Mass General Hospital

Harvard Medical School

Tragedy and Coping

On Saturday, January 8, a gunman opened fire at a local community event in Tucson, Arizona, targeting U.S. congresswoman Gabrielle Giffords.  Giffords was shot in the head and underwent immediate surgery, and there were a total of at least 18 other victims that were killed or wounded.  The dead included bystanders and colleagues of the congresswoman, including a nine year old girl and a federal judge.  The tragedy unfolded in the midst of the most ordinary of circumstances, a Saturday morning at a neighborhood grocery store, in the context of a casual event in which a political representative made herself available to constituents.  The tragedy quickly stunned and horrified the community of Tucson and the entire country, and received national and international coverage through television, the internet, and other types of media, including social networking.

We extend our condolences to the families who lost loved ones on Saturday, and our wishes for full recovery to those who are wounded.  We wish to express support for the people of Tucson, Arizona, whose community has been stunned by this violent event.

How to Help Children Cope with Violent Events:

The impact of this tragic occurrence will have effects on many levels.  Those most closely involved are at greatest risk for posttraumatic effects, but this tragedy has the potential for broad consequences.  In these types of tragedies, Individuals even far away may experience emotional symptoms.

Many parents may find themselves called upon to provide explanations and comfort to their children.

Researchers have taken note of the broadly reaching impact of traumatic events that are given coverage on a national level by television and other media.  Three to five days after the terrorist attacks on September 11, 2001, researchers surveyed a nationally representative sample from across the United States to assess the impact of the events on adults and children (Schuster et al., NEJM, 2001).  A large minority of adults and children reported at least one symptom of stress (feeling very upset, having repeated disturbing thoughts or dreams, trouble sleeping, feeling irritable or angry) related to the event (44% of adults, 35% of children).  Importantly, 47% of children were reported to have worry about his/her own safety or the safety of loved ones.  The amount of television viewing regarding the events of 9/11 were associated with the number of reported stress symptoms in children.  There was no significant association between the extent of communication between parents and children about the event and number of stress symptoms in children, highlighting the impact of television viewing of tragic events upon stress in children.  Other researchers have also reported that media exposure can increase the risk of symptoms of posttraumatic stress disorder in children even outside proximity of the actual event (Otto et al., 2007; Lengua et al., 2005).

According to the authors of these studies, the following has been learned:

1)      Tragedies can have a profound effect on those who are not present at the event.

2)      While the traumatic effects may be greatest to those directly involved, there appear to be notable effects upon those who can identify with victims.

3)      Children who are exposed primarily though television coverage can have event related stress, with symptoms sometimes lasting years.

Some recommendations for parents helping children in the aftermath of traumatic events include: (from National Institute of Mental Health: Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do, link below):

1)      Identifying and addressing one’s own feelings — this will allow them to help others

2)      Explaining to children what happened

3)      Letting children know it is okay to feel upset

4)      Letting children talk about their feelings

5)      Keeping normal routines

6)      Helping children feel in control (for example, letting them make decisions as much as possible

Take Home Points for Parents

From Dr. Paula Rauch, MD and colleagues at Massachusetts General Hospital, helping children cope can be tailored to the age of the child.

Infants:

  • Infants pick up on the anxieties and actions of those around them, so remain calm when interacting with your infant.  Keep routines and their environment consistent.
  • Infants may be fussy in reaction to anxieties around them.

Toddlers:

  • Keep routines consistent.
  • TV and radio news exposure should be limited and only in the presence of an adult.
  • Offer videos to watch, read books and play with your child.
  • If a toddler asks questions about what is going on, answer in simple terms.  Make sure your child knows that you are there to keep him or her safe.

Preschoolers:

  • TV and radio news exposure should be limited and only in the presence of an adult.
  • If your preschooler asks questions about what is going on, answer in simple terms.  Make sure your child knows that you are there to keep him or her safe.
  • Spend extra time hugging and cuddling your child.
  • Play with your child.   Connect with friends, or organize a playgroup.
  • Do some type of special activity together.  Watch a movie, play a game, bake cookies.

School Age Children:

  • TV and radio news exposure should be in the presence of an adult.
  • Give children plenty of opportunities to talk about what they think is going on, and clear up misconceptions.
  • Encourage children to share their feelings and concerns with you. Let them know it’s all right to be afraid and that you will do everything you can to keep them safe.
  • Be available, as this age group may be more interested than younger children in the events but less capable then older children of coping and communicating.
  • Reassure kids that many people are keeping them safe and that your family is safe.
  • Offer special activities or games to them.

Adolescents:

  • Listen, listen, listen.
  • Watch TV news with them.
  • Engage your adolescent in healthy conversation.  “What do you think about the events that are taking place in our world today?”  “How did you feel when you first heard about this?”
  • Share your feelings with them honestly.
  • Encourage them to express feelings of anger, and brainstorm with them about how they can deal with those feelings.

For resources to help parents address stress and traumatic symptoms in children, the following resources may be useful:

MGH PACT (Parenting at a Challenging Time) Program: http://www.mghpact.org/home.php

National Institute of Mental Health: Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do: http://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-parents/complete-index.shtml

After the Emergency is Over: Post-traumatic Stress Disorder in Children and Youth: http://www.foh.dhhs.gov/NYCU/afteremergency.pdf

International Society for Traumatic Stress Studies: http://www.istss.org/Home.htm

Marlene Freeman, MD

Mark A. Schuster, M.D., Ph.D., Bradley D. Stein, M.D., M.P.H., Lisa H. Jaycox, Ph.D., Rebecca L. Collins, Ph.D., Grant N. Marshall, Ph.D., Marc N. Elliott, Ph.D., Annie J. Zhou, M.S., David E. Kanouse, Ph.D., Janina L. Morrison, A.B., and Sandra H. Berry, M.A. A National Survey of Stress Reactions after the September 11, 2001, Terrorist Attacks. N Engl J Med 2001; 345:1507-1512

Lengua LJ, Long AC, Smith KI, Meltzoff AN. Pre-attack symptomatology and temperament as predictors of children’s responses to the September 11 terrorist attacks. J Child Psychol Psychiatry. 2005 Jun;46(6):631-45.

Otto MW, Henin A, Hirshfeld-Becker DR, Pollack MH, Biederman J, Rosenbaum JF. Posttraumatic stress disorder symptoms following media exposure to tragic events: impact of 9/11 on children at risk for anxiety disorders. J Anxiety Disord. 2007;21(7):888-902.

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One Response to Tragedy and Coping

  1. m dickinson January 13, 2011 at 4:32 pm #

    This tragedy occurred 1/2 mile from my home and I am deeply grieving with my neighbors.
    As an adult, sometimes I feel uncomfortable with my own feelings in this tragic situation. How am I able to help my child understand this senseless, horrific violence?
    As a parent, following these structured guidelines, this information helps me to help the children grieve and process the events.
    As we heal, many of us are evolving in our grief, and into the Acceptance phase. Thank you for this valuable information, to help us cope.

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