HELPING CHILDREN AND ADOLESCENTS COPE WITH VIOLENCE AND DISASTERS
We live in a world filled with change and crisis. The recent killings of 32 students and professors at Virginia Tech in April, 2007 are shocking, evil, outrageous and horrific! The reality is that we live in a world full of continual challenges and threats: wars, terrorism, random school shootings, death, human suffering, abductions 24/7.

On Monday, Oct. 2, 2006, a gunman attacked a one-room Amish school in rural Pennsylvania, shooting dead three girls, critically injuring 7 others before killing himself, police said. Since that time 2 of the injured girls have died.

In another incident - an armed 15-year-old at a Wisconsin school killed the school's principal and in Colorado a drifter took six female high school students hostage, molested them, fatally shot one and killed himself.

•   Trauma--What Is It?
•   How Children and Adolescents React to Trauma
•   Helping the Child or Adolescent Trauma Victim
•   Post-Traumatic Stress Disorder
•   Treatment of PTSD
•   Spiritual Help and Hope by Lynette Hoy, NCC, LCPC
•   Resource List

RESOURCE LIST: The National Institute of Mental Health has joined with other Federal agencies* to address the issue of reducing school violence and assisting children who have been victims of or witnesses to violent events. Nationally reported school shootings such as those that occurring in Bethel, Alaska; Pearl, Mississippi; West Paducah, Kentucky;  Jonesboro, Arkansas; Colorado; Lancaster, Edinboro, Pennsylvania; and Springfield, Oregon have shocked the country. 

Many questions are being asked about how these tragedies could have been prevented, how those directly involved can be helped, and how we can avoid such events in the future. 
School violence is not a simple issue, however, nor is the aftermath of violence predictable. 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 passage 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 torture and other violence, and survivors of natural catastrophes often 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 imme-diately or some time after the tragic event. Youngsters who
have experienced a catastrophic event often need support from parents and teachers to avoid long-term emotional harm. Most will recover in a short time, but the minority who develop PTSD or other persistent problems need treatment. 

The school shootings caught the Nation's attention, but these events are only a small fraction of the many tragic episodes that affect children's lives. Each year many children an d adolescents sustain injuries from violence, lose friends or family members, or are adversely affected by
witnessing a violent or catastrophic event. Each situation is unique, whether it centers upon a plane crash where many people are killed; automobile accidents involving friends or family members; or natural disasters such as Hurricane Andrew, where deaths occur and homes are
lost--but these events have similarities as well, and cause similar reactions in children. Helping young people avoid or overcome emotional problems in the wake of violence or disaster is one of the most important challenges a parent, teacher, or mental health professional can face. The
purpose of this fact sheet is to tell what is known about the impact of violence and disasters on children and suggest steps to minimize long-term emotional harm. 

Trauma includes emotional as well as physical experiences and injuries.  Emotional injury is essentially a normal response to an extreme event. It involves the creation of emotional memories, which arise through 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. Thus in a school shooting, the student who is injured probably will be most severely affected emotionally.
And the student who sees a classmate shot, even killed, probably will be more emotionally affected than the student who was in another part of the school when the violence occurred. But even second-hand exposure 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 for signs of emotional distress. 

Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary
according to age: For children 5 years of age and younger, typical reactions include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear ofdarkness. Children in this age bracket tend to strongly affected by the parents' reactions to the traumatic event.

Children 6 to 11 years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age. Also the child may complain of stomach aches or other bodily symptoms that have no medical basis. School work often suffers. Depression, anxiety, feelings of guilt and emotional numbing are often present as well.
Adolescents 12 to 17 years old are likely to exhibit 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 behavior. Also common are withdrawal and isolation, physical complaints, suicidal ideation, school avoidance, academic decline, sleep disturbances, and confusion. The adolescent may feel extreme guilt over his or her failure to prevent injury or loss of life, and may harbor revenge fantasies that interfere with recovery from the trauma. 
Some youngsters are more vulnerable to trauma than others, for reasons scientists don't fully understand. 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 health problem. And  the youngster who lacks family support is more at risk for a poor recovery. 

Early intervention to help children and adolescents who have suffered trauma from violence or a disaster is critical. Parents, teachers and mental health professionals can do a great deal to help these youngsters recover. Help should begin at the scene of the traumatic event.
According to the National Center for Post-Traumatic Stress Disorder of the Department of Veterans Affairs, workers in charge of a disaster scene should: 

Find ways to protect children from further harm and from further exposure to traumatic stimuli. If possible, create a safe haven for them. Protect children from onlookers and the media covering the story.  When possible, direct children who are able to walk away from the site of violence or destruction, away from severely injured survivors, and away from continuing danger. Kind but firm direction is needed.  Identify children in acute distress and stay with them until initial stabilization occurs. Acute distress includes panic (marked by trembling, agitation, rambling speech, becoming mute, or erratic behavior) and intense grief (signs include loud crying, rage, or immobility). 
Use a supportive and compassionate verbal or non-verbal exchange (such as a hug, if appropriate) with the child to help him or her feel safe. However brief the exchange, or however  temporary, such reassurances are important to 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 well as you are able. 
Encourage the children to express their feelings and listen without passing judgment. Help younger children learn to use words that express their feelings. However, do not force discussion of the traumatic event. 
Let children and adolescents know that it is normal to feel upset after something bad happens.
Allow time for the youngsters to experience and talk about their feelings. At home, however, a return to routine can be reassuring to the child.
If your children are fearful, reassure them that you love them and will take care of them. Stay together as a family as much as possible.
If behavior at bedtime is a problem, give the child extra time and  reassurance. Let him or her sleep with a light on or in your room for a limited time if necessary.
Reassure children and adolescents that the traumatic event was not their fault.
Do not criticize regressive behavior 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 children and adolescents to feel in control. Let them make some decisions about meals, what to wear, etc. 
Take care of yourself so you can take care of the children. 

When violence or disaster affects a whole school or community, teachers and school administrators can play a major role in the healing process. Some of the things educators can do are: 

If possible, give yourself a bit of time to come to terms with the event before you attempt to reassure the children. This may not be possible in the case of a violent episode that occurs at school, but sometimes in a natural disaster there will be several days before schools reopen and
teachers can take the time to prepare  themselves emotionally.
Don't try to rush back to ordinary school routines too soon. Give the children or adolescents time to talk over the traumatic event and express their feelings about it.
Respect the preferences of children who do not want to participate in class discussions about the traumatic event. Do not force discussion or repeatedly bring up the catastrophic event; doing so may re-traumatize children.
Hold in-school sessions with entire classes, with smaller groups of students, or with individual students. These sessions can be very useful in letting students know that their fears and concerns are  normal reactions. Many counties and school districts have teams that will go into schools to hold such sessions after a disaster orepisode of violence.
Offer art and play therapy for children in primary school.  Be sensitive to cultural differences among the children. In some cultures, for example, it is not acceptable to express negative emotions. Also, the child who is reluctant to make eye contact with a teacher may not be depressed, but may simply be exhibiting behavior appropriate to his or her culture. 
Encourage children to develop coping and problem-solving skills and age-appropriate methods for managing anxiety.
Hold meetings for parents to discuss the traumatic event, their children’s response to it, and how they and you can help. Involve mental health professionals in these meetings if possible.
Most children and adolescents, if given support such as that described above, will recover almost completely from the anxiety caused by a traumatic experience within a few weeks. However, some children and adolescents will need more help over a longer period of time in order to heal.
Grief over the loss of a loved one, teacher, friend, or pet may take months to resolve, and may be reawakened by a strong  reminder such as media reports or the anniversary of the death. 
In the immediate aftermath of a traumatic event, and in the weeks following, it is important to identify the youngsters who are in need of more intensive support and therapy because of profound grief or some other extreme emotion. Children who show avoidance and numbing may
need the help of a mental health professional, while more common reactions such as re-experiencing the event and hyperarousal (including sleep disturbances and a tendency to be easily startled) may respond to help from parents and teachers. 

As stated earlier, some children and adolescents will have prolonged problems after a traumatic event. These potentially chronic conditions  include depression and prolonged grief. Another serious and potentially long-lasting problem is post-traumatic stress disorder (PTSD). This
condition is diagnosed when the following symptoms have been present for longer than one month: 
Re-experiencing 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 having a foreshortened future).
Increased sleep disturbances, irritability, poor concentration, startle reaction and regression.
Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. For example, estimates range from 2% after a natural disaster (tornado), 28% after an episode of terrorism (mass shooting), and 29% after a plane crash. The disorder may arise weeks or months after the traumatic event. PTSD may resolve without treatment, but some form of therapy by a mental health professional is often required in order for healing to occur. Fortunately, it is more common for a traumatized child or adolescent to have some of the symptoms of PTSD than to develop the full-blown disorder. People differ in their vulnerability to PTSD, and the source of this difference is not known in its entirety.
Research has shown that PTSD clearly alters a number of fundamental brain mechanisms.  Because of this, abnormalities have been detected in brain chemicals that affect coping behavior, learning, and memory among people with the disorder. Recent brain imaging studies have
detected altered metabolism and blood flow as well as anatomical changes in people with PTSD.
Further information on PTSD and  research concerning it may be found in the NIMH fact sheet, Facts About Post-Traumatic Stress Disorder, which is posted on the NIMH Web site the accompanying resources list. 

People with PTSD are treated with specialized forms of psychotherapy and sometimes with medications or a combination of the two. One of the forms of psychotherapy shown to be effective is cognitive-behavioral therapy, or CBT. In CBT, the patient is taught methods of overcoming anxiety or depression and modifying undesirable behaviors such as avoidance. The therapist helps the patient examine and re-evaluate beliefs that are interfering with healing, such as the belief that the traumatic event will happen again. Children who undergo CBT are taught to avoid "catastrophizing." For example, they are reassured that dark clouds do not necessarily mean another hurricane, that the fact that someone is angry doesn't necessarily mean that another shooting is imminent, etc. Play therapy and art therapy also can help younger children to remember the traumatic event safely and express their feelings about it. Other forms of psychotherapy that have been found to help persons with PTSD include group and exposure therapy. A reasonable period of time for treatment of PTSD is 6 to 12 weeks with occasional follow-up sessions, but treatment may be longer depending on a patient's particular circumstances.
Research has shown that support from family and friends can be an important part of recovery and that involving people in group discussion very soon after a catastrophic event may reduce some of the symptoms of PTSD.
There has been a good deal of research on the use of medications for adults with PTSD, including research on the formation of emotionally charged memories and medications that may help to block the development of symptoms. Medications appear to be useful in reducing overwhelming symptoms of arousal (such as sleep disturbances and an exaggerated startle reflex), intrusive thoughts, and avoidance; reducing accompanying conditions such as depression and panic; and
improving impulse control and related behavioral problems. Research is just beginning on the use of medications to treat PTSD in children and adolescents. There is preliminary evidence that psychotherapy focused on trauma and grief, in combination with selected medications, can be
effective in alleviating PTSD symptoms and accompanying depression.
More medication treatment research is needed to increase our knowledge of how best to treat children who have PTSD.  A mental health professional with special expertise in the area of child and adolescent trauma is the best person to help a youngster with PTSD. Organizations on the accompanying resource list may help you to find such a specialist in your geographical area. 

Read Handling Crisis with Courage.  Read other FAQs about how to handle anxiety and stress and depession.  Read about grief, grief recovery , death and why God allows suffering. 

The following books may help reduce your fears and generate more hope, faith and coping skills (more books can be found on the resources page):  The God You Can Trust: Strength for the Times When it's Hard to Believe or Anchor for the Soul by Ray Pritchard. Visit: Keep Believing Ministries for sermons and spiritual encouragement. 

The Good News About Worry  by William Backus
Niv Thin Line Bible/Indexed Bonded Leather/Burgundy

Lynette Hoy, NCC, LCPC

National Institute of Mental Health Web site
Information Resources and Inquiries Branch
6001 Executive Boulevard, Rm.
8184, MSC 9663
Bethesda, MD 20892-9663
Phone: (301) 443-4513

Center for Mental Health Services (CMHS)
Emergency Services and Disaster Relief Branch
5600 Fishers Lane, Room 16C-26
Bethesda, MD 20892
(301) 443-4735

U.S. Department of Education
600 Independence Avenue, SW
Washington, DC 20202-0498
Phone: 1-800-USA-LEARN

National Center for Post-Traumatic Stress Disorder of the
Department of Veterans Affairs
215 N. Main Street
White River Junction, VT 05009
Phone: (802) 296-5132

National Organization for Victim Assistance (NOVA)
1757 Park Rd., NW
Washington, DC 20010
Phone: 1 (800) 879-6682

National Victim Center
2111 Wilson Blvd., Suite 300
Arlington, VA 22201
Phone: (703) 276-2880

Office for Victims of Crime Resource Center
National Criminal Justice Reference Service
P.O. Box 6000
Rockville, MD 20850
Phone: 1 (800) 627-6872

Hotlines, Helplines,  Support Groups