by Kimberly Allen, RN
As parents and caregivers we try to protect our children from anything that can harm them, physically or psychologically. However, in today’s world that’s not always possible. The recent events in Newtown, Ct really brings that home. The trauma of such horrific events can affect not only the surviving children of the school but the children in the community and across the country.
When most people think of trauma they think of a severe wound or physical trauma, however, trauma also refers to an emotional shock. This type of trauma is generally referred to as psychological trauma and it can occur whether or not there is physical injury. This type of trauma usually follows a traumatic event such as a school shooting. Though both adults as well as children can respond to traumatic events with increased anxiety and fear experts have found that it is much more pronounced in children. Even children that were not directly exposed to or affected by the trauma. In many cases when a child experiences a significantly violent and threatening event like a school shooting it is the first time that child’s feeling of safety and security is threatened.
Each child reacts to trauma differently. Some children regress to behaviors and/or habits like sucking their thumb or bed wetting that they had out grown before the trauma. Many children have difficulty falling asleep and/or have nightmares and don’t want to sleep alone. Some children that had been happy, well adjusted children become irritable, begin throwing regular temper tantrums and generally become difficult to manage, while others that were outgoing become withdrawn and spend more time alone. Still others develop physical symptoms like stomach aches and headaches.
The physiologic response to trauma, especially a sudden and unexpected trauma can have long term effects on the brains of children. Because the brain in young children is still developing they are particularly vulnerable to the chemical changes that occur in the brain during and immediately following the trauma. The trauma causes the sympathetic nervous system to kick in the “flight or flight” response which triggers the release of adrenalin and other brain chemicals. This can then effect both behavioral and cognitive functions. Research indicates that victims of trauma especially children demonstrate reduced memory volume in the left brain as well as difficulty processing and understanding information. The longer a child remains in an aroused state the more impaired his/her cognitive function becomes. If the child either remains in a state of arousal or repeatedly relives the event reproducing the state of arousal can cause the release of glucocorticoids like cortisol which can damage the left hippocampal area of the brain causing further memory problems.
It’s important that parents and caregivers take steps to “deactivate” the “fight or flight” arousal as soon as possible. The most important component being to reassure the child that he/she is safe and that you’re going to protect them. The longer the child continues to feel unsafe and in danger they will remain in a state of arousal and impair his/her function. It’s important to explain to the child what precautions you and others are taking to assure their safety and security. Always remember to keep your explanations short and simple and do not lie or provide more information than the child asks for. Over the past several years researchers have monitored children that were exposed to major trauma events like Columbine, Va Tech and 9/11 and found that children are just as prone to PTSD as adults and in some cases children were at a greater risk for PTSD than adults. So it’s important to monitor all children that are victims of violent crime for signs and symptoms of PTSD. PTSD does not always develop immediately following the event, it can develop years later so be aware of any changes and contact your Dr or local mental health provider for assistance.
PTSD in Children
In the past PTSD was believed to affect adults only, however over the years Drs have come to realize that PTSD can also develop in children and teens. PTSD in children and teens can develop when they have been exposed to one or more traumatic events, like natural disasters, domestic violence and more recently school shootings. Studies have indicated that 77% of children that experience school shootings will develop some degree of PTSD. PTSD can also develop in children and teens that experience domestic violence as well as physical and sexual abuse.
Experts have found that there are three primary factors that contribute not only to whether or not a child develops PTSD but also the severity. The first is the severity of the trauma. Most recently the school shooting at Sandy Hook Elementary School was about as severe as it gets so most experts believe that all the children involved will develop some degree of PTSD. The second is how the parents react to the traumatic situation. Children look to their parents for guidance on how to behave. And the third is the proximity of the child to where the trauma occurred. Those children that experience the more severe traumas, as well as those that were closest in proximity to the trauma usually have the most significant symptoms of PTSD. On the other hand children that have a lot of family support including parents that are able to remain calm and reassuring tend to display fewer symptoms of PTSD.
Children do not experience PTSD in the same way adults do. They may not have “flash backs” as adults tend to however, they do usually have dreams or nightmares about the event. Children also tend to recall the events in the wrong order. Children are also very sensitive and tend to believe there were signs indicating the event was going to occur and then be vigilent about looking for the imagined “signs” in an attempt to avoid another traumatic event. Young children between 5-12 years of age may also display symptoms of PTSD in their play by repeating one or more parts of the traumatic event. For example a child that has experienced a school shooting may persist in playing shooting games. Some children may believe they can protect themselves and others by bringing a gun to school. Children that experience a traumatic event such as a school shooting may also display exaggerated emotions like intense fear, horror and helplessness as well as denial, anger and sadness in the time immediately after the event. The symptoms of PTSD can last anywhere from a few months to years.
Early intervention is crucial to effective treatment after the traumatic event has occurred. Children with PTSD have high levels of cortisol, a hormone released during periods of high stress, High levels of cortisol can impair the the growth and development of the area in the brain that processes memory and emotion known as the hippocampus. Psychotherapy is the primary treatment for PTSD. The first and most important component of psychotherapy is helping children gain “a sense of mastery over the trauma” as well as helping them feel safe again. It’s also important to treat the many emotional as well as behavioral issues that can develop like anxiety and depression as well as impulsive behavior and eating disorders to name a few. It’s also important that parents participate in the treatment of PTSD for their child. The child’s ability to resolve their PTSD is significantly impacted by the parents abitlity to stay calm and connected to the child.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.