Over the course of this harrowing, surreal week, Dr. Gene Beresin offered some very useful professional advice on how to explain the terrible events to kids while still trying to make them feel safe and secure.
Beresin, a child psychiatrist and director of the Massachusetts General Hospital Center for Mental Health and Media, also shared this advice for stressed-out grownups struggling with Friday's city-wide lockdown, which kept millions trapped in their homes and on edge for the day.
As one Boston-area mom put it on Facebook Friday night: "So many feelings — relief its over, sadness that it all happened, grief at the losses and injuries, anger that my kids are growing up in a world of violence and just plain tired from being on high alert all week."
Now that the remaining Marathon bombing suspect has been captured, the question is: will the trauma linger on? And if so, what form will it take? In a continuing attempt to help parents mitigate any residual stress, Beresin offers these tips on trouble signs to watch for as children and families return to "normal" life and daily routines.
By Gene Beresin, MD
What a week. From Monday's Marathon bombing to Friday's city-wide "stay at home" order to, finally, the dramatic capture of the bombing suspect, the people of Boston have had an intensely stressful and emotional few days. That includes the kids.
Parents are understandably worried about the impact these events have had on their children (and themselves). We remember how long it took to recover from other tragedies.
Fortunately, kids and families tend to be incredibly resilient. However, there may be a range of emotions and behaviors that parents could notice in the short run that would tip them off about a problem.
Here are some things to look for, and even more importantly, if you do see them, things you could do to fend off longer term problems:
• Remember that kids observe your behaviors and react to your feelings and actions.
• Parents need to take care of themselves first. It is much like the statement on airplanes, if the pressure drops, put the oxygen mask on yourself first, then help the child next to you. Parents are best able to help kids of any age if they have a means of processing the tragedy. The more you can obtain support from others, calm yourself down and present yourself in a supportive way, the better this is in allowing you to help your kids. This usually means having nurturing family members and/or a community to help you.
• Kids need a few basic things:
Reassurance things are going to be OK
Assurance their daily needs will be met
Presence of caring adults who are paying attention to them
Hope for the present and future.
How can parents and caregivers distinguish normal reactions to trauma from those that are worthy of concern and perhaps professional attention? Let’s look at kids in different age groups. And remember that a change in the short run may simply be a phase and can disappear with a brief response. So don’t jump to conclusions that things are going to be terrible at the first signs of problems.
Infants, Toddlers and Preschoolers
Very young children have a limited repertoire for expressing distress. They will not tell you what is going on, so you need to watch for signs of upset. Look for changes in behavior compared to their “baseline.”
What can parents look for in this age group?
--Increased anxiety when separated from parents and caregivers
--Increased watching to see how parents are reacting
--Emotional regression, such as more clinging or whiny behavior
--Difficulty sleeping, fears of the dark, or some bed wetting
--Irritability, including temper outbursts, increased sensitivity to loud sounds, such as thunder or airplanes
--Regression to “old” behavior, such as thumb sucking, wanting to sleep with parents
What can parents to do if they see this behavior?
--Spend some additional time with your kids. Provide more hugging, cuddling, and playing with them. This will reassure parent and child.
--Be more patient and reassuring, particularly with difficult regressive behavior
--If your child wants to sleep in your bed, that’s okay, especially at times of great stress
--Turn the TV off! Limit exposure to news coverage of an attack. If you wish to watch or listen, do so when your children are not in the room. They do not yet have the ability to put the frightening images they see in perspective.
--Maintain normal routines and minimize unnecessary separations
--For toddlers and preschoolers, ask if they have any worries. Share your feelings to demonstrate that it is okay to talk about feelings (not the events with preschoolers). Some kids may express their feelings by drawing, coloring or playing fantasy games, such as those with dolls’ houses or action figures. Encourage this, and try to play along. Such play may reveal their emotional struggles and simultaneously help them resolve the feelings they are struggling with
Children ages 6-12 are more advanced intellectually. They have a clear sense of right and wrong, but tend to be strictly rule oriented. They have a simplistic view of “good guys” and “bad guys”. They feel safest if things are clear-cut.
They also have a greater sense of empathy, and can appreciate the sadness or fear of others, even those they see on television. They have begun to understand the finality of death. Despite these advances, they are not able to comprehend abstract concepts, such as justice, and they have a limited sense of causality. They also are not able to distance themselves emotionally from events, and see things truly objectively. They tend to “personalize” events, as if they happened or will happen to them or their families.
While they may be reassured by talking and understanding more than younger children, they may easily become overwhelmed and confused with complex events that are highly charged emotionally.
What can parents look for in this age group?
--Anxiety around separation from family, sometimes not wanting to play with friends or go to school
--Problems with sleep, fear of the dark, fear of burglars or harm coming to themselves or parents
--Re-experiencing exposure to traumatic events through repetitive thinking, playing, talking about the event, or nightmares
--Increase in physical complaints, such as stomach aches, head aches
--Poor concentration at home or at school, occasional with decreased school performance
--Thoughts about death and dying
--Worrying, either about bad things happening, or seemingly trivial details of daily life
--Irritable mood, crabby behavior, occasional temper outbursts
What can parents do if they see this behavior?
--Remember that kids often work through their emotional issues with play instead of words. Children use toys to replay scary things they’ve seen or imagined. This is normal behavior and can be rewarding for them (though it may be hard for you to watch!).
--You should expect that school-age kids have seen images of the bombing or heard news reports. Televisions and computers are everywhere, and there may be discussions about the Marathon in school. Many of these experiences are terrifying. Ask them what they have seen or heard, and be prepared to provide reassurance and hope, and to instill a sense that they will be kept safe.
--Let younger children know that even though they have seen the same pictures or images of the bombing, it only happened once and is over.
--Remember that school-age kids may have no idea where Boston (or Watertown or Cambridge) is. You should remind them where it is located in relation to your house.
--Kids need to have perspective. You can assure them that the finish line of the Boston Marathon is a very important, but their house or school is not the same as a national monument.
--If your kids ask questions, this is great. You want them to talk and express their feelings. Be patient and try to answer them simply and honestly.
--Encourage your child to express his or her feelings, worries and concerns, and respond in kind by sharing yours. Allow feelings of anger, but try to re-direct misplaced feelings of hate.
--Remind your children that there are many, many more good people in the world than there are bad people, and that the good people will try to take care of them and protect them.
--Also remind them to look for the helpers. The wonderful quote by Mr. Rogers is very important for kids and adults alike. Not only are there many good people in the world, but we all can be helpers, and the more the better!
--Let your children participate in efforts to make things better. This makes them feel like they are the helpers! This might include raising money and sending it for relief efforts, helping in community activities, or sending a note, card or drawing to victims of terrorism.
--Help your children get back to “business as usual”. Keeping a normal schedule will reassure them. Provide comforting, shared activities, such as listening to music, playing games or telling stories.
Teens are much more aware of the dangers in the world. They are grappling with issues of personal and societal dangers. They appreciate the risks involved in life, and many have lost pets, loved ones such as grandparents, or know of friends who have dealt with death. They themselves have taken risks or know of others who have; they know about “near misses.” They may be fearful of what is going to happen to the world, their life and their future.
Situations such as the Marathon bombing and subsequent manhunt raise fears about the uncertainties in life. After such tragedies as 9/11, the Newtown shooting or the Aurora Cinema shooting, many teens felt a sense of foreboding, fearfulness about manmade as well as natural disasters.
The aim of working with teenagers is to see how they are reacting at home, school and with peers, and watch for any clear changes in behavior.
What can parents look for in their teens?
--Watch for changes in sleep, appetite, and normal routines
--Some teens may be much more anxious and fearful of even basic activities like going to school, watching the news or even their favorite TV show
--Watch for increased irritability, crabbiness, refusal to help in ways they typically did not act before
--Some teens will isolate themselves from friends and family
--Be on the lookout for dramatic “personality change,” such as a talkative kid who is now very quiet, or a calm teen who is really jumpy and anxious.
What can parents do if they see behavioral changes in their teens?
It is very useful to watch the news with them, and ask them their opinions and reactions to what you are viewing. Ask them questions. Ask them how such things can happen in the world, what will make the world a safer place, how they would change things. Get them to open up.
Remember, you may be putting together the Marathon Bombing with 9/11, the Newtown or Aurora shootings but your teens may not. Do not assume that they are seeing the world in negative terms. But also keep in mind that while you remember all these events, some of your teenagers may not. Try not to put all the negative events in their lives on the table, as this will be overwhelming. Teens need hope for a positive future.
Most of all teenagers want to be heard and understood. At the same time, they may be wary of sharing their inner fears to parents, unless there is a long history of talking together. It is very helpful to share your own personal concerns with them. Teens are eager to hear about your life experiences, losses, near misses and frightening times. Adolescents love to hear about parents’ lives and their own struggles. If you had experienced dangerous or frightening situations, share them with your teenagers.
Remember that most kids and parents will gradually recover from the shock we experienced following the Marathon bombing. If your child continues to show many of the behaviors mentioned above even after a week or two, and you have tried some of the techniques suggested, or if new symptoms appear, it may be a good idea to take her or him to your pediatrician, school guidance counselor, or seek a child psychologist or psychiatrist for advice.
College students are more advanced than teenagers intellectually. Their experience involves an increased ability and interest in grappling with the important issues in their lives and in the world. In addition, they have often met with more “near miss” experiences than teenagers. They have probably known of relatives, or sadly even friends who have died. They are concerned about their place in life, their future role in the workplace, and what the world will be like for themselves and their future family.
Many will identify with the loss of the graduate student in the bombing and intensely appreciate the fragility of life. At the same time, they may be desperately trying to understand why anyone would do such a thing – considering political, personal, and emotional motives. Many will be actively talking with each other, and certainly processing the events socially and in the classroom. They will try to put together the historical terrorist attacks in the United States and around the world. Remember, college kids today lived through 9/11 when they were early school-age kids. Further, they will be actively seeking information about the event by increased use of digital and social media.
While over half of psychiatric disorders begin in childhood and adolescence, the onset of emotional problems peaks in college, particularly mood disorders. This may add to vulnerability. Though this age group may be better equipped to deal with the bombing intellectually, college students still feel quite insecure and will need considerable guidance and attention in order to understand an event that is baffling to the most stable adult. And since they are often away from family in the school setting, they may have less of a protective environment than younger kids. College students often look and feel very much like adults, but truth be told, they still need their parents to provide guidance and reassurance. And since they are struggling with their own issues of identity, they may be more open to discuss and consider profiling and labeling than younger kids.
College kids want to express their ideas, feelings and worries about current events. Ask open-ended questions about the bombings and see what they come up with. Then enter into conversation about what could cause events like this to occur and how they may be prevented.
Talk with them about their sense of safety and role in the world. How do they feel about their future? Are they worried that the world will be a dangerous place? How might they want to help change things? College age kids usually are idealistic, and need to feel that they may be able to make a difference in the world.
If your conversations uncover significant emotional issues, such as depression, social isolation, excessive anxiety, lack of interest in the future, or use of substances, perhaps discussing the possibility of talking with a professional to get further guidance.
Most children, teens and college kids will cope with the support and understanding of their parents, teachers, coaches, friends and clergy. Some who may be vulnerable because of previous personal experiences may need special attention from a school counselor or family pediatrician.
Readers, any specific questions lingering in your minds? Please post questions below, or tweet Dr. Beresin at @GeneBeresinMD.
This program aired on April 20, 2013. The audio for this program is not available.