Helping children of trauma -- Here and in Haiti

For the past few weeks we have watched with feelings of horror and sympathy as the Haitian people struggle to survive the aftermath of the earthquake.  Of the many pictures of suffering that have come out of Haiti, it is the pictures of the children that haunt me most.  They are without shelter or safety.  Many have lost their parents.  This is trauma.

Would it surprise you to hear me say that there are children right here in our community in a similar situation?  Yes, there are children adopted from Haiti, and more will find new homes and families here, hopefully very soon.  But I am referring to children whose homes and families have fallen apart because of domestic violence, parental substance abuse or divorce.  Or their community has crumbled when gang and drug-related violence has moved into their neighborhood.  Other children have been removed from their parents' care by a child welfare system trying to protect them from abuse and neglect.  This, too, is trauma.

The children of Haiti and some children in our community have this in common:  what was once shelter and safety has caved in.  Their world has fallen apart.  All of these children are at risk of developing a psychological reaction to the trauma they have endured.  We can help these children by providing safety and support, by listening to them and answering their questions and by recognizing the signs and symptoms of reaction to trauma. 

Not all children in traumatic situations will suffer trauma.  But some children who appear unaffected may actually be struggling internally to make sense of what has happened to them.  While some children will experience their trauma reactions immediately, others may experience a delayed reaction to the traumatic event.  The following are normal reactions children may have to events or situations that are outside the range of normal experience.  A child may experience one or more of these reactions, in any combination.

• Sleep disturbance: nightmares, talking or yelling in sleep, fitful or restless sleep, trouble falling asleep or fear of sleeping, bed wetting.
• Guilt: blaming self for traumatic event, inappropriately blaming self for other things, excessive "bad" behavior that requires punishment, or excessive "good" behavior that replaces the child's usual level of maturity and playfulness.
• Acting younger: clinging to adults, not wanting to be left alone, demanding attention and privileges, acting "like a baby."
• Fear: of things related to the trauma (for example fear of raised voices after witnessing domestic violence), of sudden moves or of being touched, of being alone, of strangers.
• Decreased concentration and attention (in school or home).
• Changes in school performance.
• Changes in appetite.
• Frequent changes in mood: sadness or depression, increased irritability, increased anger outbursts, or temper tantrums.
• Changes in activities (they may not want to do the things they used to do).
• Withdrawal from family members or peers.

In my work with traumatized children I have come to trust their symptoms and behaviors as markers on their way to healing.  Most children will move on from these reactions in time and return to their "usual self:" their level of maturity, humor and playfulness before the trauma.  As they begin to recover children generally regain their ability to concentrate.  They may appear more genuinely calm, and experience a better quality of sleep.  School performance, sociability and interests should return to the level the child enjoyed before the traumatic event.   Depending on the child's age, level of verbal development and inclination to story-telling, the child may be able to tell the story of what happened in a way that hangs together in terms of the order of events, the meanings of those events and a sense of the passage of time.  Some children, however, become stuck in their trauma reactions and do not seem to get better over time.  Children who are most at risk include:

• Those who have been subjected to previous traumatic experiences without adequate recovery.
• Children who have been neglected or abused by their primary caregiver.
• Children who have lost their parents or other primary caregivers (including orphans and children in the foster care and adoption systems).
• Children who have developmental disabilities or disabilities due to previous injury.

Here is a S.C.R.I.P.T. to serve as a reminder of what these children need:

• Support and safety:  at home and at school the child needs to feel that adults are competent, safe to be around and "on the child's side."  Rules should be clearly stated and consistently applied, and geared more to support of good behavior rather than to punishment of bad.
• Communication:  listen to the child, and answer his or her questions honestly.    When children are talking and asking it is because they are ready.  If they are silent, let them know you are there and open, but don't try to force it.
• Routine:  can be a great comfort.  Meal times and bedtimes especially should be kept on a regular schedule.  Also, try to keep these times calm and as free as possible from strife and distraction.  Our minds and bodies are best able to take nourishment and rest when we are calm.
• Intervention by a Professional experienced in Trauma therapy:  When a child does not seem to get better over time it is important to seek help for recovery.  Prolonged unresolved trauma reactions may interfere with the child's emotional, cognitive and social development.  You may want to enlist your child's pediatrician as a member of the support team and stay in touch with any concerns you have.  

Therapeutic support may be needed if the child seems "stuck" in the trauma reaction; his or her pediatrician may refer you to a mental health professional to address these issues.

• When seeking a mental health professional for the traumatized child,  look for experience with techniques such as EMDR, play therapy, sand  tray therapy, or with trauma relief work. 
• You should feel comfortable with the counselor's therapeutic approach: does the counselor prefer to work with the parent in the therapy room or  with the child alone while the parent waits in the waiting room?  Does the counselor make a therapeutic partnership with the parent, or is he or  she more directive?  Is the counselor more empathetic, or more  intellectual in his or her approach to you and your child?

One last note:  parents and other care givers of traumatized children often experience reactions of their own to their child's pain.  It is common to feel guilty about what has happened to the child, or about being unable to protect him or her.  A parent or caregiver may become anxious or overprotective.  They may become inconsistent with discipline and expectations, or over-indulging, letting their child "get away with things," or overly strict and punitive in an effort to protect.  A parent or caregiver may even experience sleep disturbance.  These are normal reactions that the caring adult may have to their child's distress.  Seeing a counselor may be helpful for the parent or caregiver of a traumatized child, for support and for processing the feelings and fears the situation brings up.

Much of the information in this article can be found at two very good resources:  The Child Trauma Institute (www.childtrauma.com) and The National Center for School Crisis and Bereavement.

In particular, the NCSCB (www.cincinnatichildrens.org) has an excellent pamphlet written for parents and caregivers:  "Listen, Protect and Connect: Psychological First Aid for Children, Parents and Other Caregivers after Natural Disasters" by M. Schreiber, R. Gurwitch, M. Wong and D. Schonfeld.  Just click on "Psychological First Aid."  The pamphlet can be downloaded for free from their website.

Have hope.  If there is anything I have learned from my work with children it is this:  that human beings are drawn to growth and healing and find a way to do so even in the most desperate circumstances.  Many of the children in Haiti, as well as in our own community will show resilience.  With help and support they will overcome the shock, numbness and fear, and they will even find a way to grow stronger through their trials.

Catherine Wells, M.A., L.C.P.C. is a counselor in private practice in Springfield, specializing in attachment-based counseling for children and adolescents.  She can be reached at cwellslcpc@hughes.net.