Sadly, we are living in a society where children are no longer able to remain children for very long. Increasing violence in the media is unfortunately no longer the greatest worry facing concerned parents, but rather increasing violence at school, in the community at large and even in the home.
Cases of extreme child neglect reported by the media catch our attention, but these events are only a small fraction of the many tragic episodes that affect children’s lives. Each year many children and adolescents sustain injuries from violence, lose friends or family members, or are adversely affected by witnessing a violent or catastrophic event. Every situation is unique, whether it centres upon a bus accident where many people are killed, sometimes involving family and friends, abuse of some kind, over either a short or longer period of time, or natural disasters like the recent floods, where deaths occur and homes are lost, but these events also have similarities and cause similar reactions in children.
Trauma includes emotional as well as physical injuries. Emotional injury is essentially a normal reaction to an extreme event. It involves the creation of emotional memories, which arise from a long-lasting effect on structures deep within the brain. The more direct the exposure to the traumatic event, the higher the risk for emotional harm, but even second-hand exposure to to violence can be traumatic. For this reason, all children and adolescents exposed to violence or a disaster, even if only through graphic media reports, should be watched closely for signs of emotional distress.
Research has shown that both adults and children who experience catastrophic events show a wide range of reactions. Some suffer only worries and bad memories that fade with emotional support and the passing of time. Others are more deeply affected and experience long-term problems. Research on post-traumatic stress disorder (PTSD) shows that some soldiers, survivors of criminal victimization, torture and other violence, and survivors of natural and man-made catastrophes suffer long-term effects from their experiences. Children who have witnessed violence in their families, schools or communities are also vulnerable to serious long-term problems. Their emotional reactions, including fear, depression, withdrawal or anger, can occur immediately or some time after the tragic event. Loss of trust in adults and fear of the event happening again are common responses. Other reactions may vary according to age.
For children 5 years of age and younger, typical reactions include: a fear of separation from the parent, crying, screaming, immobility and/or aimless motion, trembling, frightened facial expressions, excessive clinging and regressive behaviours like thumb-sucking, bedwetting and fear of the darkness. Children in this age bracket tend to be strongly affected by their parent’s reactions to the traumatic event.
Children 6 to 11 years old may show extreme withdrawal, disruptive behaviour, inability to pat attention, regressive behaviours, sleep problems, nightmares, irrational fears, irritability, school refusal, outbursts of anger and fighting. School work often suffers and depression, anxiety, feelings of guilt and emotional ‘numbing’ are often present as well. Also the child may complain of stomach aches or other bodily symptoms that have no medical basis.
Adolescents from the age of 12 to 17 years old may show responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers and anti-social behaviour. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances and confusion. The adolescent may feel extreme guilt over his/her failure to prevent injury or loss of life, and may harbour revenge fantasies that interfere with recovery from the trauma.
Some children and adolescents will have prolonged problems after a traumatic event. These potentially chronic conditions include depression, prolonged grief and post-traumatic stress disorder (PTSD). PTSD is diagnosed when the following symptoms have been present for longer than one month:
· Re-experiencing of the event through play or in trauma-specific nightmares or flashbacks, or distress over events that resemble or symbolize the trauma.
· Routine avoidance of reminders of the event or a general lack of responsiveness (e.g. diminished interests or a sense of a foreshortened future).
· Increased sleep disturbances, irritability, poor concentration, startle reaction and regressive behaviour.
PTSD may arise weeks or months after the traumatic event and sometimes may resolve without treatment, but usually some form of therapy by a mental health professional is required in order for healing to occur. For more information about PTSD and its treatment, telephone counselling or referrals to appropriate mental health professionals, contact the Depression and Anxiety Support Group, Mondays to Fridays, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011)783-1474/6.
Fortunately, it is more common for a tramatized child to have some of the symptoms of PTSD than to develop the full-blown disorder. People differ in their vulnerability to PTSD, although the source of this difference is not known in its entirety. It has been shown that the impact of a traumatic event is likely to be greatest in the child or adolescent who previously has been the victim of child abuse or some other form of trauma, or who already had a mental problem. The youngster who lacks family support has also been shown to be more at risk for a poor recovery.
With thousands of children being exposed to violence daily through being the victims of emotional, sexual or physical abuse and through witnessing traumatic events, more and more questions are being asked about how these tragedies can be prevented, how those directly involved can be helped and how we can avoid such events in the future.
Early intervention is the answer. At the scene of a disaster:
· Find ways to protect children from further harm and from further exposure to traumatic stimuli
· When possible, direct children who are ale to walk away from the sight of violence or destruction and severely injured survivors and away from continuing danger
· Identify children in acute distress (trembling, agitation, mute, rambling speech and intense grief) and stay with them until initial stabilisation occurs
· Use supportive and compassionate verbal or non-verbal exchange with the child to help them feel safe. However brief or temporary these exchanges, such reassurances are important for children.
After violence or a disaster occurs, the family is the first-line resource for helping. Among the things that parents and other caring adults can do are:
· Explain the episode of violence or disaster as best as you can
· Encourage the children to express their feelings and listen without passing judgement, however do not force discussion of the traumatic event
· Let them know that it is normal to feel upset after something bad happens
· Allow time for them to experience and talk about their feelings, but at home a gradual return to normal routine can be reassuring
· If your child is fearful, tell them that you love them and that you will take care of them. Stay together as a family as much as possible
· If behaviour at bedtime is a problem, reassure them and allow them to sleep with the light on or in your bedroom for a limited amount of time if necessary
· Reassure children and adolescents that the traumatic event was not their fault
· Don’t criticize regressive behaviour or shame the child with words like “babyish”
· Allow children to cry or be sad. Don’t expect them to be brave or tough
· Encourage them to feel in control. Allow them to make some decisions about meals, what to wear etc.
· Take care of yourself so that you can take care of the children