How Emergencies May Impact Children and Youth
Objective of this section
This section represents a brief overview of the main issues related to understanding the psychological reactions children experience after stressful events and losses. In the later sections more detailed plans are presented for work with children, parents and teachers themselves. The theory and information that is provided in this section should form the basis for implementation of psychosocial activities in schools. Remember that there are very many similarities between the reactions seen in children and in adults after stressful events, and it is useful both for children and for adults to learn more about these reactions. That is why the objective of this program is to share information, to educate, to promote an open communication both between adults and between adults and children. This section is important to read and discuss for everyone that participates in the program, as the content of this section represents a key element when you later will work with children, parent and teachers.
Understanding children when they are NOT in distress
Around the world, when children are protected and feeling safe they tend to naturally engage in two primary activities as they select and expand their natural attachments to other humans inside and outside of their biological families. These two primary activities are playing and learning. An important component to be successful at either of these activities is the capacity for empathy. Empathy literally means to feel with others – to be able to feel happy when others are happy, and to be able to feel sad when others are sad. Like all other emotions, feelings of empathy strongly affect our behaviours. They lead us to rejoice with others when they are happy, to console them when they are sad, and to condole with them when they grieve for the loss of loved ones. And finally, our ability to empathize with others hinders us from being inconsiderate, harmful or cruel to others.
Normally, when children get sufficient love and attention from their caretakers and when they feel safe and secure in their surroundings, their ability to empathize with others will develop and grow spontaneously, without any form of explicit learning. And when children are safe and calm they are usually able to use their developing faculties of attention, concentration, focus and memory to increase their learning both at home and in school.
When children and young adults have both an internal and external sense that their environment is safe and their caretakers can be consistently trusted, youth are naturally predisposed to practice and develop play skills and learning skills, and perhaps most importantly youth are willing, even excited to share their experiences with others. These sharing processes are necessary prerequisites for children’s intellectual and emotional development. These sharing processes are the essential foundation upon which organized and safe attachments are built and nurtured.
By being aware of the nature and function of developing attachments, care providers can better understand the behavioural reactions of children and young adults in safe times and in times of distress, and thereby also support them better.
Understanding children when they are in distress
It is normal for children to experience a broad range of stress reactions after scary and painful experiences. When children are frightened, insecure or angry, their reactions will be expressed in at least four different ways: intellectually, emotionally, physically and behaviourally. Therefore, when working with distressed children it is important for teachers and pedagogues to keep in mind some fundamental characteristics of human reactions to life-threatening events. We have little direct control over our stress reactions during and after life-threatening events. Emotions, thoughts, physical reactions and behaviours are usually normal expressions of our will to survive in the face of extreme threat; we do not have any control over how these reactions occur initially. These reactions, which are many times uncomfortable and distressing, are not something we would ever chose to experience, nor is the threat we are faced with something we would ever choose to experience. Many normal stress reactions to extreme threat, or perceived threat, do have great influence on our behaviours immediately after exposure to the threat. So in the widest psychological sense, traumatic stress reactions manifest themselves in four different ways:
(e.g. “My parents/teachers cannot keep me safe”, “I did something wrong that made this happen – this is my fault”, “This terrible thing could happen again, “I am vulnerable – I am not safe”.)
Emotions or Feelings
(e.g. “I am angry”, “I am frightened”, “I am anxious and nervous”, “I am sad and hopeless, “I am guilty”.)
in the body
(e.g. blood rushing to the face, increased frequency of-heartbeats, restricted breathing, increased muscle tension, extreme sweating, chills, disturbances in appetite and digestion and sleep etc.)
(e.g. the child yells and attacks a classmate. The child does not play with other children and isolates or appears very numb. The child clings to its caretakers when strangers come visiting. The child engages in high risk or destructive play.
Traumatic Stress Reactions are difficult to verbalize
There is probably not a single thinkable thought that human beings cannot express through their language, but the same cannot be said about their emotions. Due to the extreme changes that occur in our brain biology during traumatic stress reactions our emotions are exceedingly difficult to verbalise, or to process using the spoken word. In addition, bodily sensations usually accompany strong emotions and these bodily reactions are often difficult to describe using the spoken word. Yet the expression of these very strong emotions may be the threads that support the reintegration of our sense of safety and justice in the world after terrible things have happened. To express to others our feelings of pain when we lose loved ones or when our life, health and integrity have been threatened is often very difficult, especially using the spoken word immediately after the terrifying event. Prior to asking children to talk about their emotions using the spoken word, a safe and stable environment must be established that will allow children to decrease their overall arousal from the traumatic stress response. Once kids have had the opportunity to decrease their threat detection behaviours and increase their safety seeking behaviours verbalising their emotions can often define and increase their sense of self-worth and well-being.
Lastly, emotions may also be difficult to verbalise because of limitations in our language and cognitive ability. This is especially true for children below 6-7 years of age. It is important to note that children between 7 and 10 years old may have difficulties using the spoken work to express strong reactions, especially to fearful events, due to shortcomings in their meta-cognitive ability. The term meta-cognitive ability describes our ability to monitor and regulate our own thought processes, which allows us to clearly distinguish between the ‘self’ and the reactions of the self to a frightening event. Although there is great variability it is usually not until the age of 11 or 12 years that children are both able to reflect on their thoughts and feelings, and have a vocabulary large enough to put these thoughts and feelings into words.
Traumatic Stress Reactions are an automatic part of our survival
Stress Reactions have an important function – they are involved in the survival of the species. Different reactions are involved in different survival functions – startle response allows us to detect danger and seek safe exits; increased heart rate and heightened sensory awareness allow us to prepare for appraising whether it is best to fight or flee from perceived danger. The reaction of fear is both a thought and an emotion and it is essential to survival because fear generally acts the as the “great mental mobilizer” allowing us to develop response plans that maximize our chances of survival when we detect danger and are seeking safety.
Prolonged Traumatic Stress Reactions may lead to maladaptive coping
Prolonged traumatic stress reactions can be considered survival reactions that continue to remain active more than 30 days after exposure to life-threatening or perceived life-threatening events and may include:
- Continuing hypervigilance in order to detect perceived threat and danger
- Acting as if the traumatic event is still occurring or about to occur again
- Seeking out dangerous activities or high risk relationships in order to’ practice’ gaining control over uncontrollable events
- Disturbed sleep, appetite and digestive functions
- Decreased ability to empathize or to take another’s social perspective
- Decreased ability to contemplate future events (sense of foreshortened future)
- Decreased ability to concentrate, focus, attend, memorize or learn
- Decreased interest in safe play or social engagement
- Difficulties in communicating with pre-incident social milieu
Overlapping behavioural responses to traumatic stress and traumatic bereavement
There are generally held and unsubstantiated prevailing opinions about the “stages of grief” or the ”types of reactions” traumatized children and youth may exhibit after exposure to life threatening events or sudden violent loss. Current research and field experience indicate that a majority of children and youth may cycle rapidly through non-linear stages of behavioural reactions in order to regain their equilibrium and re-establish trust in significant attachments.
Children may experience a phase when they will act out their emotional difficulties
Children may act out their difficulties by becoming aggressive and demanding. They may try to dominate their peers, defy their teachers, or take to different forms of destructive behaviours. They may exhibit restlessness both physically and mentally, which may manifest itself in an inability to sit still in the classroom or an inability to generate safe and reasonable solutions to problems. These youth may blame others for their behavioural problems.
Children may experience a phase when they will hide their emotional difficulties
Children may attempt to hide their distress and intense emotional reactions in a normal effort to seek the attention and assistance of adults who can regain control over the chaotic and random events produced by the traumatic event. These children and young adults may react with helplessness, self-blame, apathy, fatigue and depression. These children often show signs of social withdrawal by “blocking out” the usual two-way communication with their close social environment. They may become excessively quiet and detached. They may show little interest in play-activities and will limit contact with friends.
Children may experience a phase when they will become passive, numb and choose more dependency
Some children react to the scary and painful events they have experienced by becoming numb and passive, and by taking refuge in their fantasies. Numbing and passivity may be further exhibited by choosing to revert to earlier developmental stages whereby the child will obtain assistance and attentive care from adult caretakers. A good example of this may be children who will not sleep in their own bed after a traumatic event, but rather insist on sleeping with their adult caretakers. Although this has been pathologized and many times labeled as “regressive”, it is actually a highly adaptive coping mechanism that allows the youth survivor to revert to an earlier developmental stage where they feel in control and can practice some mastery. That is to say that they attempt to regain control over their lives by behaving in ways that they did at an earlier stage of their development. In some cases, younger children can take to clinging to their parents, wetting their beds at night or even to stop talking.
Older children may become too dependent on their caretakers and teachers. Some children may become so fearful of being separated from their parents that they may refuse to go to school. All the behavioural responses to stressful experiences we have described above can range from mild to severe. Children’s traumatic stress reactions are considered severe when they become very intense, last for a long time and significantly disturb their day-to-day functioning. In such cases these children require more specialized help than their teachers can offer. However, a large majority of children who experience traumatic events will be able to resume living normal lives provided they are given adequate support in the natural settings of their home and school environment.
It is important to rebuild a sense of safety and stability before asking children what they experienced or what they are feeling about the traumatic event
The first step when supporting a child who is significantly distressed after exposure to traumatic events will be to establish an environment in which the child can feel safe; a physical space and a strong psychosocial relationship(s) in which the youth survivor can practice safety seeking rather than threat detection. It is critical to understand that early exploration of the traumatic narrative, or asking the youth to describe in detail the horrifying experience of the traumatic event can cause great harm and actually significantly increase, rather than decrease, any number of traumatic stress reactions. At the same time it is important to realize that it is possible to engage in communication with children about their experiences even if the situation is still marked by instability. One can establish a sense of safety in children even during times of distress, and this is one of the important tasks we face when working with children during and after disasters.
Reactions to traumatic events and losses
In disasters many children experience something we call a “traumatic event”. With this we mean an event that is “outside of the ordinary or common life experience which would be extremely upsetting and difficult to cope with for any person”. Examples of such events are many, like seeing people being wounded or killed, experiencing the physical destruction and that my own life is in danger. Everybody who has experienced and survived a disaster knows how scary it can be. A child can also experience a traumatic event in normal times, like eye witnessing or being part of a traffic accident or some other event that involves loss of or threat to life.
During disasters there are two main exposure scenarios. The first type of exposure includes eye witnessing very dramatic events and/or being in extreme danger, sometimes resulting in severe traumatic stress reactions. Although completely normal, these reactions can be very strong and frightening for both children and adults. For the vast majority of children and adults these reactions decrease over time, but in some they may last for a long time. That is why this program encourages you, the teachers, to share information about these reactions with other teachers, with parents and with the children themselves.
The second exposure scenario includes the experience of losing very close friends and family members, as well as homes and belongings during and after the disaster. It is normal to feel grief reactions after such experiences, and in some children these reactions may be lasting and result in more depressive type of reactions. It is important to understand that there are significant discreet differences between traumatic stress reactions and traumatic bereavement and this program in not designed to address such complex differences. This program will normally allow teachers to observe if youth are experiencing significant difficulties in recovering from either a traumatic stress reaction or traumatic bereavement. If teachers observe these difficulties it will be most important to refer these youth to professionals for additional assistance.
How to help children who have experienced losses or traumatic events?
All these different reactions we have described here are often seen in children who have experienced traumatic events and losses. Children display different behaviours that reflect what they have experienced. In many children, the reactions decrease over time but some will show many reactions even if half a year has passed since the disaster. By helping children to express their fears and worries in a warm and receptive environment, play leaders can convey to them that they are healthy and strong people who have survived a terrible disaster.
Adults are role models
Both during and after the experience of stressful events, the children look to disasters adults to see how they cope with their lives and to seek support from them. Therefore it is so important that caretakers come together, learn about and discuss how the disaster has affected both the children and themselves, and what they need to do to become even better role-models and helpers for the children. In training seminars these difficult issues can be dealt with both through verbal and written information to the participants. The participants and trainers will be asked to discuss in small groups how specific issues related to grief in children can best be addressed in the everyday lives of children.
Ways of communicating pain, suffering and loss may differ from place to place and from culture to culture. There may be cultural differences between how a rural family communicates about death to that of a family from an urban environment, as well as differences between other groups of the population. It is important to discuss and learn about these cultural factors, for instance how different habits may exist related to children’s attendance in funerals, or how the messages about death of a family member is communicated to a child. That being said, it should also be stressed that it is a common finding from many parts of the world that the adult culture is not adequately sensitive to the needs of the children. If there is one thing the training should emphasize, it is that the adults should be open and honest in their communication, and include the children in the sharing of information that adults do. The typical example of a misunderstood way to try to “protect” children is to keep information away from them when something very sad has been confirmed, for instance that a close relative is confirmed killed in the disaster.
Sometimes adults may choose not to share this information with the child, hoping that the child will be better off in this way. Firstly, children will recognize changes in the adults’ behaviour when something has happened, even if the child is not directly informed. Secondly, the child will usually learn about the sad news from someone else, rather than from the parents/caregiver that optimally should tell the child such news. Thirdly, the fantasies connected to not knowing anything may be worse than the knowledge of actually knowing what has happened. Because of these reasons, it is better to inform children about what has happened.
In this section we have reviewed some basic theory regarding how children understand and process things they experience, and how their emotions and reactions are influenced by these experiences. In disaster many children experience events that can be very sad, distressing or traumatizing. These experiences can result in some very specific reactions, and these reactions can be very strong and distressing. Trauma and grief reactions are, however, a normal reaction to abnormal experiences, and it is important for the schools to normalize and validate the children’s experiences. With this we mean that it is important that the children understand that their reactions are normal, and that others have had or have similar reactions. Children (1.5 years to 7 years) and youth (8 years to 18 years) usually depend on their adult caregivers to protect them from terrible loss, fear, threat or other potentially harmful situations. During and after difficult circumstances, like political and community violence, natural disasters, or becoming a refugee, children and youth may see their world as out of control, no longer dependable.
Youth survivors may think and feel extremely threatened, unsafe, isolated, even hopeless and angry with themselves and with the adults who were supposed to protect them from harm. Sometimes these confusing thoughts and feelings may make youth survivors:
- Act younger than they really are
- Expect adults to take care of them as if they have become a baby again
- Become very startled at loud or sudden sounds
- Exhibit a lot of nervousness in their body motion and in their thinking
- Experience feeling numb and/or depressed
- Experience difficulty sleeping
- No longer care about food
- Refuse to be with anyone except their parents or primary caretaker
- Refuse to go anywhere without their parents or primary caretaker
- Become very agitated when asked to make changes in location or activities
- No longer have control of their emotions
- Loose their tempers and cry or scream frequently
- Act as if they no longer care any more about their future
- Revolt against their regular daily routines
- Disrespect or ignore their parents or adult caregivers
- Or try hard to take care of their parents, as if their parents are now the children
- Have difficulty paying attention and learning
- Have extreme difficulty talking about the emergency or other difficult circumstance
- Practice very inappropriate or risky play activities or risky social behaviours
- Engage in play or activities that remind them of the emergency or difficult circumstance
- Experience constant reminders of the emergency or difficult circumstance
- Try hard to avoid any reminders of the emergency or difficult circumstance
- Be disrespectful and even harmful to their siblings, their peers and themselves
- Not understand when it is okay to play again or be joyful again
Source: Psychosocial Activity Book for Children and Youth Exposed to Difficult Circumstances. UNICEF – Mena 2002.