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9-11
United in Courage & Grief |
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9-11
United in Courage & Grief |
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Light their way
when the darkness surrounds them
Give them love,
let it shine all around them.
Note: The information in this section is provided for educational purposes and cannot substitute for a professional evaluation by a physician or mental health practitioner. If you have any concerns about your child's behavior contact your child's physician.
In the aftermath of the terrorist attacks on New York City, Washington, D.C., and Pennsylvania, children and adults alike are struggling to deal with the impact of such enormous destruction and senseless losses of life. We are trying to make sense of the world now in the days since September 11, 2001, the day our world changed.
As we deal with our own responses and grief, we must remember that children are especially at risk to experience fear and anxiety as reactions to these events. For a child following a disaster (as with many of us) his or her view of the world as a safe and predictable place is temporarily lost. They may fear that another event is likely to occur and that they or their family will be injured or killed. Research has shown that children and adults who experience catastrophic events may demonstrate a wide range of reactions. These reactions--fear, depression, withdrawal, anger, acting out--can occur immediately following the event, or the reactions may occur sometime after the tragedy.
Children will turn to their parents, their teachers and other trusted adults for answers and guidance; they need support to avoid long-term emotional harm. Parents and teachers can help children and young adults avoid or overcome emotional reactions that may result following a tragedy. How a parent or other adult react to a child following any traumatic event can aid in the recovery process.
We tend to think of trauma and tragedy occurring from disastrous events large enough to make the news. There are the natural disasters--earthquakes, fires, floods, hurricanes. There are the unexpected disasters--plane crashes, train derailments, automobile accidents. Yet these large tragedies are only a small percentage of the many tragedies that can affect children's lives. There are also the human random acts of violence--bombings, mass shootings or gang warfare and unfortunately the not so human acts of violence--shootings, stabbings, murder etc. Each year many children and young adults sustain both physical and emotional injuries from tragedies. They may lose friends, teachers, or family members in accidents or tragic events. In today's society exposure to violence can occur in the home or on the streets where children live and play. Research is demonstrating that children who witness violence in their families, schools, or communities are also vulnerable to serious long-term emotional harm.
For the children who have lost parents in this tragedy we are fortunate to have the resource A Letter to the Youngest Victims of the Terrorist Attack, written by a child survivor of another national tragedy.
As adults we know that overexposure to the media can be traumatizing. It is not advised to let children or adolescents view footage of traumatic events over and over, or watch the media coverage alone. Even with the tragic nature of the events of September 11 it may be difficult for most children to comprehend the extent of the damage, injuries, and deaths that were sustained. Given the nature of what they may have seen on television, children need to be reassured that the violence is isolated to certain areas and they will not be harmed.
Discussing the events with children is critical in particular being available to answer their questions. (See "How to Talk to Children a bit later in this page) Adults need to help children understand the significance of these terrorist acts. One way of explaining things to children is by telling them "There are 'bad' people in the world and sometimes bad people do bad things." Furthermore, children should be reminded that not all people in a particular religious or ethnic group are "bad." Lashing out at a particular group--just because they are the same religion, ethnicity or nationality of the terrorists will only cause more harm.
Children who experience tragic events either in person or watching on television may demonstrate a wide range of reactions and emotions. Much depends of the type of event viewed. Many will experience fear and anxiety. Some may only worry or have bad memories of the event that will fade with emotional support and the passage of time. Others can be more deeply affected and experience long-term problems.
Fear is a normal reaction to a scary event--real or imaginary; it is an intense concern or worry caused by real and/or imagined danger. Sensitive children with vivid imaginations are even more prone to intense fear reactions. Children younger than five years old cannot always distinguish fantasy from reality. As we well know media or cinematic depictions of attacks can be as frightening as the real attacks.
Some children will demonstrate fear by developing physical symptoms--stomachaches, headaches, feeling "sick," or complaining of a lump in the throat--some through their behavior, not necessarily in words--crying, abnormal fussiness or agitation. Children may become fearful about being left alone. They may also demonstrate regression and begin acting younger than their age. Common behaviors for a younger child may reappear in an older child including bedwetting, thumb sucking, clinging to parents and fear of strangers. Children may experience problems at bedtime. He/she may start having nightmares, not wanting to sleep alone, becoming more afraid of the dark, or falling asleep or remaining asleep. In addition children can experience difficulty thinking and concentrating. They can become easily distracted easily, feel confused and disoriented and often find it difficult to stay focused. These various reactions can be triggered by smells, objects or activities that are associated with the trauma. Frequently a child is unaware of the triggers and of the behavioral changes that occur.
Adolescents in particular can be impacted by these kinds of events. Those who have started demonstrating some independence may shift and want to spend more time with their families. They may also be fatigued, have problems with sleep disturbances and show a lack of interest in favorite activities. Adolescents may also turn to illicit substances--drugs or alcohol as a way of coping.
A key factor in dealing with children is reminding them that they are safe. Parents should try to assure children that they are doing everything they can to keep their children safe. Children, especially the young, have a sixth sense that enables them to sense an adult's fear and anxiety.
Early Childhood: Birth to 2 years
Children at this age are unable to describe how
they are feeling. They may not know what is going on but they are likely
to pick up on the parent's anxiety or apprehension. Babies may become more
irritable, cry more often and need to be held and cuddled frequently. It
is important to try and stay calm around babies and toddlers. They will
calm down with caring. The child's normal routine should be maintained
as much as possible; this is reassuring for babies and young children.
Children of this age involved in a trauma can retain memories of particular
sights, sounds, or smells. When they are older, these memories may emerge
in their play. Babies and toddlers should be shielded from media reports
as much as possible.
Preschoolers and Kindergartners
Preschoolers will be more aware of what has happened.
They may have heard or seen media reports. They have probably heard others
discussing the attacks. Preschoolers and Kindergartners should not watch
the news reports of frightening events. Children of this age are most concerned
about their own safety and the safety of their parents, relatives and friends.
Children this age are not always able to distinguish between fantasy and
reality. Generally, they cannot understand the concept of permanent loss.
They believe that consequences are reversible. Faced with an overwhelming
event, very young children may feel helpless, powerless, and unable to
protect themselves. When the safety of their world is threatened, they
feel insecure and fearful. Acknowledge to them that something very scary
has happened, but that you and other adults will make sure they are safe.
Let them know that adults will figure out what is happening. They will
repeatedly recreate parts of the disaster in their play. These are all
normal reactions. This group needs lots of comforting--hugs, physical and
verbal reassurances. Abandonment is a major childhood fear, so children
need frequent reassurance they will be cared for and will not be left behind.
School age (7 to 11 years)
Children at this age are able to understand the
permanence of loss from a trauma. Since their thinking is more mature,
their understanding of the disaster is more complete. This can result in
a wide range of reactions: guilt, feelings of failure, and anger. They
can also understand what is happening and how other people are reacting.
Be sure to talk with your child. Be honest with them about the events.
Tell them what you know without exaggerating or overreacting. Don't assume
that they are too young to know what is happening. As with all children
they will need more comfort and reassurance. Children in this age group
are most concerned about their own safety and safety of family and friends.
They may become preoccupied with details of the event and want to talk
about it continually. It is important to limit television coverage for
this group. School age children can also slip back into earlier behaviors.
As with younger children, sleep problems can appear. Their anxiety and
fear may be manifest as an increased number of physical complaints. They
may have difficulty concentrating in school and their grades may drop.
Middle School: Pre-adolescence and adolescence
(12 to 15 years)
Children in this age group will be very much
aware of what is happening and be more interested in details. Their reactions
are a mixture of earlier age group reactions and reactions that are more
adult. The pre-adolescent and adolescent need to appear knowledgeable and
experienced to the world, especially in the eyes of their friends. They
also need to feel their anxieties and fears are shared by their peers and
are appropriate. Experiencing a trauma can leave them feeling that the
world is unsafe. Overwhelmed by intense reactions, teens may be unable
to discuss them with their family members. They may act on scary feelings
or may become more withdrawn. Jokes or humor can mask fears for this age
group. If they live through and survive a traumatic event, they may feel
immortal which can lead to reckless behavior and risk taking.
Historical examples--Pearl Harbor, Challenger
Space Shuttle--can be used to explain that bad things happen to innocent
people. Despite bad things happening as people and as a nation we go on
with our lives and resolve bad situations.
High School
High school aged young adults will talk with
their friends about the events. They may also want to watch the television
coverage following the latest news. It is important for parents to be honest
with these young adults and let them know what is happening. As with all
age groups, it is important to talk to the young adults about what has
happened. It is also important to talk about your and their feelings. Acknowledge
the other emotions they may be feeling--fear, sadness, and anger. he teen
and young adult may show a variety of responses. Some may just block out
the whole event and refuse to acknowledge that anything big has happened.
They may act as though they don't care. This coping strategy often masks
their real fears and feeling overwhelmed. Some may make jokes. Recognize
that this is another coping strategy. Let them know you do not find the
jokes funny without lecturing them. Some may want to discuss the various
issues that the event raises. Be willing to have serious discussions. As
a response to the stress, young adults may feel that they need to so something
to "prove that they're alive." They may want to avoid friends, miss school,
and be alone or spend extra time with your family. Be careful to avoid
placing blame on a whole group of people or targeting particular groups.
Reinforce to them that lashing out at a particular group--just because
they are the same religion, ethnicity or nationality of the terrorists
will only cause more harm. With high schoolers you can talk with them about
responses to other historical tragedies--Pearl Harbor, The Challenger Space
Shuttle. Discuss with them possible resolutions for the situation such
as government responses, foreign policy changes, tighter airport security
etc. Invite them to share their ideas and solutions.
Maintaining Routines
Children of all ages can benefit if the family
keeps to their usual routines for meals, activities, and bedtimes. Keeping
the routine as close to normal as possible allows a child to feel more
familiar and therefore more secure and in control. As much as possible,
children should stay with people with whom they feel most familiar.
Reaffirm Relationships - Remember Hugs
Love and care in the family is a primary need.
Following a tragedy children may become more dependent for a period of
time. Give they extra hugs or touching if needed. Physical closeness is
needed. (It can also be helpful for adults!) Let them keep the light on
at night or not sleep alone or return to having their favorite teddy bear
or blanket. Don't complain about their clinging behavior.
Limiting Exposure to News Coverage
As adults we know that overexposure to the media
can be traumatizing. Children can also become traumatized by watching tragic
events on television, particularly those in the Preschool to Kindergarten
age groups who are often unable to distinguish between fantasy and reality.
Babies, toddlers and preschoolers should be shielded from media reports
as much as possible. It is best not to allow children or adolescents view
footage of traumatic events over and over, or watch the media coverage
alone. Parents should view the images in newspapers and magazines before
allowing their children to see the images. With this event there have been
many graphic photos of the events--planes crashing into buildings, people
jumping out of buildings, images of the dead, images of destruction--that
would be very disturbing to children and even some adults. Their exposure
should be limited and parents or teachers should watch the news coverage
with the children, to be available for answering questions.
Feelings and Reactions
Following a tragedy children may express their
feelings and reactions in different ways. Parents and other significant
adults in the child's life need to acceptance of the various feelings and
emotions that may result. Some children may become withdrawn and
unable to talk about the event. Others will feel intensely sad or angry
at times and at other times they may act as though the disaster never happened.
Some children may appear not to have been affected by the events. Some
may have delayed reactions that may take days, weeks or months to manifest.
Some children may never have a reaction. How parents and other adults react
makes a difference to how your child recovers from the trauma. Parents
should be prepared to tolerate regressive behaviors and accept manifestations
of aggression and anger especially in the early phases after the tragedy.
Other ways of Expressing the Event
Children may find it useful if they are given
other ways of expressing how they are feeling. Some useful alternative
ways of expression include painting, drawing, or writing about the
event. Adults or older children can help pre-school children to reenact
the event since pre-school children may not be able to imagine alternative
"endings" to the disaster and hence may feel particularly helpless.
If the following changes persist for longer than three months following the trauma, it is time to seek professional help:
Parents who are concerned about their children should ask their pediatrician or family doctor to refer them to a counselor or mental health professional that can help. Following a trauma, many adults and children have found it helpful to talk with a counselor who has specialized training in post traumatic reactions and can help them understand and deal with how they are feeling about the events.
Nothing's gonna
harm, you not while I'm around
No one's gonna
hurt you, no one's gonna dare
Demons are prowling
every where, nowadays
I'll send 'em howling
I don't care, I got ways
...Nothing can
harm you, not while I'm around
American Academy of Child and Adolescent Psychiatry
Helping Children After a Disaster http://www.aacap.org/publications/factsfam/disaster.htm
Children and Grief http://www.aacap.org/publications/factsfam/grief.htm
American Academy of Experts in Traumatic Stress
- Articles are PDF Files
Articles available free of cost from the AAETS
Publication A Practical Guide
For Crisis Response in Our Schools
Parent Guidelines for Crisis Response http://www.aaets.org/parentguidelines.pdf
Teacher Guidelines for Crisis Response http://www.aaets.org/teacherguidelines.pdf
American Academy of Pediatrics and the Center
for Mental Health Services
Psychosocial Issues for Children and Families
in Disasters: A Guide for the Primary Care Physician. Authored by the Work
Group on Disasters American Academy of Pediatrics
http://www.mentalhealth.org/publications/allpubs/SMA95-3022/SMA3022.htm
American Counseling Association
How Much Should You Tell Your Children http://www.counseling.org/tragedy/children.htm
Helping Your Teen Face Tragedy http://www.counseling.org/tragedy/teens_tragedy.htm
Helping Children Cope with Trauma http://www.counseling.org/tragedy/trauma.htm
American Psychological Association
Help with Trauma http://www.apa.org/psychnet/coverage.html
Reactions and Guidelines for Children Following
Trauma/Disaster http://helping.apa.org/daily/ptguidelines.html
The Center for Mental Health Services, U.S.
Department of Health & Human Services
Tips for Talking About Disasters: Children and
Adolescents http://www.mentalhealth.org/cmhs/EmergencyServices/after.htm
Hospice Foundation of America
Sudden Loss Resources http://www.hospicefoundation.org/sudden.htm
International Critical Incident Stress
Foundation, Inc.
Children's Reactions and Needs After Disaster
http://www.icisf.org/Acrobat%20Documents/TerrorismIncident/Children_and_terroristattack.htm
Terror: How to Talk to Children
http://www.icisf.org/Acrobat%20Documents/TerrorismIncident/Dyregrov_terrorism.htm
Journey of Hearts
Fulgham K. A Letter to the Youngest Victims of
the Terrorist Attack http://www.kirstimd.com/911_fulgham.htm
Dyer K. Helping Children to Cope with Tragedy
for parents and educators. http://www.kirstimd.com/911_kids.htm
Dyer K. Ways of Coping then Helping includes
a section on "How Children can Help" http://www.kirstimd.com/911_cope.htm
National Association of School Psychologists
Various resources for parents and teachers http://www.nasponline.org
National Education Association
List of Resources for parents and teachers from
their Crisis Communication
Guide
http://www.nea.org/crisis/americaunited/01crisis.html
National Institute of Mental Health
Helping Children and Adolescents Cope with Violence
and Disasters.
http://www.nimh.nih.gov/publicat/violence.cfm
Depression in Children and Adolescents. Fact
Sheet for Physicians. http://www.nimh.nih.gov/publicat/depchildresfact.cfm
Other
Resources and Information: