For children 5 years of age and younger,typical reactions can include a fear of being separated from theparent, crying, whimpering, screaming, immobility and/or aimlessmotion, trembling, frightened facial expressions and excessiveclinging. Parents may also notice children returning to behaviorsexhibited at earlier ages (these are called regressive behaviors), suchas thumb-sucking, bedwetting, and fear of darkness. Children in thisage bracket tend to be strongly affected by the parents' reactions tothe traumatic event.

Children 6 to 11 years old may showextreme withdrawal, disruptive behavior, and/or inability to payattention. Regressive behaviors, nightmares, sleep problems, irrationalfears, irritability, refusal to attend school, outbursts of anger andfighting are also common in traumatized children of this age. Also thechild may complain of stomachaches or other bodily symptoms that haveno medical basis. Schoolwork often suffers. Depression, anxiety,feelings of guilt and emotional numbing or "flatness" are often presentas well.

Adolescents 12 to 17 years old mayexhibit responses similar to those of adults, including flashbacks,nightmares, emotional numbing, avoidance of any reminders of thetraumatic event, depression, substance abuse, problems with peers, andanti-social behavior. Also common are withdrawal and isolation,physical complaints, suicidal thoughts, school avoidance, academicdecline, sleep disturbances, and confusion. The adolescent may feelextreme guilt over his or her failure to prevent injury or loss oflife, and may harbor revenge fantasies that interfere with recoveryfrom the trauma.

Some youngsters are more vulnerable to trauma than others, forreasons scientists don't fully understand. It has been shown that theimpact of a traumatic event is likely to be greatest in the child oradolescent who previously has been the victim of child abuse or someother form of trauma, or who already had a mental health problem.Andthe youngster who lacks family support is more at risk for a poorrecovery.

HELPING THE CHILD OR ADOLESCENT TRAUMA SURVIVOR

Early intervention to help children and adolescents who havesuffered trauma from violence or a disaster is critical. Parents,teachers and mental health professionals can do a great deal to helpthese youngsters recover. Help should begin at the scene of thetraumatic event.

According to the National Center for Post-Traumatic Stress Disorderof the Department of Veterans Affairs, workers in charge of a disasterscene should:

• Find ways to protect children from further harm and from furtherexposure to traumatic stimuli. If possible, create a safe haven forthem. Protect children from onlookers and the media covering the story.
• When possible, direct children who are able to walk away fromthe site of violence or destruction, away from severely injuredsurvivors, and away from continuing danger. Kind but firm direction isneeded.
• Identify children in acute distress and stay with them untilinitial stabilization occurs. Acute distress includes panic (marked bytrembling, agitation, rambling speech, becoming mute, or erraticbehavior) and intense grief (signs include loud crying, rage, orimmobility).
• Use a supportive and compassionate verbal or non-verbalexchange (such as a hug, if appropriate) with the child to help him orher feel safe. However brief the exchange, or however temporary, suchreassurances are important to children.

After violence or a disaster occurs, the family is the first-lineresource for helping. Among the things that parents and other caringadults can do are:

• Explain the episode of violence or disaster as well as you are able.
• Encourage the children to express their feelings and listenwithout passing judgment. Help younger children learn to use words thatexpress their feelings. However, do not force discussion of thetraumatic 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 abouttheir feelings. At home, however, a gradual return to routine can bereassuring to the child.
• If your children are fearful, reassure them that you lovethem and will take care of them. Stay together as a family as much aspossible.
• If behavior at bedtime is a problem, give the child extratime and reassurance. Let him or her sleep with a light on or in yourroom 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 healingprocess. Some of the things educators can do are:

• If possible, give yourself a bit of time to come to terms with theevent before you attempt to reassure the children. This may not bepossible in the case of a violent episode that occurs at school, butsometimes in a natural disaster there will be several days beforeschools reopen and teachers can take the time to prepare themselvesemotionally.
• Don't try to rush back to ordinary school routines too soon.Give the children or adolescents time to talk over the traumatic eventand express their feelings about it.
• Respect the preferences of children who do not want toparticipate in class discussions about the traumatic event. Do notforce discussion or repeatedly bring up the catastrophic event; doingso may re-traumatize children.
• Hold in-school sessions with entire classes, with smallergroups of students, or with individual students. These sessions can bevery useful in letting students know that their fears and concerns arenormal reactions. Many counties and school districts have teams thatwill go into schools to hold such sessions after a disaster or episodeof violence. Involve mental health professionals in these activities ifpossible.
• Offer art and play therapy for young children in school.
• Be sensitive to cultural differences among the children. Insome cultures, for example, it is not acceptable to express negativeemotions. Also, the child who is reluctant to make eye contact with ateacher may not be depressed, but may simply be exhibiting behaviorappropriate 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. Involvemental health professionals in these meetings if possible.

Most children and adolescents, if given support such as thatdescribed above, will recover almost completely from the fear andanxiety caused by a traumatic experience within a few weeks. However,some children and adolescents will need more help perhaps over a longerperiod 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 bereawakened by reminders such as media reports or the anniversary of thedeath.

In the immediate aftermath of a traumatic event, and in the weeksfollowing, it is important to identify the youngsters who are in needof more intensive support and therapy because of profound grief or someother extreme emotion. Children and adolescents who may require thehelp of a mental health professional include those who show avoidance behavior, such as resisting or refusing to go places that remind them of the place where the traumatic event occurred, and emotional numbing, a diminished emotional response or lack of feeling toward the event. Youngsters who have more common reactions including re-experiencing the trauma, or reliving it in the form of nightmares and disturbing recollections during the day, and hyperarousal,including sleep disturbances and a tendency to be easily startled, mayrespond well to supportive reassurance from parents and teachers.

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Excerpts from Helping Children and Adolescents Cope with Violence and Disasters, The National Institute of Mental Helath (NIMH)