|Supporting Our Grieving Youth
Identifying Seriously Traumatized Children:
Tips for Parents and Educators
National Association of School Psychologists
as the Oklahoma City bombing, terrorist attacks in New York and Washington, DC, and even natural disasters such
as tornadoes and floods place everyone at risk for some degree of trauma reaction. It is normal and
expected that most children will experience some symptoms of acute distress—shock, crying, anger, confusion,
fear, sadness, grief and pessimism. Depending on circumstances, particularly the additional trauma of
loss of family members, most children will experience a gradual lessening of these symptoms over the days and weeks
following the event and will be able to resume normal routines and activities with little change in
performance. However, a large-scale crisis event places a significant number of children are at risk for severe
It is important
to recognize that severe psychological distress is not simply a consequence of experiencing a threatening and/or
frightening event; it is also a consequence of how a child experiences the event, coupled with his or
her own unique vulnerabilities. If a child you are teaching or caring for has had experiences and risk
factors such as those described below, you may need to consider a referral to a mental health professional
such as a school psychologist or a private practitioner.
The Child’s Experience With Trauma
How traumatic is the event for a given child? The degree of psychological distress is associated with
The closer a child is to the location of a threatening and/or frightening event, and the longer the exposure,
the greater the likelihood of severe distress. Thus children living near, or whose parents work
at or near, the site terrorist attacks, a school shooting, or a severe tornado are at greater risk than children
living far away. However, for many children, the length of exposure is also extended by repeated
images on television, regardless of their location.
- Relationships. Having relationships with the victims of a disaster (i.e., those who
were killed, injured, and/or threatened) is strongly associated with psychological distress. The
stronger the child’s relationships with the victims, the greater the likelihood of severe distress.
Children who lost a caregiver are most at risk.
- Initial reactions. How children first respond to trauma will greatly influence how
effectively they deal with stress in the aftermath. Those who display more severe reactions (e.g., become
hysterical or panic) are at greater risk for the type of distress that will require mental health assistance.
- Perceived threat. The child’s subjective understanding
of the traumatic event can be more important than the event itself. Simply stated, severely
distressed children will report perceiving the event as extremely threatening and/or frightening. Among
the factors influencing children’s threat perceptions are the reactions of significant adult
caregivers. Events that initially are not perceived as threatening and/or frightening may become so after
observing the panic reactions of parents or teachers. In addition, it is important to keep
in mind that children may not view a traumatic event as threatening because they are too developmentally immature
to understand the potential danger. Conversely, unusually bright children may be more vulnerable
to stress because they understand the magnitude of a disaster.
Personal Factors Related to Severe Distress
Personal experiences and characteristics can place children at risk for severe stress reactions following
traumatic events. These include the following
- Family factors. Children who are not living with a nuclear
family member, have been exposed to family violence, have a family history of mental illness, and/or have caregivers
who are severely distressed by the disaster are more likely themselves to be severely distressed.
- Social factors. Children who must face a disaster without supportive
and nurturing friends or relatives suffer more than those who have at lease one source of such support.
- Mental health. The child who had mental health problems
(such as depression or anxiety disorders) before experiencing a disaster will be more likely to be severely
distressed by a traumatic event.
- Developmental level.
Although young children, in some respects, may be protected from the emotional impact of traumatic
events (because they don’t recognize the threat), once they perceive a situation as threatening, younger children are more likely to experience severe stress reactions than are older children.
- Previous disaster experience. Children who have experienced
previous threatening and/or frightening events are more likely to experience severe reactions to a subsequent
disaster event severe psychological distress.
Severe Stress Disorders
The most severely
distressed children are at risk for developing conditions known as Acute Stress Disorder (ASD) or Posttraumatic
Stress Disorder (PTSD). Only a trained mental health professional can diagnose ASD and/or PTSD,
but there are symptoms that parents, teachers, and caregivers can look out for in high-risk children. Symptoms
for ASD and PTSD are similar and include:
- Re-experiencing of the trauma during play or dreams. For example, children may: repeatedly act out what
happened when playing with toys; have many distressing dreams about the trauma; be distressed when
exposed to events that resemble the trauma event or at the anniversary of the event; act or feel as if the event
is happening again.
- Avoidance of reminders of the trauma
and general numbness to all emotional topics. For example, children may avoid all activities that
remind them of the trauma; withdraw from other people; have difficulty feeling positive emotions.
- Increased "arousal" symptoms. For example, children
may have difficulty falling or staying asleep; be irritable or quick to anger; have difficulty concentrating;
startle more easily.
is distinguished from PTSD primarily in terms of duration. Symptoms of ASD occur within four weeks of the
traumatic event, but then go away. If a youngster is diagnosed with ASD and the symptoms continue
beyond a month, your child’s mental health professional may consider changing the diagnosis to PTSD.
Know the Signs and Get Help if Necessary
Parents and other significant adults can help reduce potentially
severe psychological effects of a traumatic event by being observant of children who might be at greater
risk and getting them help immediately. Knowledge of the factors that can contribute to severe psychological distress
(e.g., closeness to the disaster site, familiarity with disaster victims, initial reactions, threat
perceptions and personal vulnerabilities) can help adults distinguish those children who are likely to manage
their distress more or less independently from those who are likely to have difficulties that may require
mental health assistance.
health service providers who are part of the school system—school psychologists, social workers and counselors—can
help teachers, administrators and parents identify children in need of extra help and can also help
identify appropriate referral resources in the community. Distinguishing “normal” from extreme reactions
to trauma requires training and any concern about a child should be referred to a mental health professional.
For further information about the signs and symptoms of
AST and PTSD in children and adolescents, please refer to the National Center for PTSD at the following
website: http://www.ncptsd.org/facts/specific/fs_children.html or the National Association of School Psychologists www.nasponline.org
Adapted from “Identifying Psychological
Trauma Victims,” by Stephen E. Brock . In Best Practices in School Crisis Prevention and
Intervention, edited by S. E. Brock, P. J. Lazarus, and S. J. Jimerson (2001), National Association of School Psychologists.
Modified from the article posted on the NASP website in September 2001.
© 2002, National Association of School Psychologists, 4340 East
West Highway, Suite 402, Bethesda, MD 20814, (301) 657-0270, Fax (301) 657-0275; www.nasponline.org
Helping Children Cope with Loss, Death and Grief
Excerpt from National Association of School Psychologists (www.nasponline.org)
Death and Grief: Supporting Children and
Death and loss within a school community can affect anyone, particularly children and adolescents.
Whether the death of a classmate, family member, or staff member, students may need support in
coping with their grief.
Reactions will vary depending on the circumstances of the death and how wellknown the deceased is both to individual students
and to the school community at-large. Students who
have lost a family member or someone close to them will need particular
attention. It is important for adults to understand the reactions they may observe and to be able to identify children or
who require support. Parents, teachers, and other caregivers should also understand how their own grief reactions
and responses to a loss may impact the experience of a child.
GRIEF RESPONSES IN CHILDREN:
There is no right or wrong way to react to a loss. No two individuals
will react in exactly the same way. Grief reactions among children and adolescents are influenced by their developmental level,
personal characteristics, mental health, family and cultural influences, and previous exposure to crisis, death, and loss.
However, some general trends exist that can help adults understand typical and atypical reactions of bereaved children. Sadness,
confusion, and anxiety are among the most common grief responses and are likely to occur for children of all ages.
The Grief Process
grief does not follow a specified pattern, there are common stages that children and adolescents may experience with varying
sequencing and intensity. The general stages of the grief process are:
· Denial (unwillingness to discuss the
· Anger or guilt (blaming others for the loss)
· Sorrow or depression (loss of energy, appetite,
or interest in activities)
· Bargaining (attempts to regain control by making promises or changes in one’s
· Acceptance or admission (acceptance that loss is final, real, significant, and painful)
Grief Reactions of Concern
The above behaviors are expected and natural reactions to a loss. However, the following behaviors may
· Decreased verbalization
· Increased anxiety (e.g., clinginess, fear of separation)
behaviors (e.g., bedwetting, thumb sucking)
· Difficulty concentrating or inattention
· Somatic complaints (e.g., headaches,
· Sleep disturbances (e.g., nightmares, fear of the dark)
· Repeated telling and
acting out of the event
· Increased irritability, disruptive behavior, or aggressive
· Increased anxiety (e.g., clinging, whining)
· Depression, guilt, or anger
Middle and high school level:
· Emotional numbing or depression
· Avoidance or withdrawal
· Peer relationship problems
· Substance abuse or other high-risk behavior
Signs That Additional Help Is Needed
Adults should be particularly alert to any of the following as indicators
that trained mental health professional (school psychologist or counselor) should be consulted for intervention and possible
- Severe loss of interest in daily activities
(e.g., extracurricular activities and friends)
- Disruption in ability to eat or sleep
- School refusal
- Fear of being alone
- Repeated wish to join the deceased
- Severe drop
in school achievement
- Suicidal references or behavior
Risk Factors for Increased Reactions
Some students (and adults) may be a greater risk for grief reactions that require professional intervention.
This includes individuals who:
- Were very close to
the person(s) who died
- Were present when the person died
- Have suffered a recent loss
- Have experienced a traumatic event
- Are isolated
or lack a personal support network
- Suffer from depression,
Posttraumatic Stress Disorder, or other mental illness
Keep in mind that groups, particularly adolescents, can experience collective or even vicarious grief. Students may
feel grief, anxiety or stress because they see classmates who were directly affected by a loss, even if they didn’t
personally know the deceased. Additional risk factors include the deceased being popular or well-known, extensive media coverage,
a sudden or traumatic death, homicides or suicides.
SUPPORTING GRIEVING CHILDREN
How adults in a family or school community
grieve following a loss will influence how children and youth grieve. When adults are able to talk about the loss, express
their feelings, and provide support for children and youth in the aftermath of a loss, they are better able to develop healthy
coping strategies. Adults are encouraged to:
about the loss. This gives children permission to talk about it, too.
- Ask questions to determine how children understand the loss, and gauge their physical and emotional reactions.
- Listen patiently. Remember that each person is unique and will grieve in his or her own way.
- Be prepared
to discuss the loss repeatedly. Children should be encouraged to talk about, act out, or express through writing or art the
details of the loss as well as their feelings about it, about the deceased person, and about other changes that have occurred
in their lives as a result of the loss.
children important facts about the event at an appropriate developmental level. This may include helping children accurately
understand what death is. For younger children, this explanation might include helping them to understand that the person’s
body has stopped working and will never work.
children understand the death and intervene to correct false perceptions about the cause of the event, ensuring that they do not blame themselves or others for the situation.
- Provide a model
of healthy mourning by being open about your own feelings of sadness and grief.
- Create structure and routine for children so they
experience predictability and stability.
- Take care of yourself so you can assist the children and adolescents in
your care. Prolonged, intense grieving or unhealthy grief reactions (such as substance abuse) will inhibit your ability to provide adequate
- Acknowledge that it will take time to mourn and that bereavement is a process that occurs over months and years. Be aware that normal grief reactions
often last longer than six months, depending on the type of loss and proximity to the child.
- Take advantage of school and community resources such as counseling, especially
if children and youth do not seem to be coping well with grief
TIPS FOR CHILDREN AND TEENS
WITH GRIEVING FRIENDS AND CLASSMATES
Seeing a friend try to cope with a loss may scare or upset children who
have had little or no experience with death and grieving. Some suggestions teachers and parents can provide to children and
youth to deal with this “secondary” loss:
with younger children, it will be important to help clarify their understanding of death. See tips above under “helping
- Seeing their classmates’
reactions to loss may bring about some fears of losing their own parents or siblings. Children need reassurance from caretakers
and teachers that their own families are safe. For children who have experienced their own loss (previous death of a parent,
grandparent, sibling), observing the grief of a friend can bring back painful memories. These children are at greater risk
for developing more serious stress reactions and should be given extra support as needed.
- Children (and
many adults) need help in communicating condolence or comfort messages. Provide children with age-appropriate guidance for
supporting their peers. Help them decide what to say (e.g., “Steve, I am so sorry about your father. I know you will
miss him very much. Let me know if I can help you with your paper route….”) and what to expect (see “expressions
of grief” above).
- Help children anticipate some changes in friends’ behavior. It is important that children understand that their
grieving friends may act differently, may withdraw from their friends for a while, might seem angry or very sad, etc., but
that this does not mean a lasting change in their relationship.
- Explain to children that their “regular”
friendship may be an important source of support for friends and classmates. Even normal social activities such as inviting
a friend over to play, going to the park, playing sports, watching a movie, or a trip to the mall may offer a much needed
distraction and sense of connection and normalcy.
- Children need to have some options for providing support—it will help
them deal with their fears and concerns if they have some concrete actions that they can take to help. Suggest making cards,
drawings, helping with chores or homework, etc. Older teens might offer to help the family with some shopping, cleaning, errands,
etc., or with babysitting for younger children.
children who are worried about a friend to talk to a caring adult. This can help alleviate their own concern or potential
sense of responsibility for making their friend feel better. Children may also share important information about a friend
who is at risk of more serious grief reactions.
and teachers need to be alert to children in their care who may be reacting to a friend’s loss of a loved one. These
children will need some extra support to help them deal with the sense of frustration and helplessness that many people are
feeling at this time.
Adapted from “Death and Grief in the Family: Tips for Parents” in Helping
Children at Home and School
III, NASP, 2010 and from materials posted on the NASP website after September 11, 2001.
© 2010, National Association of School Psychologists, 4340 East West Highway, Suite 402,
Bethesda, MD 20814, www.nasponline.org