Jewish World Review June 18, 2002 / 8 Tamuz 5762



Helping our kids
deal with trauma



By Dr. Abraham Twerski, M.D.

http://www.jewishworldreview.com | Just as knowing what to expect of ourselves is important in coping with the aftermath of a trauma, so it is important to know how children are likely to react. In addition to insomnia some kids are sleeping closer to their parents. To be sure, the tension does not effect everyone equally, but there are subtle emotional and physiologic changes that kids are experiencing.

Separation Anxiety. Children have heard that some parents left for work on the morning of September 11 and never came home. This may cause them to worry whether something unexpected may happen to their parents. They may become anxious and/or cry when their parents leave the house. They may say: "Are you going to be OK? When are you coming back?" They may cling to their parents; they may become moody and whiny. These are symptoms of mild separation anxiety.

Lack of concentration. Like adults, children may lose interest in things they had previously enjoyed. They may be unable to concentrate. Their school performance may be affected. They may refuse to go to school or leave the house. They may complain of headaches or stomach aches.

Children may talk repeatedly about the attack. It is as though talking about it gives them some control over it. They may ask questions about death or talk about dying. Incidentally, we should avoid using euphemisms about death. We may think that words like "die" or "death" are too harsh for a child. The use of other terms like "passed away" may be confusing to a child, reinforcing the fear that if someone goes "away" that they are not coming back.

Regression. Kids who previously had no fear of the dark may develop it now. There may be a recurrence of bed-wetting or other signs of regression, such as tantrums, thumb sucking or baby talk. These regressions may also occur when a new baby is brought home. It is as if by behaving as though they were younger and more helpless they will receive more parental attention. Don't be alarmed at such regressions. Take this as a signal from the kids and give them the extra attention that they are asking for. This phase will pass.

Aggressiveness. Some children may try to overcome a fear of violence by being violent themselves. This is a manifestation of a psychological defense mechanism: "identification with the aggressor". Victims of abuse may take on the very characteristics of the abuser that they despise. This may give them the illusion that they are not completely powerless.

Role Playing. Kids may play-act the disaster scene. I witnessed some 6 year olds building towers out of blocks and flying paper airplanes into them. This may be irritating and worrisome, and some parents may be tempted to say, "Stop doing that! That's disgraceful!"This constitutes suppression and may deprive children of an opportunity to get a handle on what has happened. Rather, allow children to play act and talk to them about their feelings. Even if they make shocking statements, it is advisable to respond in a calm, empathetic and reassuring manner. You can say: "I guess this is how you see what the terrorists did. It must make you feel pretty upset"? Letting them know that this is a normal way of dealing with their emotions about a scary event validates their feelings.

Talk to your kids. Be open. While we may be critical that the government is not doing enough, we should share with the children that steps are being taken to improve security. "Wow! I was searched twice at the airport. They are really careful to prevent anyone from taking anything dangerous on the plane. It sure slows down the trip but it makes us feel more safe". When the kids talk about the potential dangers, acknowledge their concerns and point out that police and firemen are getting special training to deal with emergencies.

Are schools safe? Children have undoubtedly heard about the Columbine and other school tragedies. The World Trade Center attack, attacks on American interests abroad and media reports of further potential attacks may make them concerned about the safety of their school. Reassure them that measures are being taken to make school a safe place. (At the same time, place a call to the school principal asking what security measures are being taken at school).

Why do people hate us? When asked this question we should not respond with hate. We should point out that people sometimes are under mistaken impressions and make unfounded assumptions about people they don't know or cultures they do not understand. They may have developed wrong ideas that may cause them to be afraid of people from other cultures and/or jealous of them. Some people with such erroneous ideas may act in a horrible way, but there are really few people who are so evil.

Support system. Children want to feel that the world is a safe place to be. They may be very trusting and think that everyone in the world is good. The trauma of a fire or an accident, even if the child is directly involved, relates only to that local disaster, and does not destroy their feeling of security about the world. A terrorist attack, however, affects everyone. Not only is their concept about the world undermined, but their support system-parents, family, friends, neighbors-all have been affected. This may shatter their sense of security.

The children may ask: "Is that going to happen here?" The fact is that the odds are that it will not and if we are convinced of that, then we can be reassuring to our children. We can point out to them that earthquakes and volcano eruptions have occasionally occurred, but here we are, safe and sound. Children want to know that they are safe, and in good conscience, we should be able to reassure them.

Speak Clearly. Young children may misinterpret the words and phrases we say. When they hear that a company "fired" its employees they may think that they were thrown in the fire. One child heard his father say that he may be fired and tearfully asked: "Is daddy's company going to burn him, too"? Listen to your children carefully so that you can clear up their misconceptions. Unless you actively listen to them, you can't really know what's going on in their minds.

Too much news. Don't over-expose your children to the news. Suppressing all talk about terrorism is denying reality, but too much conversation about it is anxiety-provoking. We should also keep our own exposure to the news at a minimum. This is even more important for children. Not only is the repetition of the news reinforcing of their anxiety, but their perception of their parents' preoccupation with the news raises their concern that there will be additional terrorist attacks.

If the children are present when you listen to a newscast, hold them on your lap or sit with your arm around them. Their need for reassurance is greater when there is talk about danger and violence.

Family activities. Make time for family activities. A picnic, an outing to the zoo or any other shared amusements can diminish anxiety. It lets them know that life carries on as usual. Planning vacations together can be particularly helpful. It is a very effective way of letting them know that you fully expect life to carry on and that all will be well.

A nationally recognized heart specialist was often consulted by patients with serious heart problems. After doing all the necessary tests, he would call the patient into his office, and in the patient's presence he would call the referring physician. After giving the referring doctor his report, he would say: "I wish to ask you a favor. I am interested in this particular condition and I would like to do a follow up, re-examining the patient at two year intervals. Please make a note on his chart to see me again in two years".

People with heart disease are likely to be afraid of sudden death. Telling the patient: "Don't worry, you'll be fine", is not all that effective. Patients expect the doctor to give them reassuring words even if they are not true. But this doctor did not do this. Instead, he allowed the patient to overhear a conversation with his doctor, requesting a return visit in two years! Obviously the doctor expects him to be alive in two years, and furthermore he has people with his condition back every two years. That is effective reassurance.

Planning a summer vacation is a similar reassurance of survival. Going over the details, with pictures or brochures, of where the family is going to spend vacation this summer is like the cardiologist calling the referring doctor. Similarly, talking about forthcoming holidays is reassuring about the future.

Spouses should make an EXTRA effort to get along in front of the kids. It is only normal for husbands and wives to disagree about things, but disagreeing should not take on an attitude of hostility. Given the anxiety and increased irritability that parents are experiencing, they may lose their cool when they disagree about something. When parents shout at each other and disagree with sharp words, children may fear that the parents cannot get along and may separate. Such a feeling always provokes anxiety in children, but it can be especially toxic when the children have a greater need for parental support.

Children may express anger. Anger outbursts or hate expressions may occur. Sleep may be erratic. They may have a fear of falling asleep and may experience nightmares. Parents should not be afraid to discuss these behaviors with their children and suggest that they may have something to do with the general anxiety that pervades the community.

Many children may not manifest these behaviors, but their thoughts may well be related to the terrorist activity and it is reasonable to assume that they are frightened. Anything that parents can do to give their children a feeling of safety and security is beneficial. Parents should spend more time with their children, give more hugs and be sure to tuck the little ones into bed. If they want a night light, they should have it.

Adolescent Behavior. Studies comparing normal adolescents with adolescents who had behavior and substance abuse problems revealed an important fact. The single outstanding factor that was present in normal adolescents that was absent in families of problem youngsters is that for better adjusted youth, the family ate together more often. This may be because the first bonding of mother and infant is with food. Even though we mature, the bonding potency of food remains. In addition the family interaction around the table allows an interchange of ideas and thought where the children have a chance to be heard and validated. This is an important component of self esteem.

Maintain a normal routine. This helps children understand that life must go on and that there are boundaries. Bedtime is bedtime, piano lessons continue and helping clear the table is still a required family duty. These rules create a framework whereby the child feels his world is ordered, secure and where he feels taken care of.

Validate feelings. Children need to have their feelings validated. This means that they should know that the grown ups are aware of how they are feeling. If the request for a night light is turned down because, "That's silly. Nothing is going to happen to you," the child feels that no one understands that he is afraid. He may conclude that it is wrong to be afraid, and he may become afraid of being afraid. If he is startled by loud thunder, the parent may say: "That was a loud one! It frightened me, too".

Be happy. Sadness over a tragedy should not preclude appropriate joy. Children need to know this. It is OK for them to play, laugh and enjoy life while others around them may be distressed. They should not feel guilty or be made to feel guilty about having fun.

Don't lie to your children. Sometimes we might think that lying about something frightening will avoid anxiety. This is not true. Children can feel when a parent is lying, and this undermines their trust. When dealing with a frightening issue or episode, choose your words carefully and give extra support by holding her hand or by putting an arm around him.

Listen to your child. Don't guess at what is bothering him or her. Be patient and let him tell you. Don't ask the child directly: "So tell me, what is bothering you"? It is unlikely to work. Spend time shmoozing with the child, play a board game or do the dishes together, and through the bonding the child is more apt to open up to you. If your child calls you at work, don't tell him you can't be disturbed. He needs to talk. It's your job to listen.

Foster spirituality. Take your child to your place of worship, but make the experience meaningful. The children need to know that both we and they can have a relationship with G-d. It is an important matter of faith that the child realize that G-d hears us and wants us to enter into a dialogue with Him. Let your prayer be sincere and meditative. Allow your child to overhear a prayer you may whisper to G-d. Allow your child to feel that our dialogue with G-d is real.

Express your love. Think of ways in which you can demonstrate to your children that you love them. Express your love in tangible ways. Say more than: "I love you". Say: "I love you.... and I like you". Utter a prayer at night as you lie down with your kids: "Thank you G-d for giving me the gift of this child". Turn to the child while hugging him at night and say: I love you like a chamber of my own heart. I love you like my own breath".

Most symptoms following a traumatic event are likely to subside with time. How much time? That is variable. Perhaps a good guideline is: when your own anxiety subsides. If you have any doubt whether your child's reaction is excessive or lasting too long, consult a child psychologist. Most children will adjust with good parenting. Those who need psychotherapy should receive it as early as possible.

Previously:

The Creator helps those who help themselves
Knowing what to expect
Psychological fallout in the shadow of terrorism
Self-esteem in the face of world terrorism


Abraham J. Twerski, M.D. is a psychiatrist and ordained rabbi. He is the founder of the Gateway Rehabilitation Center in Pittsburgh, a leading center for addiction treatment. An Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, he is a prolific author, with some 30 books to his credit. He has recently launched a new 12 step program for self esteem development www.12steps2selfesteem.com Send your comments by clicking here.

© 2002, Abraham J. Twerski, M.D.