Helping Children With Post-traumatic Stress
The authors outlined cognitive, affective, behavioral and somatic symptoms of posttraumatic stress - responding to an event with intense fear, helplessness or horror. Strategies for use in school were designed to help students, individually or in groups, resolve traumatic episodes to avoid delayed or chronic responses and to maintain functioning. In addition to training children to use traditional relaxation techniques as a behavioral strategy for managing stress, the authors described affective and cognitive coping strategies.
Affective coping strategies allow expression of fears and feelings and assist the child to gain control. For example, the child selects materials to create a picture of what occurred, then describes what the picture means and how he feels. Irrational and realistic fears are discussed with the adult who role plays or engages the child in identifying ways to avoid bad outcomes, e.g., what can you do to not get hurt? The child gains control of the fear by choosing how to destroy the picture, and is commended for facing the fear and getting rid of it. Symbolic destruction of the fear helps the child gain a sense of mastery.
Cognitive coping helps children better understand the traumatic event in a safe setting with a group that shared a common occurrence, e.g., weather disaster. With ground rules to support the expression of uncomfortable feelings, children each tell what happened and how they feel about the event. The leader summarizes the event that occurred and describes the usual signs of stress in age-appropriate language to help the children recognize the normalcy of their feelings and behaviors. Positive ways to handle stress feelings are shared, e.g., telling an adult, keeping a diary.
(Richards T. Recognizing posttraumatic stress in children. J Sch Health 1997;67(10):441-443)
COMMENT: The author, a school nurse and emergency nurse, sees the importance of the school team including nurse, counselor/social worker, teachers and parents to create a support system to help students deal with a traumatic event. -J.O.