9 - Simple Ways for addresses the issue of: Traumatic events in young childhood
Each year in South Africa approximately five million
children experience some form of traumatic experience. More than two million of
these are victims of physical or sexual abuse. Millions more are living in the
terrorizing atmosphere of domestic violence. Natural disasters, car accidents,
life-threatening medical conditions, painful procedures, exposure to community
violence – all can have traumatic impact on the child. By the time a child
reaches the age of eighteen, the probability that any child will have been
touched directly by interpersonal or community violence is approximately one in
four. Traumatic experiences can have a devastating impact on the child, altering
their physical, emotional, cognitive and social development. In turn, the impact
on the child has profound implications for their family, community and,
ultimately, us all.
Traumatic events in childhood increase risk for a host of social (e.g., teenage
pregnancy, adolescent drug abuse, school failure, victimization, anti-social
behaviour), neuropsychiatric (e.g., post-traumatic stress disorder, dissociative
disorders, conduct disorders) and physical health problems (e.g., heart disease,
asthma). The deterioration of public education, urban violence and the alarming
social disintegration seen in some of our communities can be linked to the
escalating cycles of abuse and neglect of our children. For most children,
thankfully, a traumatic event is a new experience. And like all new experiences,
the unknown will add to the confusing and frightening circumstances surrounding
this overwhelming experience. The trauma may significantly challenge the child’s
sense of the world. A flood, car accident, shooting or abuse by a caregiver -
all challenge the child’s beliefs about the stability and safety of their world.
Very young children may not understand what happened and will be confused or
even frightened by the reactions of their siblings or caregivers.
The acute post-traumatic period is characterized by an attempt by the child to
reorganize, re-evaluate and restore their pre-traumatic world. Many of the
emotional, behavioural and cognitive signs and symptoms of the acute
post-traumatic period are due to these efforts. Unfortunately, children often do
not have the same capacity to understanding or explaining most traumatic
experiences. Young children may make many false assumptions about the event –
“the accident came because God was mad.”
As with most situations, children seek answers and comfort from adults around
them, yet we often feel helpless in this role. Indeed, most traumatic
experiences challenge the most mature and experienced adult. While adults do not
have all the answers, they can help children better understand the traumatic
event and the ways we respond following trauma.
This simple guide addresses some of the key issues related to the child's
complex set of reactions that often follow traumatic events. While focused on
caregivers, this information may be helpful to caseworkers, teachers, other
family and other adults working and living with traumatized children.
This simple guide is intended to inform and provide general principles -- it is
not intended to be comprehensive or to exclude other observations or approaches
to helping traumatized children. The more we understand these children and the
impact of traumatic experiences, the more compassionate and wise we can be as we
try to help these children.
1. Don’t be afraid to talk about the traumatic event. Children do not benefit
from not thinking about it' or 'putting it out of their minds'. If a child
senses that his/her caretakers are upset about the event, they will not bring it
up. In the long run, this only makes the child's recovery more difficult. Don't
bring it up on your own, but when the child brings it up, don't avoid
discussion, listen to the child, answer questions, and provide comfort and
support. We often have no good verbal explanations, but listening and not
avoiding or over-reacting to the subject and then comforting the child will have
a critical and long-lasting positive effect.
2. Provide a consistent, predictable pattern for the day. Make sure the child
has a structure to the day and knows the pattern. Try to have consistent times
for meals, school, homework, quiet time, playtime, dinner and chores. When the
day includes new or different activities, tell the child beforehand and explain
why this day's pattern is different. Don't underestimate how important it is for
children to know that their caretakers are 'in control.' It is frightening for
traumatized children (who are sensitive to control) to sense that the people
caring for them are, themselves, disorganized, confused and anxious. There is no
expectation of perfection; caretakers themselves have often been affected by the
trauma and may be overwhelmed, irritable or anxious. If you find yourself being
this way, simply help the child understand why, and that these reactions are
normal and will pass.
3. Be nurturing, comforting and affectionate, but be sure that this is in an
appropriate 'context.’ For children traumatized by physical or sexual abuse,
intimacy is often associated with confusion, pain, fear and abandonment.
Providing a hug, a kiss and other physical comfort to a young child can be very
reassuring. A good working principle for this is to be physically affectionate
when the child seeks it. When the child walks over and touches you, return in
kind. The child will want to be held or rocked – feel free. On the other hand,
try not to interrupt the child's play or other free activities by grabbing them
and holding them. Further, be aware that many children from chronically
distressed settings may have what we call attachment problems. They will have
unusual and often inappropriate styles of interacting. Do not tell or command
them to 'give me a kiss' or 'give me a hug.' Abused children often take commands
very seriously. It reinforces a very malignant association linking
intimacy/physical comfort with power (which is inherent in a care giving adult's
command to 'hug me').
4. Discuss your expectations for behaviour and your style of 'discipline' with
the child. Make sure that there are clear 'rules' and consequences for breaking
the rules. Make sure that both you and the child understand beforehand the
specific consequences for compliant and non-compliant behaviours. Be consistent
when applying consequences. Use flexibility in consequences to illustrate reason
and understanding. Utilize positive reinforcement and rewards. Avoid physical
discipline.
5. Talk with the child. Give them age appropriate information. The more the
child knows about who, what, where, why and how the adult world works, the
easier it is to make sense' of it. Unpredictability and the unknown are two
things which will make a traumatized child more anxious, fearful, and therefore,
more symptomatic. They May be more hyperactive, impulsive, anxious, and
aggressive and have more sleep and mood problems. Without factual information,
children (and adults) 'speculate' and fill in the empty spaces to make a
complete story or explanation. In most cases, the child's fears and fantasies
are much more frightening and disturbing than the truth. Tell the child the
truth, even when it is emotionally difficult. If you don't know the answer
yourself, tell the child. Honesty and openness will help the child develop
trust.
6. Watch closely for signs of re-enactment (e.g., in play, drawing, behaviours),
avoidance (e.g., being withdrawn, daydreaming, avoiding other children) and
physiological hyper-reactivity (e.g., anxiety, sleep problems, behavioural
Impulsivity). All traumatized children exhibit some combination of these
symptoms in the acute post-traumatic period. Many exhibit these symptoms for
years after the traumatic event. When you see these symptoms, it is likely that
the child has had some reminder of the event, either through thoughts or
experiences. Try to comfort and be tolerant of the child's emotional and
behavioural problems. These symptoms will wax and wane - sometimes for no
apparent reason. The best thing you can do is to keep some record of the
behaviours and emotions you observe (keep a diary) and try To observe patterns
in the behaviour.
7. Protect the child. Do not hesitate to cut short or stop activities that are
upsetting or re-traumatizing for the child. If you observe increased symptoms in
a child that occur in a certain situation or following exposure to certain
movies,
Activities and so forth, avoid these activities. Try to restructure or limit
activities that cause escalation of symptoms in the traumatized child.
8. Give the child 'choices' and some sense of control. When a child,
particularly a traumatized child, feels that they do not have control of a
situation, they will predictably get more symptomatic. If a child is given some
choice or some element of control in an activity or in an interaction with an
adult, they will feel safer, comfortable and will be able to feel, think and act
in a more 'mature' fashion. When a child is having difficulty with compliance,
frame the 'consequence' as a choice for them - "You have a choice- you can
choose to do what I have asked or you can choose….." Again, this simple framing
of the interaction with the child gives them some sense of control and can help
defuse situations where the child feels out of control and therefore, anxious.
9. If you have questions, ask for help. These brief guidelines can only give you
a broad framework for working with a traumatized child. Knowledge is power; the
more informed you are, the more you understand the child, the better you can
provide them with the support, nurturing and guidance they need. Take advantage
of resources in your community. Each community has agencies, organizations and
individuals coping with the same issues. They often have the support you may
need to help.