association of School
Psychologists. Modified from the article posted
on the NASP website in September 2001.
© 2011, National Association of School
Psychologists, 4340 East West Highway, Suite
402,
Bethesda, MD 20814, (301) 657-0270, Fax (301)
657-0275; www.nasponline.org
|
