Recognition and Response to
Childhood Trauma in the
Elementary School Setting
Ally Burr-Harris, Ph.D.
The Greater St. Louis Child Traumatic Stress Program
University of Missouri-St. Louis
November 13, 2003
Greater St. Louis
Child Traumatic Stress Program
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Member of National Child Traumatic Stress Network
(NCTSN) - www.nctsnet.org
 Services provided by Children’s Advocacy Center
and Center for Trauma Recovery at UMSL
 Free assessment and treatment of children and
adolescents who have experienced a trauma
 Consultation and training of education, mental health,
and medical professionals in the area of child trauma
 School-based group therapy for children and
adolescents exposed to violence
What is a Traumatic Event?
Involves actual or threatened death or
serious injury, or a threat to the person’s
physical integrity
 Involves feelings of intense fear,
helplessness or horror (children may
show disorganized or agitated behavior
instead)
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Types of Traumas
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Natural disasters
Kidnapping
School violence
Community Violence
Terrorism/War
Homicide
Physical Abuse
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Sexual Abuse
Domestic violence
Medical procedures
Victim of crime
Accidents
Suicide of loved one
Extreme Neglect
How Common are
Traumatic Experiences?
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69% of the general U.S. population report
exposure to one or more traumatic events
14 to 43% of children/adolescents report
having experienced a traumatic event
23% of national sample of adolescents report
being victim or witness of violence
Up to 91% of African American youth in urban
settings report violence exposure
Among refugee children, rates of trauma
exposure approach 100%
Large-scale traumas in schools are very rare
but highly publicized
Effects of Trauma on Children
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Most people experience posttraumatic stress
symptoms up to several weeks post-trauma.
 Approximately 20% of youths exposed to
serious trauma have persistent PTSD
 Rates much higher for severe, chronic, or
interpersonal trauma
 PTSD rates:
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School shooting: 77%
Sexual abuse: up to 90%
Murder/sexual assault of parent: up to 100%
Community violence: 35%
Effects of Violence Exposure
on School Functioning
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Decreased school performance
Decreased school attendance
Increased concentration problems
Decreased academic and cognitive scores
Linked to aggression, conduct problems,
social deficits, substance abuse, delinquency,
and psychiatric problems
Identifying Physical Abuse
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Bruises, welts, burns, fractures, cuts & abrasions
Injuries to multiple body areas
Various stages of healing
Wearing clothes to cover injuries
Reluctance to seek medical help
Extensive history of injury
Inconsistent/unbelievable explanation of injury
Excessive fear of punishment and/or caregiver
Wary of physical contact
Frequent school absences
Running away
Child discloses physical abuse
Identifying Sexual Abuse
Difficulty walking or sitting
 Sudden refusal to change for gym or to participate in
physical activities
 Inappropriate sexual knowledge/behavior
 Pregnancy/STD
 Enuresis/encopresis
 Frequent urinary tract/vaginal infections
 Wary of physical contact
 Running away
 Abnormal fears about bodily functions (e.g., urination)
 Child discloses sexual abuse
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Identifying Neglect
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Frequent absences from school
Begs or steals food/money from classmates
Lacks needed medical, visual or dental care
Consistently dirty, poor hygiene
Insufficient or ragged clothing
Abuses alcohol or other drugs
Malnourished/constant hunger
Tiredness
Lack of supervision
Child discloses neglect
Identifying Emotional
Abuse/Neglect
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Extreme behaviors (e.g., passive-violent)
Developmental delays
Self-deprecation
Overreaction to mistakes
Withdrawal
Aggressive behavior
Pseudomature behavior
Negative affect/flat affect
Passivity/apathy
Poor social skills (e.g., indiscriminately friendly)
Child discloses emotional abuse
“Something Is Wrong”
Indicators
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Anger/irritability
Symptoms of depression/anxiety
Sudden changes in behavior
Sudden changes in school performance
Loss of interest/social withdrawal
Self-destructive behaviors
Loss of energy
Difficulty concentrating/attending
Sudden change in activity level
Immediate Reactions To
A Trauma Or Crisis
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Intense longing/concern for caregivers or loved ones
Emotionally labile
Extreme emotions (rage, fear)
Tearful, crying
Excited
Clinging to caregivers
Shock, numbness
Denial, inability to acknowledge situation
Dazed, feelings of unreality, dissociation
Confused, disorganized
Difficulty making decisions
Suggestible
Fight or flight mode, physical symptoms
Trauma Symptoms in
Elementary School Children
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Sadness, crying, irritability, aggression
Increased activity level
Poor frustration tolerance
Safety-related fears
Generalized fear
Unable to verbalize distress
Nightmares
Trauma themes in play/art/conversation
School avoidance; decline in school
performance
Trauma Symptoms in
Elementary School Students
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Physical complaints
Poor concentration
Regressive behavior (e.g., clingy, wetting
bed, babytalking)
Eating/sleeping disturbances
Attention-seeking behavior
Withdrawal
Magical thinking related to trauma/death
Trauma Symptoms in
Middle and High School Students
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Depression
Feelings of shame/guilt
Detachment, denial of feelings
Avoidance of trauma cues
Intrusive images, thoughts, memories
Withdrawal from peers and/or family
Low energy, loss of interest
Appetite/sleep disturbance
Generalized anxiety, safety fears
Foreshortened future
Trauma Symptoms in
Middle and High School Students
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Physical ailments/complaints
Increased anger, irritability, aggression
Agitation
Peer problems (e.g., fighting)
Decreased interest in opposite sex
Increased risk-taking, rebellious behaviors
“Pseudomature” behaviors
Substance abuse
Decline in school performance/attendance
Risk Factors for Post-Trauma
Adjustment Problems
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Previous trauma exposure
 Severity of trauma
 Extent of exposure
 Proximity of trauma
 Understanding and personal significance
 Interpersonal violence
 Parent distress, parent psychopathology
 Separation from caregiver
 Previous psychological functioning
 Genetic predisposition
 Lack of material/social resources
Protective Factors for PostTrauma Adjustment
Strong academic and social skills
 Active coping, self-confidence
 Social support
 Family cohesion, adaptability, hardiness
 High neighborhood/school quality
 Strong religious beliefs, cultural identity
 Effective coping and support by parents
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Comforting Traumatized Children
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Reinforce ideas of safety and security
Allow them to be more dependent temporarily
if needed
Follow their lead (hugs, listening, supporting)
Use typical soothing behaviors (rest, comfort,
food, hugs, stuffed animal, music)
Use security items and goodbye rituals to
ease separation with younger children
Distract with pleasurable activities*
Let the child know you care
*normally occurring
Controlling Child’s Environment
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Maintain normal routines as much as possible
Reduce class workload as needed
Avoid exposing children to unnecessary
trauma reminders (e.g., media)
Minimize contact with others who upset child
Guide other children in supporting child
Give trauma cues positive change
Discussing the Trauma
with Children
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Encourage children to express their traumatic
experience but don’t pressure
Be an active listener
Remain calm when answering questions and use
simple, direct terms
Don’t “soften” the information you give to children
Help children develop a realistic understanding of
what happened
Gently correct trauma-related distortions
Be willing to repeat yourself
Normalize “bad” feelings
Intervening with
Traumatized Children
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Identify triggers (e.g., trauma cues) that upset child
and plan ahead
Defuse anger
Address acting out behaviors involving aggression or
self-destructive activities quickly and firmly
Model/coach adaptive coping with upsetting feelings
Set up behavior management plan reinforcing
adaptive coping and appropriate behavior
Do not tolerate inappropriate negative behavior
(harassment, bullying, threats)
Avoid traumatizing classmates during trauma
reenactments/discussions
Be patient and calm
Facilitating Trauma Resolution
Use play, art, stories to assist with
trauma resolution
 Normalize symptoms/reactions
 Reinforce positive messages
 Positive reminiscing of deceased
 Encourage constructive activities
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– Teach tolerance and respect
– Recovery events
How to Talk (and Listen) to
Traumatized Children
Children need to have their feelings
accepted and respected
 Listen quietly and attentively
 Acknowledge their feelings with a word
or two
 Give their feelings a name
 Give them their wishes in fantasy
 Show empathy
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Responses That ARE NOT So
Helpful
Denial of feelings
 Philosophical response
 Advice
 Too many questions
 Defense of the other person
 Pity
 Amateur Psychoanalysis
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Common Trauma-Related
Distortions in Youth
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Self-blame
Guilt, survivor guilt
Overgeneralization of danger/risk
Shame/embarrassment b/c of trauma
Shame over PTSD symptoms
Hero fantasies related to trauma
Omen formation
Foreshortened future
Magical thinking
Correcting Distorted Beliefs
Point out the child’s distorted belief by
briefly summing it up
 Label how you think they might feel
 Validate their feeling; show empathy
 Let them know how it makes you feel to
hear the distorted belief
 Suggest a healthier belief; keep it brief
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Helping Grieving Children
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Don’t be afraid to talk about the death
Be prepared to discuss the same details over
and over again
Be available, nurturing, reassuring and
predictable
Assist youths in developing grieving rituals
and in finding meaning
Help other students learn how to respond
Anticipate need for extra support when child
faces loss reminders (e.g., holiday)
Helping Grieving Children
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Assist younger children in understanding
finality of death.
Use youth’s (family’s) own belief system
when discussing afterlife
Share memories and talk about the person
who died when appropriate
Gently remind children ALL feelings are okay.
Use reminders like “you did not cause this” or
“it is not your fault.”
Helping Parents of Traumatized
Children
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Communicate with parents frequently about child
 Encourage parents to listen to child closely
 Encourage parents to set aside special time for child
 Recommend maintenance of normal routine
 Encourage parents to remain calm and to get help for
themselves if needed
 Normalize child’s emotional/behavioral difficulties
after trauma
 Model soothing behaviors with younger children
 Assist in developing plan for behavior mgmt.
When to Refer for
Psychological Care
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Appear depressed, withdrawn, noncommunicative
Strong resistance to affection/support from caregivers
Suicidal or homicidal ideation
Dangerous behaviors to self/others
Increased usage of alcohol or drugs
Rapid weight gain or loss
Significant behavioral changes or problems (e.g.,
sexual)
Discontinue attending to hygienic needs
Significant acute stress symptoms
When to Refer for
Psychological Care
Showing these changes for more than 1 month after trauma
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Intense anxiety or avoidance behavior triggered by
trauma reminders
 Unable to regulate emotions (crying, angry outbursts)
 Poor academic performance and decreased
concentration
 Continued worry about event (primary focus)
 Excessive separation difficulties
 Physical complaints (nausea, headaches)
 Continued trauma themes in play
 Unable to grieve/mourn death of loved one
We’re done!
For additional questions, references, or
referrals, contact Ally Burr-Harris, Ph.D.
Phone: 314-516-5440
Email: Burrharrisa@msx.umsl.edu