Supporting children in response to the Sydney siege

The siege that we are seeing unfold in Sydney today will be having, and will continue to have a significant impact on many people around Australia. There has been building anxiety  that there will be deliberate harm done to people in public and the threat that this siege poses will touch on the fears of individuals, families and children. 

The nature of events, such as this siege, is that they are seemingly random, unexpected and take place in places where people go about their daily business with the belief that they are safe. And this is one of the factors that makes an event such as this trigger our fear. It threatens one of our core beliefs that we are essentially safe. 

Media coverage at times like this is important in providing people who are affected with news and information about loved ones, about where to go and when it is safe. Reading and watching the media coverage and following what is happening on social media leads to feelings of worry, anxiety and distress for most of us. It is normal to feel anxiety and sadness for those who are involved, their loved ones and others that are affected. We know, though, that for some people, this ongoing media coverage has the potential to lead to some more significant feelings of anxiety, worry and sadness. This can be especially true of children, who do not always have a good understanding of what they are reading about or witnessing in the media, and to some extent need to be protected from some of this ongoing coverage. 

When distressing events, such as this siege, are shown on TV, or covered on the radio or internet, parents need to be mindful of how much exposure their child has to this. The media can tend to focus on some of the more frightening aspects and images. Seeing this type of media coverage can cause distress or worry for children and young people. Children may also discuss these events amongst themselves, so even though children may not see images on TV, they may still be exposed through their conversations with others. 

Some of the ways this sort of media coverage can affect children and young people includes: 

• It can lead to children and young people thinking a lot about the event, which can impact on their sleep and can also impact on their concentration when they are at school. 
• It can cause worry and anxiety that the same thing may happen to them or their family. 
• It can lead them to feel generally unsafe and worried and that some other bad event may happen to them or their family. 

Families can help to support children at this time by: 

• Restricting the amount of media coverage children see of the event. 
• Watching media coverage with your child so that you are there to answer any questions they may have. 
• Helping to remind your child that they are safe and that you are there to answer any questions for them if they feel unsafe. 
• Giving support to your child if they are upset and comforting them. 

Many children may feel worried or anxious over the days to come, but for most this will settle. If your child has worries or sadness about this event that continues over the days and weeks, then it is good to speak with a health professional about how your child is going. 

The Trauma & Grief Network: Supporting Families website has lots of helpful information for families on helping children with the impact of trauma. Some helpful resources include: 

Disasters, the media and your child

Signs of possible trauma in children and adolescents

The strengths of children and families

The Australian Child & Adolescent Trauma, Loss & Grief Network website also has an extensive range of resources on the impact of trauma for people working with children. 

Trauma and the impact on children's education

There is a movement in the United States at the moment towards creating what are called Trauma Sensitive Schools. It is of course no surprise that when children experience trauma, many of them experiences difficulties at school. For some kids these difficulties will be short lived, but for others the difficulties will persist over time and significantly impact on their ability to learn, as well as their relationships at school. This is especially true for those children who live in environments where there is constant stress or ongoing abuse. 

Just some of the difficulties that these children may face at school include: 

• problems with concentration and attention
  
• difficulties with short term memory
• decreased ability to follow instructions in the classroom
• difficulties transitioning between activities and between teachers
• difficulties in managing their emotions
• problems trusting adults and teacher

For more extensive information on the difficulties that children may face in schools click here. 

In Washington State in the US, there has been an ongoing study looking at just how trauma and adversity impacts on children at school. Researchers worked with teachers to find out which children had experienced trauma at home. They asked teachers to identify children who had: 

• parents divorced / separated
• residential instability
• witnessed domestic violence
• been involved with child protection
• a family member in prison
• a family member with a substance abuse problem
• basic needs not met
• a family member with a mental health difficulty
• a family member with a physical disability
• been exposed to community violence
• a parent or caregiver who had died. 

They then looked at key areas in the child's schooling including whether the child was meeting grade expectations at school, attendance problems, behaviour problems and poor health. Not surprisingly they found that trauma and adversity in a child's life was strongly related to how the child was functioning at school. 

Children who experienced just one adversity were two times more likely to have attendance problems and 2.5 times more likely to have behaviour difficulties at school than those children who had not experienced any trauma or adversity. When they considered children who had three or more adversities present, the results were significant. These children were three times more likely to have academic failure; five times more likely to have attendance problems; six times more likely to have behaviour difficulties; and four times more likely to have poor health. Unless these difficulties are addressed within the school, children fall behind and some disengage from schooling altogether.

These findings have led to the implementation of programs to create schools that are trauma sensitive. A school that is trauma sensitive is one that builds meaningful relationships with students and parents or carers; create an environment of safety and predictability for all students; promote skill development for all students; help to build reasoning and problem solving; and add targeted supports where necessary. In order to do this, they start by building social emotional learning into universal practice across schools. All school staff are provided with professional development on social emotional learning and trauma informed practice. This assists teachers to look at new ways to address classroom management and to recognise and reduce triggers for trauma responses amongst students. 

The results of these trauma sensitive schools have been positive. There have been fewer behaviour difficulties in children and less suspensions and an increase in teachers satisfaction and self efficacy. This New York Times article provides a good overview of some of the interventions and the successes of the program. 

Of course, changing the way any system works takes time, knowledge, resources and a willingness for change. But it can be done. And considering that the long term benefits of children completing schooling include better physical and mental health, improved ability to participate in family life and more opportunities for employment and financial security, it seems crucial that we start to take steps to make schools a safe and engaging place for everyone. 

A cost effective way to help children after trauma

There is an increasing shift in community health to looking at more cost effective models to treat children and young people who have a range of mental health difficulties, including anxiety, depression and more recently post-traumatic stress. One of the models that is currently being trialled is a stepped care model. You can read more about the latest research on this here. 

Stepped care models provide treatments that are designed to minimise the use of therapist hours as well as costs, time and inconvenience to those participating in the therapy. Therapists provide treatment in steps according to the needs of the individual they are treating. Step 1 involves few therapist sessions, with clients working through material at home and accessing support as needed. Clients are monitored and assessed to determine if they then need more intensive treatment following Step 1, and if they do, they proceed to Step 2, involving an increase in one on one sessions with therapists. 

This is a particularly useful model to consider in the treatment of young children who have experienced trauma. There is often limited access to therapists who are well trained in treating symptoms of trauma in young children, and the services that they typically present to - community and public health systems - are often limited in terms of providing cost intensive treatments. Step 1 of the stepped care model for treating trauma, also puts the parent in the role of providing some of the treatment, an element which has been strongly supported in therapy with younger children. A potential barrier to treatment for parents of young children seeking or completing treatment is the parents desire to solve the problem related to the child on their own. With both parents and children both actively involved in therapy it is likely that it will be more successful. Some of the components of the intervention that has been trialled include: 

• 3 sessions with a therapist
• workbooks for both the parents and the child to work through at home that incorporates exposure tasks and relaxation exercises
• phone calls to therapist for support
• access to psychoeducation through online resources 

This is a promising development in the area of treating children affected by trauma, with the potential to allow greater access to children earlier in life. For more information on the latest research and news coming out in this area, subscribe to the Australian Child & Adolescent Trauma, Loss & Grief Network and visit our Journals section. 

A link between ADHD and trauma

A recent study by the American Academy of Pediatrics has found that children who have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) are more likely to experience more adverse life events than those children without ADHD. The researchers involved in the study analysed data from the National Survey of Children's Health in the United States. They found: 

• 17% of children with ADHD experienced 4 or more adverse events compared to 6% of children without ADHD. 
• These children with 4 or more adverse events were more likely to be using medication to treat the ADHD. 
• The parents of these children with ADHD and 4 or more adverse events were more likely to rate their child's ADHD as moderate to severe. 

The adversities that were measured as part of the study included divorce; death of a parent or guardian; discrimination; domestic violence; mental health difficulties in the family; incarceration of a family member; neighbourhood violence; living in poverty; and substance abuse in the family. 

The results of this study are interesting for many reasons, especially given the ongoing public concern that there is an over diagnosis of ADHD in the community. 

Many of the symptoms that a child displays when they have been negatively impacted by an adverse or potentially traumatic event, are very similar to symptoms that children who are diagnosed with ADHD present with. These include symptoms such as difficulties in concentration and attention, difficulties in organisation, difficulties in relating to others and difficulties in behaviour. 

The study highlights the need that those working with children and young people need to be trauma aware and trauma informed. Unfortunately, there are some cases where children do get misdiagnosed and treating a child for ADHD when they are presenting with behaviours and symptoms of trauma is not meeting the needs of the child. 

6 ways that every parent can support their child after trauma

If you are a parent or carer of a child who has experienced a traumatic event, it can feel overwhelming, upsetting and confusing knowing what you can do to help. This is true for parents and carers whether the traumatic event is a one off, like a fire or a car accident, or whether it is something that has been happening repeatedly, like child abuse. 

We know from lots of studies and research that kids who have had a traumatic experience do much better when their parents or carers are coping well and are there to support them. So what are the steps that you can take to support your child and help them to get through all the emotions that they may be experiencing after the event. 

Well, there are many ways that you can provide support. We have put together a list of 6 effective ways that can be a great starting point for helping your child. 

1. Get information. It is really helpful if you educate yourself about what sort of thoughts, feelings and emotions your child may experience after a traumatic event and how these may come out in their behaviour or play. There is lots of information available on the internet that can help you to understand how trauma impacts on children of different ages and stages. Knowing more about how your child may possibly react can help you to support your child. 
2. Acknowledge feeling or loss and fear, and other emotions, that your child may demonstrate. Provide assurance to your child that the thoughts, feelings and reactions they are having are normal even though they may be upsetting. 
3. Reassure your child that they will feel better over time and that if they need extra support to feel better, you will make sure it is there for them. 
4. Encourage your child to feel free to talk about the traumatic event if they wish to. Don't push them to talk if they are not ready and also be aware if they are talking about the event all the time. 
5. Model positive coping strategies. Children who see their parents using a number of positive coping strategies to cope with difficult circumstances are more likely to also cope better themselves. 
6. Demonstrate to your child that you have an optimistic view of the future. Tell them that even though things may be especially difficult right now, there is hope that things will get better. 

Overall, keep in mind, that most children will get through the experience of a traumatic event and return to normal within the weeks and months that follow without the need from any additional support. However, if you do have concerns about how your child may be coping, remember to talk to your GP, child health worker or school counsellor. 

Young people and their experiences of trauma focused therapy

There is so much research around that discusses the success of therapeutic approaches in terms of measuring changes and outcomes in individuals and the ease of which a therapist can utilise an approach, that it is really great to see research that looks at the experience of the individual during the therapy. This is especially the case when it is the experience of a child or young person. 

Engaging in a useful, helpful and supportive therapeutic relationship with children and young people who have experienced trauma is crucial to the success of therapy and to the ongoing wellbeing of the young person. We now know so much about the long term damaging impact that trauma can have, that effective therapy can be our chance to mitigate this impact and change the trajectory for the child. 

New research appearing in the Child Abuse & Neglect journal, has looked at the experience of receiving Trauma-Focused Cognitive Behavioural Therapy (TF - CBT) from the perspective of the young people involved in the therapy. There have been several studies that have demonstrated the efficacy of TF-CBT, both with adults and young people. The authors of this study state that they believe that this is the first to really examine the experience of TF-CBT from the a young persons perspective. 

"Because therapeutic work with traumatised children who struggle with posttraumatic stress symptoms may entail specific challenges, gaining greater knowledge from the children themselves about what is experienced as difficult or helpful in therapy may bring the field a step closer to helping the many children who suffer from traumatic experiences."

The authors of this study interviewed thirty 11-17 year olds in the weeks after they had completed their treatment. Their traumatic experiences included events such as bullying, sexual abuse and violence within and outside of the family. 

Results
Responses were grouped in to four main themes: 

• changing expectations (expectations of the therapist, expectations of the process)
• talking to the therapist and sharing information
• working through the trauma narrative
• change and change processes

The study reported that most young people found that engaging in therapy was initially anxiety provoking, but that working with a therapist who was kind, empathetic and knowledgable helped to reduce their anxiety. Primarily this experience of anxiety was around discussing their trauma history with a person they didn't know, which the authors believe may be closely related to the young person experiencing a prior breach of trust with adults and therefor experiencing an increased reluctance to place trust in the therapist. The young people in the study reported that they felt more willing to engage in work around the trauma narrative when the therapist had clearly explained why this was important, was able to work at the child's pace and not push them, and was also able to contain the strong emotions of the child that arose during the trauma narrative. 

Young people involved in the study also reported that confidentiality was particularly important for them, but that when issues around their trauma were discussed with their families (with the permission and prior planning of the young person) that this was helpful and appreciated. 

Most of the young people involved in the study reported that they experienced change as a result of the therapy and that it had assisted them by reducing the symptoms they experienced as well as to develop new skills to manage any trauma symptoms they may continue to experience. 

"Many therapists have found that working with traumatised youths is challenging, and talking about the traumatic events seems to be particularly demanding. However, the data from the present study suggests that youths view working with their trauma stories as one of the most helpful interventions."

Reference: 
Dittmann, I., & Jensen, T.K. Giving a voice to traumatized youth - Experiences with Trauma-Focused Cognitive Behavioral Therapy. Child Abuse & Neglect (2013).