Many children will experience fearful situations, but they also have remarkable resilience and an ability to bounce back.
The experience of a traumatic event itself (such as a death or accident) does not necessarily mean that your child will experience any ongoing symptoms. However, in some cases where children struggle with the experience of a trauma, Psychologists look to the following guidelines for Posttraumatic Stress Disorder (PTSD) in the DSM-5*:
Firstly, to be diagnosed with PTSD, a child must have:
1. Directly experienced, witnessed or learned about a traumatic experience of a close family member or friend. In cases of actual or threatened death to a family member of friend, the event must have been violent or accidental. Witnessing traumatic footage via media only (e.g., watching news footage) would not meet the threshold for a diagnosis of PTSD.
2. The presence of distressing memories and/or dreams of the event. This can be through repetitive play in which themes or aspects of the traumatic event are expressed, and through frightening dreams (which may not have any recognisable content).
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the event were recurring. For children, this may be expressed through re-enactment play (e.g., Barbie crashing her car over and over).
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or represent aspects of the event (e.g., feeling worried if see a similar car).
5. Marked physiological reactions at exposure to internal or external cues that symbolise or represent aspects of the event (e.g., crying or feeling sick if see a similar car).
6. Persistent avoidance of stimuli associated with the traumatic event (s), as evidenced by one or both of the following:
- Avoidance of distressing memories, thoughts or feelings
- Avoidance of reminders (people, places, conversations, activities or objects) associated with the traumatic event.
7. Negative changes in thoughts and feelings as evidenced by two or more of the following:
- Inability to remember important aspects of the event (not due to head injury)
- Persistent, exaggerated negative beliefs (e.g., “I’m bad”, “no one can be trusted”, “the world is completely dangerous”)
- Persistent, distorted thoughts about causes or consequences about the event that cause the individual to blame self or others (e.g., “if only I’d left the house two minutes later”)
- Persistent feelings of anger, guilt, shame, horror, confusion or fear
- Diminished interest or participation in significant activities (including play)
- Being withdrawn
- Persistent inability to experience positive emotions (e.g., inability to feel happiness, satisfaction or love)
8. Marked alterations in reactivity, as demonstrated by two or more of the following:
- Irritable behaviour, or angry/violent outbursts (with no provocation)
- Reckless or self-destructive behaviour
- Exaggerated startle response
- Problems concentrating
- Sleep problems
Generally speaking, the symptoms will have appear and persisted for longer than one month after the traumatic event. In some individuals, delayed reactions can occur after 6 months.
How do Psychologists help children who have experienced trauma?
The first stage of therapy involves rapport building and assessment (with younger children this is usually through semi-structured play, where we observe and are guided by where the child wants to take the session – within reason!).
Unless the purpose of the visit is for a specific assessment (e.g., establishing likelihood of childhood abuse for court), therapy for children is very child-directed. This means that we take the time to ensure that your child feels safe and comfortable, which usually takes several sessions to establish.
The second stage of therapy is about clarifying (what does the child think happened? What specific thoughts or feelings does he or she have about the event?).
After clarifying the child’s thoughts, the third stage is about correcting ongoing worries, fears and negative thoughts (e.g., “I’m bad”, “every time I get in the car it will crash”) with the aim of:
- building on your child’s strengths and coping resources,
- re-establishing that they are safe in the world, and
- in the case of death, some work around grief.
How can parents help children who have experienced trauma?
Aim to clarify, before reacting to your child’s thoughts and behaviours. For example, a younger child crashing cars together might be a sign of flashbacks for one child, but for another child he or she might simply enjoy crashing cars together!
For younger children, you might simply state commentate (‘you’re crashing the cars together’) and see what the reply is. Wait for your child to tell you what’s going on, rather than suggesting (‘you’re thinking about the car crash we were in, weren’t you?).
Avoid the desire to avoid. Try to keep in mind the pink elephant principle. That is, if I tell you not to think about a pink elephant and keep telling you, no matter what try to put the elephant out of your mind or think of something else, chances are you are going to think about the pink elephant.
If you allow the thoughts and conversations to come in, acknowledge that they are there, and then go back to what you were doing, this actually decreases the level of the intrusion later on. If your child brings up the event, allow him or her to talk about it and ask questions, but keep in factual and calm.
You might read or talk to your child about the story of Pandora’s Box. Then talk about how if we try to put our thoughts away without sorting them, they will stay out of sight out of mind for a while, but eventually the box gets too full and spills open.
Try to teach your child that your brain is like a filing cabinet and we need time to sort through everything. When a thought or a memory comes in, practise thinking about whether it’s useful or not useful. If it’s not useful (i.e., it doesn’t make us feel happy) then practice phrases like “we can put that in the junk folder now” and go back to what we were doing.
Find regular opportunities to catch yourselves in a good moment. Children learn best ‘in the moment’ rather than trying to imagine the future. For example, if you catch them laughing and having a good time stop and point it out to them.
You might also encourage them to have a book or box of memories to add drawing, pictures, writing and other mementos to. Each day you can review the happy memories in the box to provide encouragement and reassurance that life is full of happy and safe times.
* Source: American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.