At various times in their lives, most children and young people will experience events that are stressful and upsetting. Many will experience incidents that are traumatic and have the potential to have a lasting negative impact on them (for example, one study found that before they are 18 years old nearly a third of people in England and Wales will be exposed in one way or another to actual or threatened death, serious injury or sexual violence[i]) After such traumatic events, some children and young people will actually seem to be relatively unaffected. However others can become very distressed and have significant difficulties. Common reactions include:
- Distressing memories or thoughts of the event repeatedly popping into their minds
- Feeling as if it is actually happening again
- Repeatedly playing or drawing about the event
- Actively avoiding thinking or talking about what happened
- Avoiding activities, places or people that might trigger memories of the event
- Getting angry or upset more easily
- Not being able to concentrate
- Not being able to sleep well
- Being more jumpy and on the look-out much of the time
- Being more clingy with parents, carers or other known adults
- Physical complaints such as stomach aches or headaches
- Losing some skills (for example feeding or toileting)
- Having problems at school
Such reactions are quite natural following such events. And for many children and young people they will lessen over the weeks following the events.
But what can we do to maximise the chances that such reactions will reduce, and that children and young people will do well?
Well, psychological research[ii] tells us that by thinking about five specific principles we can create an environment around children and young people in which they are most likely to recover. This is not a manualised approach that will tell you exactly what to do (how could it be? The people that produce all the research don’t know your particular child or young person like you do.); but it does provide some clear guidance that you can adapt to your situation and your child or young person.
Sense of Safety
The first principle is about developing a sense of safety. Following traumatic events, children and young people can often struggle to see things as safe enough – they are suddenly all too aware of how dangerous or unpredictable the world is; or they may start to see themselves as vulnerable and at risk; or they may start to believe that everyone around them is a potential danger. So, in addition to making sure that they are actually safe enough, it can be useful to help them to realise just how safe they are.
They may be accessing news media or social media that is focusing on the most sensational aspects of the events, and this may be adding to them feeling unsafe; so it might be useful for you to find out what they are accessing and speak with them about it. This way they can either reduce their exposure to it, or at least talk with you about it so that they can make more useful judgements.
Returning to familiar routines can really help children and young people to start to see their world as safer, sooner. If routines didn’t really exist before the traumatic events, then it’s a good time to put them in place. The more predictable their world can be, the safer they will feel. Returning to normal everyday activities can also help them to reduce the extent to which they feel that their world has become completely unpredictable.
Although it can be tempting to ‘get an expert in’ following traumatic events, in fact the people that children and young people already know and trust, are much better placed to help people feel safe and secure.
Sense of Calm
At the time of the trauma, and even after it, their stress response (sometimes called their fight-flight-freeze response) may have been really useful. It may be the thing that helped them to get away from danger, or to notice other genuine threats. But if the event was traumatic rather than just stressful, then they may need some help bringing their emotions back down to a more manageable level. It might be useful to explain that such strong feelings are very natural after such events, so that they don’t have the additional worry about their reactions. But if their high arousal levels are causing problems or going on for a long time, then it can be useful to help the young person to find some strategies to regulate their emotions and start to feel calmer and more peaceful. Some children benefit by helping them to think about their breathing and gently make it more regulated; however other children might find that focusing on their breathing actually makes it worse. Some can be supported best by other strategies such as physical activity, reading a book, colouring, doing puzzles, listening to music, or deliberately bringing to mind a place where they feel peaceful, calm and relaxed. (This is not a quick fix though – it takes time and practice).
Sense of connection and social support
After traumatic events, some children and young people can feel very isolated. Their usual sources of support such as friends and family may not know what to say, or they may worry that they will say the wrong thing, so they back off rather than step forward. Connection and social support are not antidotes to traumatic events, but they can form a fundamental part of the environment in which they are most likely to recover. You can help them by actively supporting them to connect with others, as well as making sure that they feel as supported by you as they want to be.
Sense of control
Often traumatic events take away a child or young person’s sense that they are able to make decisions about what happens to and around them. And the resulting feelings of helplessness can have an enormous impact on a child or young person. If they do not believe that what they do will make a difference, then they may stop trying to do anything. And this in turn then adds to their feelings of helplessness. It can be helpful to give them choices and help them to see that there some things in their lives over which they do have control.
Sense of Optimism
Sometimes traumatic events can rob children and young people of any ideas they had that their futures will be positive. And this can lead to very negative thinking about the future and very low mood. They may start to catastrophise, where they see everything very negatively and start to always expect things to go wrong for them. And then they start to only notice the things that go wrong, and ignore the things that go right for them (or distort them so that they think that it went wrong in some way when it didn’t). You can help, by gently weaving in some positive aspects of their future. Too much too soon will not work, and they may feel that you have not understood them, or that you have not understood how traumatic the events were. Very small steps might include making some small plans to do something that they can look forward to, and this can start to break up some of the negative thinking.
Understanding and making sense of the event is crucial, and relies on an accurate and balanced understanding of what happened
Sometimes parents and carers try to ‘protect’ their children and young people from further distress by not talking about what has happened; some hope that by keeping quiet, the child or young person will forget about it. Children and young people may learn pretty quickly that certain people do not want to talk about what happened, so they stop mentioning it to them, and this means that they are left trying to make sense of things on their own.
Children and young people need a truthful, age-appropriate explanation that makes sense of the main facts. Even younger children can benefit from being given a description and an explanation of what happened. Without sufficient understanding, they may be confused or scared, and in their attempts to make sense of things, they may end up creating an explanation based on their fantasy, which may be even worse than the reality. For example, they may believe that the event was their fault, or that they should have done something to stop it. Without the opportunity to ‘recalibrate’ their sense of responsibility, their sense of guilt may be overwhelming. If nobody has helped them to understand why and how the traumatic event happened, how can they know it isn’t going to happen again at any time?
Conversations can help them to shed the light of reason on their thinking and help them to develop more balanced views of things. Talking with children and young people can be very helpful but needs to be done carefully and sensitively and at the right moment. And preferably with someone that they already know and trust. It can be helpful to provide opportunities, support and encouragement to help them talk about it if and when they are ready to, rather than forcing them to. Finding out what their questions are, and then answering them honestly and appropriately can ensure that you take things at their pace.
When to seek more help
If things don’t seem to be getting any better, even several weeks after an event, or if they are causing significant distress or problems, then it may be worth speaking with your GP, or a professional at school to consider getting some additional help and support. If they are harming themselves or suicidal, then it is paramount to seek additional help, and if you are worried about their safety and feel that there may be an immediate risk, the Hospital Emergency Department, or 999 is the next step.
If you want to know more about what parents and carers can do to maximise the chances of recovery for children and young people, the book, Helping Your Child with Loss and Trauma: A self-help guide for parents, provides more in-depth information
[i] Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., … & Danese, A. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet Psychiatry, 6(3), 247-256.
[ii] Summarised in this article Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., … & Ursano, R. J. (2007). Five essential elements of immediate and mid–term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315.