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Department of Psychiatry experts respond to Newtown tragedy

Offer advice to help parents and children deal with the trauma

By Dennis Nealon

Department of Psychiatry Communications

diciembre 19, 2012

Faculty in the Department of Psychiatry offer information and expert advice to help parents, families and children deal with the trauma associated with the mass shooting on Friday, Dec. 14, in Newtown, Conn.

moore-phoebePhoebe Moore, PhD, assistant professor of psychiatry, directs the Pediatric Anxiety Disorders Clinic at UMass Memorial Medical Center. Dr. Moore specializes in the treatment of children and families affected by anxiety disorders.

The natural thing for parents to think of first is how to help their children. One of the best things that we parents can do for our children is to take care of ourselves. This event has had a tremendous impact on the emotional life of all parents, so I want to emphasize that parents should prioritize taking care of themselves as well. Processing your own feelings with fellow parents, getting emotional support as needed, shoring up your own reserves via restorative activities like exercise, meditation, yoga or community activities like altruism, or seeking treatment if your distress levels are interfering with daily functioning—all of these things can help you find the resilience you need to parent your child effectively in this challenging time.

Talking with your child

As a parent, trust your own judgment about how to talk to your child about what happened. Children and teens will vary in how much information they request and how much they want to talk—this will depend both on developmental level and personality. Be sure to let them guide the discussion. Ask them specifically if they have any worries or concerns they would like to talk about, rather than guessing about what their fears might be. Validate their feelings and offer coping thoughts if they seem distressed (e.g., “Even though this was a very scary event, it is also a very rare and unusual thing to have happen;” or “My school, my parents and my community are all focused on keeping me safe.”) Answer questions as honestly as possible; you may need to balance your child’s need for information against your own wish to protect them from specific details. For younger children especially, limit media exposure; for teens who are interested in the coverage, watch with them or review with them what they have learned from traditional and social media, in order to dispel misinformation and assist in emotional processing.

griffin-jessica-lJessica L. Griffin, PsyD, assistant professor of psychiatry and pediatrics, is principal investigator for the new Child Trauma Training Center, based at UMass Medical School. A clinical and forensic psychologist, Dr. Griffin is a nationally recognized expert in the identification, evaluation and treatment of childhood trauma. The only national-level trainer in Trauma-Focused Cognitive-Behavioral Therapy in the Commonwealth of Massachusetts, she provides training and consultation for trauma-focused therapy to hundreds of clinicians across New England, and serves as a consultant and instructor to a variety of professionals in the courts system, in law enforcement, schools and for pediatric groups.

This is an intensely sad, difficult time for our country, for parents, caregivers, families and children. Tragedies like the shooting at Sandy Hook Elementary underscore the critical need in our country to ensure that professionals (teachers, physicians and law enforcement) are trained to respond to trauma—and that the mental health field is equipped with effective, evidence-based tools and treatments to serve families experiencing traumatic events.

The new Child Trauma Training Center, funded by the National Child Traumatic Stress Network (NCTSN), Substance Abuse and Mental Health Services Administration (SAMHSA), represents a tremendous resource to help us address these types of issues and scenarios.

In the aftermath of the Connecticut school shooting, children and families may have a variety of feelings, ranging from anger and sadness, to confusion and fear.

Below are some suggested guidelines for parents and caregivers to follow after traumatic events like the Sandy Hook Elementary School shooting:

· Limit media exposure. This includes not only the television news, but also Twitter, Facebook, and other social networking sites. Too much exposure to the media coverage following these tragedies can lead to misinformation and rumors, and can be further traumatizing and confusing to children, exaggerating events in their minds.

· Children may seek out additional comfort during this time. At the same time, parents too, may have an urge for physical proximity and closeness with their children and families.

· Some children may demonstrate regressive behaviors, such as thumb-sucking or bedwetting. These behaviors are to be expected and children should not be made to feel ashamed for having these behaviors.

· Encourage your children to share their feelings about the event. Parents can model this by sharing their own sadness, but should take care to not demonstrate overwhelming emotions in front of children. If children have questions about the shooting, provide factual details (without graphic detail). For example, if a child wanted to know if people were hurt, you could say, “Many children were hurt. Some children died. This is a very sad time.” Continue the conversation by reassuring children that adults are doing everything they can to make sure that children and their schools are safer and that this event was rare. For example, you could say, “Police, teachers, mommies and daddies are doing everything they can to make sure that you and other children are safe.”

Children are resilient and many may exhibit few to no symptoms following traumatic experiences. Reactions that may occur include sleep or appetite disturbance, nightmares, intrusive thoughts or memories (e.g. “flashbacks”), regressive behaviors, withdrawal, aggression, fearfulness, confusion, distorted thinking, irritability, physical agitation, bodily complaints (headaches, stomachaches) and many others.

Children who had a previous history of trauma or adversity are more at risk for post-traumatic stress reactions following events like the Connecticut mass shooting.

In the aftermath of a traumatic event, it is important for parents to set the tone, providing structure and maintaining routines. If Friday night is pizza night, have pizza night. With time and with parents or caregivers setting the tone, most children will bounce back after traumatic events within weeks to months. If, however, your child continues to demonstrate symptoms that have not improved or have worsened, it is suggested that you seek consultation/help from mental health professionals.

beheshti-negarNegar Beheshti, MD, assistant professor of psychiatry and pediatrics, is the assistant director of the Department of Psychiatry’s Division of Child Psychiatry, director of the Child Psychiatry Consultation/Liaison Service and director of Child Emergency Mental Health Service.

Violent acts are frightening to people of all ages, especially children and adolescents. Even if the youth has not experienced an event like this first hand, it can still leave him or her feeling vulnerable, confused and scared. They may struggle with understanding what they are seeing on television or hearing discussed by adults. As parents, caregivers and teachers, talking about the event in words that the youth can understand and at a level of detail that will not overwhelm her or him is important.

In addition, having parents who can model appropriate coping skills is essential to helping the youth feel safe. Falsely minimizing the danger to their children will not end the youth’s worry or concern. Parents should allow and encourage the youth to talk about his or her fears and feelings; about what he or she understands. Parents should also share some of their own feelings about the tragedy—sad, scared or even angry—and stress that it is okay to have such emotions after a traumatic event.

If the youth is very young, then lots of affection, like hugs, kisses and cuddles, as well as verbal support, will be helpful. Monitoring the youth’s television viewing and minimizing exposure to graphic images will help avoid further feelings of fear and vulnerability. However, watching some coverage together, with parents, may present the opportunity to talk about what the youth is seeing and allows the youth to ask questions and share her or his feelings in a protective environment.

Depending on the youth’s age, reactions will vary. Some reactions to watch for in children younger than 12 may be:

· Refusing to return to school and exhibit “cling” behavior where they may shadow their parents around the house due to persistent fears related to the disaster, such as being permanently separated from their parents

· Having sleep disturbances like nightmares and bedwetting

· Appearing more withdrawn and exhibiting atypical behavior problems, such as misbehaving in school or at home

Youths over the age of 12 may exhibit physical complaints such as stomachaches and headaches for which a physical cause cannot be found. They may become defiant, frustrated and irritable at home or school, or become withdrawn from their family and friends.

Professional advice or treatment for the youth is probably a good option if you see any of the above symptoms and they persist for an extended period of time after the tragedy. Getting help can prevent or minimize the development of post traumatic stress disorder. Parents can ask their pediatrician or family doctor to refer their child for evaluation and counseling if they are concerned.