REACTIONS AND GUIDELINES FOR PARENTS AND CAREGIVERS FOLLOWING TRAUMA/DISASTER

Compiled by Robin H. Gurwitch, Ph.D., Jane F. Silovsky, Ph.D., Shelli Schultz, Ph.D., Michelle Kees, Ph.D., & Sarah Burlingame, B.A.; Department of Pediatrics, University of Oklahoma Health Sciences Center

• Increased somatic complaints (e.g., headaches, stomachaches, aches and pains)
• Changes in school performance
• Recreating event (e.g., talking repeatedly about it, "playing" the event)
• Increased sensitivity to sounds (e.g., sirens, planes, backfires, loud noises)
• Statements and questions about death and dying
• Changes in sleep
• Changes in appetite
• Lack of interest in usual activities
• Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears, anger, worries)
• Regression in behaviors (e.g., baby talk, bedwetting, tantrums)
• Hate or anger statements

• Encourage children to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting the feelings, listening carefully, and reminding them that these feelings are okay following a very scary event. Information focused on safety will be important. For example, the President of the USA and other "helping people" (e.g., the firefighters, military, police, doctors) are all working together to make us safe.

• Some children might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help them separate thoughts and feelings about the specific people who caused the tragedy from generalizing to larger groups of people, including their classmates or other people they might know (e.g., all people of Arab descent).

• Young children will process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults. Try to respond in a calm manner, answering the questions in simple, direct terms. Knowing they can talk to you is important.

• Use simple, direct terms to describe what happened. Avoid terms designed to "soften" the information, which inadvertently further confuse children. For example, use the term "died," rather than "went to sleep."

• Children may misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.

• Children may ask the same types of questions repeatedly, which can be confusing and/or frustrating for adults. Understand that they may need to hear the information multiple times before being able to integrate and understand it. Give them time to cope with fears.

• Expect some angry outbursts from children. Try to catch them before they "act out," by taking them aside, and helping them calm down and regain control of their behavior. Do activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards.

• Expect some brief, temporary declines in the children's school performance.

• Provide reassurance to children that uncomfortable feelings will get smaller and easier to handle over time. Expect and understand children's regression (acting younger) and other difficult behaviors that are not typical. (e.g. bed wetting, whining, needing more help with dressing and feeding).

• Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to have your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events -- even when you think they are not listening, they often are.

• Maintain the family routines, particularly around sleeping, eating, and extracurricular activities (e.g., sports, church, and dance). Be sure the bedtime routine includes safely tucking them in at night. Young children may want a night light again.

• Make sure your child is receiving a balanced diet and enough rest.

• Avoid unnecessary separations from important caregivers.

• Expect temporary regression in your child's behaviors (e.g., starting to babytalk, wetting the bed). Do not panic, as your child is likely to return to previous functioning with time and support.

• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc.

• Increase patience with your child and with yourself. Give your family time to cope. Find ways to emphasize to the children that you love them.

Middle School Children

• Decreased attention and/or concentration
• Increase in hyperactivity
• Changes in academic performance
• Irritability with friends, teachers, events
• Anger outbursts and/or aggression
• Withdrawal
• Absenteeism

• Increased somatic complaints (e.g., headaches, stomachaches, chest pains)
• Discomfort with feelings, particularly those associated with revenge
• Increased likelihood to discuss the gruesome details
• Repeated discussions of event
• Increased sensitivity to sounds (e.g., sirens, planes, backfires, loud noises)
• Negative impact on issues of trust and perceptions of others, particularly of those that are "different"
• Repetitive thoughts and comments about death and dying
• Changes in sleep or appetite
• Lack of interest in usual activities (e.g., after-school activities, time with friends)
• Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears, anger, worries)
• Hate or anger statements
• Denial of impact

What To Do? Guidelines for Middle School Children

• Listen to and tolerate retelling of events, as well as playing out the events. However, set limits on scary or hurtful talk (e.g., specific threats of retribution) or aggressive play.

• Encourage the middle-school-aged children to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting the feelings, listening carefully, and reminding them that these are normal reactions (any of these feelings are okay) following a very scary event. Discuss their perceptions of media descriptions of events. Information focused on safety will be important. For example, the President of the USA and other "helping people" (e.g., the firefighters, military, police, doctors) are all working together to make us safe (give examples). Review of safety plans may also be helpful.

• Some children might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help them separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates or other people they might know (e.g., all people of Arab descent). It may be helpful to have discussions about how world leaders can help with reducing hate and preventing future violent acts.

• Children will often process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults, including questions that have gruesome details or focus on death. Try to respond in a calm manner, answering the questions in simple and direct terms. Knowing you are willing to listen is important. Use simple direct terms to describe what happened, rather than terms designed to "soften" the information, which inadvertently further confuses children. For example, use the term "died," rather than "went to sleep."

• Children will often misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves; may believe things happened that did not happen, may believe that terrorists are in the school, etc. Gently help them develop a realistic understanding of the event. Children may ask the same types of questions repeatedly, which can be confusing and/or frustrating for adults. Understand that children may need to hear the information multiple times before being able to integrate and understand it. Give them time to cope with fears.

• Expect some angry outbursts from children. Try to catch them before they "act out," by taking them aside, and helping them calm down and regain control of their behavior. In addition, redirect siblings who are being irritable with each other, which could escalate to direct conflict.

• Do activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or projects of collecting pennies or aluminum cans.

• Expect some brief (temporary) declines in children's school performance.

• Provide reassurance to children that uncomfortable feelings will get smaller and easier to handle over time.
• Monitor how children are coping with the demands of school, home, and community activities. Should difficulties coping with the event persist and interfere with the daily functioning, consider seeking help from a mental health professional. In addition to helping those who are clearly angry or depressed, monitor children who are withdrawn and isolated from others.

• Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to have your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events - even when you think they are not listening, they often are.

• Maintain the family routines, particularly around sleeping and eating and extracurricular activities (e.g., sports, church, and dance). Make sure your child is receiving a balanced diet and enough rest. Extra time with friends who are supportive and meaningful to him/her may be needed.

• Avoid unnecessary separations from important caregivers.
  
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc. Some middle school students benefit from writing their thoughts and feelings in a journal or drawing.

• Address acting-out behavior involving aggression or self-destructive activities quickly and firmly with limit setting. Monitor comments about death and dying as well as suicidal thoughts. If these behaviors are severe or persist, seek professional help.

• Increase patience with your child and with yourself. Give your family time to cope. Find ways to emphasize to the children that you love them.

High School Youth

• Withdrawal
• Irritability with friends, teachers, events
• Anger outbursts and/or aggression
• Changes in academic performance
• Decrease in attention and concentration
• Increase in hyperactivity
• Absenteeism

• Discomfort with feelings, particularly revenge, but also those of vulnerability
• Increased risk for substance abuse, including drinking
• Discussion of events and reviewing of details
• Negative impact on issues of trust and perceptions of others, particularly those that are "different"
• Increased sensitivity to sounds (e.g., sirens, planes, backfires, loud noises)
• Repetitive thoughts and comments about death or dying (including suicidal thoughts)
• Changes in sleep or appetite
• Lack of interest in usual activities (e.g., after-school activities, time with friends)
• Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears, anger, worries)
• Hate or anger statements
• Denial of impact

What To Do? Guidelines for High School Youth

• Listen to and tolerate your adolescent's retelling of events. However, set limits on scary or hurtful talk (e.g., specific threats of retribution). Discuss emotions behind this kind of talk.

• Encourage older adolescents to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting feelings, listening carefully, and reminding them that these are normal reactions following a very traumatic event.

• Discuss their perceptions of media descriptions of events. Information focused on safety will be important. For example, discuss what the US and other world leaders are doing to address safety. From this tragedy, opportunities for learning and discussion of world events are heightened.

• Some young people might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help them separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates and other acquaintances (e.g., all people of Arab descent). It may be helpful to have discussions about how world leaders can help with reducing hate and preventing future violent acts.

• Some older adolescents will often process the information about the events at unpredictable times throughout the day. As they try to develop an understanding for what has happened, they may ask questions that are initially shocking to adults, including questions that have gruesome details. Try to respond in a calm manner, answering the questions in simple, direct terms.

• All children will often misunderstand the information about the event as they are trying to make sense about what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc.

• Gently help them develop a realistic understanding of the event. Adolescents may ask the same types of questions repeatedly, which can be confusing and/or frustrating for adults. Understand that they may need to hear the information multiple times before being able to integrate and understand it. Give them time to cope with their fears.

• Expect some angry outbursts from your adolescents. Try to catch them before they "act out," taking them aside, helping them calm down and regain control of their behavior. In addition, redirect siblings who are being irritable with each other which could escalate to direct conflict.

• Do activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting money or aluminum cans or making origami cranes.

• Expect some brief (temporary) decline in adolescents' school performance.

• Provide reassurance to your older children that the uncomfortable feelings will get smaller and easier to handle over time.

• Maintain communication with others in your high schooler's life (teacher, coach, etc.). Monitor how they are coping with the demands of school, home, and community activities. Should difficulties coping with the event persist and interfere with their functioning, consider seeking help from a mental health professional. In addition to helping those who are clearly angry or depressed, monitor those who are withdrawn and isolated from others.

• Remain aware of your own reactions to your adolescent's handling of the event, as well as your own reactions to the trauma. It is okay to express emotions to your adolescents, such as "I am feeling sad about what happened." However, if you are feeling overwhelmed with emotion, it is important to take care of yourself and to seek support from other adults, not your child.

• Avoid exposing your teen to reminders of the trauma. This includes monitoring your teen's exposure to the news and other television programs about the tragedy. When you can, watch it with your teen, and talk to your teen after to clarify their understanding of the events and the images seen. Be aware that your teens are often listening when adults are discussing the events. Protect your teen from re-exposure includes limiting exposure to adult conversations, however, find time to include them in age appropriate discussions about the events and resulting thoughts and feelings.

• Maintain the family routines, particularly around sleeping and eating and extracurricular activities (e.g., sports, church, and dance). Make sure your teen is receiving a balanced diet and enough rest. Extra time with friends who are supportive and meaningful to him/her may be needed.

• Avoid unnecessary separations from important caregivers.
  
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc. Some high school students benefit from writing their thoughts and feelings in a journal or drawing.

• Address acting-out behavior involving aggression or self-destructive activities quickly and firmly with limit setting. Monitor comments about death and dying or suicidal thoughts. If these behaviors are severe or persist, seek professional help.

• Encourage your teen to delay making big decisions. Increase patience with your teen and with yourself. Give your family time to cope. Find ways to emphasize to your teens that you love them.