How does intervener survival impact a responder? Why important? How do effective communications skills aid in intervention? Is not just plain talk enough?CouragetoCommitChapter8.docx

Childhood Crises

Childhood crisis might be more difficult to assess than adult crisis. Children have a limited fund of experience with which to handle crisis, limited cognitive structure, limited training, and usually an immature emotional base. Perhaps even more important is the fact that very young children have not yet developed a sense of cause and effect or a sense of time. Therefore, whatever pain occurs seems to go on forever. As the child becomes older and struggles with their identity, independence, psychological changes, peer pressures, and cultural and parental demands, the potential for heightened stress increases. Often, as occurred with Judy, the child’s need for help goes unrecognized, or is ignored or belittled. Often, as occurred with Judy, the child is told to go out and play; to be a big boy or a big girl; to be the man of the house now that Daddy is gone as a result of divorce, military service, job transfer, or illness; or to be seen but not heard.

Often, in an act of protectiveness, parents exclude children from discussions of crises. Questions may

be answered evasively or not at all, as in the case of Judy. Protectiveness carried to extremes may result in the child’s having little ability to communicate concerns, to have questions answered, or to establish the cognitive and emotional channels necessary for their own adaptation to change and loss.

As needed, an intervening police officer can help the child deal with concerns such as the following:

• Threat to nurturance • Changing patterns of expression of feelings • Disrupted patterns of communication • Changes in lifestyle because of finances • Disrupted scheduling • Necessity of assuming responsibilities beyond their abilities • Perception of loss • The need to grieve • Witnessing of violence either in person or by social media and television • Active citizen protests

Difficulties with schoolwork and peer relationships; excessive withdrawal; repeated angry outbursts;

and involvement in repetitive, ritualistic, symbolic acts may reflect the stresses experienced by the child. These difficulties can be managed through skillful intervention.

As an example, in intervening with Judy, the little girl in the case described above, the following

procedure might have been used by her mother: 1.

Legitimize her feelings. Judy clearly expressed her need to be heard and her frustration at being discounted. She felt abandoned by her grandmother, yet possibly responsible for her leaving them through some unknown behavior on her part. She grieved over unfinished business with her grandmother. There was no chance to hear the end of the stories and share secrets. An effective intervener would listen to the child and acknowledge her feelings with honesty and caring.

2.

Provide Judy information according to her emotional and cognitive capacity. Perhaps the mother could explain, “Grandma did not desert you; and we did not send her away. Sometimes people need care that they can best get in a hospital or a special nursing home. Mommy and Daddy loved Grandma as you do, and we wanted her to have the best care possible. We picked a very special place that we thought she would like. Grandma loved you very much. She enjoyed telling you those stories. Soon you will be able to read them yourself. That might be a special way of spending some pretend time with Grandma.”

3.

Assure her that Grandma is no longer suffering pain or discomfort. “I saw Grandma after she died. She looked comfortable and not in pain.” It is not necessary at this time to go into a long, detailed description. Judy merely needs some reassurance about what dead people, and her grandmother in particular, look like.

4.

Offer to take Judy to the gravesite. Based on the age of the child, allow it to be their choice to accept or reject the offer. Going there will provide Judy an opportunity for visiting with Grandma and seeing the site. Let her dictate whether she wants you to stand beside her or would prefer a few moments of privacy with her grandmother. Afterward, ask if she has any other questions or wants to share any ideas or feelings. Judy might just jump in the car and suggest getting an ice cream cone. The relief of seeing that everything is in order is an important part of the adaptation process.

5.

Provide her the nurturing that she asked for. Return her hug and hold her. Let her know by your touch that you are not pushing her away.

If necessary, explain that you are tired now and would like some time alone. At this point, Judy can probably accept your need to move to some other activity. Her immediate needs have been met.

Although many feelings and reactions are shared by people of all ages in response to the direct or indirect

effects of crisis, meeting the needs of children requires special attention. Typical reactions of children, regardless of age, include the following:

• Fears stemming from the crisis extending to their home or neighborhood • Loss of interest in school • Regressive behavior • Sleep disturbances and night terrors • Fears of events that may be associated with the crisis situation, such as airplane sounds or loud noises

Children of different age groups tend to react in unique ways to the stress caused by crises and their

consequences. The following typical reactions to stress are summarized for each age group and are followed by suggested responses.

Preschool (Ages 1–5) Typical reactions to stress include the following:

• Thumb sucking • Bed wetting • Fear of the dark or of animals • Clinging to parents • Night terrors • Loss of bladder or bowel control or constipation • Speech difficulties • Loss of or increase in appetite • Fear of being left alone • Immobility

Children in this age group are particularly vulnerable to disruption of their previously secure

world. Because they lack the verbal and conceptual skills necessary to cope effectively with sudden stress by themselves, they look to family members for comfort. These children are often strongly affected by the reactions of parents and other family members.

Abandonment is a major fear in this age group. Children who have lost family members (or even pets

or toys) because of circumstances either related or unrelated to the crisis will need special reassurance. The following responses may help children integrate their experiences and reestablish a sense of security

and mastery:

• Encourage expression through play reenactment where appropriate. • Provide verbal reassurance and physical comforting. • Give the child frequent attention. • Encourage the child’s expression of feelings and concerns regarding the loss, temporary or permanent, of family members, pets, toys, or friends.

• Provide comforting bedtime routines. Allow the child to sleep in the same room with the parent. Make it clear to the child that this is only for

a limited period.

Although many feelings and reactions are shared by people of all ages in response to the direct or indirect

effects of crisis, meeting the needs of children requires special attention. Typical reactions of children, regardless of age, include the following:

• Fears stemming from the crisis extending to their home or neighborhood • Loss of interest in school • Regressive behavior • Sleep disturbances and night terrors • Fears of events that may be associated with the crisis situation, such as airplane sounds or loud noises

Children of different age groups tend to react in unique ways to the stress caused by crises and their

consequences. The following typical reactions to stress are summarized for each age group and are followed by suggested responses.

Preschool (Ages 1–5) Typical reactions to stress include the following:

• Thumb sucking • Bed wetting • Fear of the dark or of animals • Clinging to parents • Night terrors • Loss of bladder or bowel control or constipation • Speech difficulties • Loss of or increase in appetite • Fear of being left alone • Immobility

Children in this age group are particularly vulnerable to disruption of their previously secure

world. Because they lack the verbal and conceptual skills necessary to cope effectively with sudden stress by themselves, they look to family members for comfort. These children are often strongly affected by the reactions of parents and other family members.

Abandonment is a major fear in this age group. Children who have lost family members (or even pets

or toys) because of circumstances either related or unrelated to the crisis will need special reassurance. The following responses may help children integrate their experiences and reestablish a sense of security

and mastery:

• Encourage expression through play reenactment where appropriate. • Provide verbal reassurance and physical comforting. • Give the child frequent attention. • Encourage the child’s expression of feelings and concerns regarding the loss, temporary or permanent, of family members, pets, toys, or friends.

• Provide comforting bedtime routines. Allow the child to sleep in the same room with the parent. Make it clear to the child that this is only for

a limited period.

Early Childhood (Ages 5–11) Common reactions to stress in this age group include the following:

• Irritability • Whining • Clinging • Aggressive behavior at home or at school • Overt competition with younger siblings for parent’s attention • Night terrors, nightmares, or fear of darkness • School avoidance • Loss of interest and poor concentration in school • Fear of personal harm • Confusion • Fear of abandonment • Generalized anxiety

Fear of loss is particularly difficult for these children to handle, and regressive behavior is most

typical of this age group. The following responses may be helpful:

• Patience and tolerance • Play sessions with adults and peers where affective reactions can be openly discussed • Discussions with adults and peers about frightening, anxiety-producing aspects of events and about appropriate behavior to manage the child’s concerns and the stress

• Relaxation of expectations at school or at home; it should be made clear to the child that this relaxation is temporary and that the normal routine will be resumed after a suitable period

• Opportunities for structured, but not unusually demanding, chores and responsibilities at home • Maintenance of a familiar routine as much as possible and as soon as possible

Preadolescent (Ages 11–14) The following are common reactions to stress for this age group:

• Sleep disturbances • Appetite disturbance • Rebellion in the home • Refusal to do chores • School problems, such as fighting, withdrawal, loss of interest, and attention-seeking behavior • Physical problems, such as headaches, vague aches and pains, skin eruptions, bowel problems, and psychosomatic complaints

• Loss of interest in peer social activities • Fear of personal harm; fear of impending loss of family members, friends, or home • Anger • Denial • Generalized anxiety

Peer reactions are especially significant in preadolescence. These children need to feel that their fears are both appropriate and shared by others. Responses should be aimed at assessing tensions, anxieties, and possible guilt feelings.

The following responses may be helpful:

• Group activities geared toward the resumption of routines • Involvement with same age group activity • Group discussions geared toward examining feelings about the crisis and appropriate behavior to manage the concerns and the stress

• Structured, but undemanding, responsibilities • Temporarily relaxed expectations of performance at school and at home • Additional individual attention and consideration

Adolescent (Ages 14–18) Common reactions in this age group include the following:

• Psychosomatic symptoms, such as rashes, bowel problems, and asthma • Headaches and tension • Appetite and sleep disturbances • Hypochondriasis • Amenorrhea or dysmenorrhea • Agitation or decrease in energy level • Apathy • Decline in interest in the opposite sex • Irresponsible behavior, delinquent behavior, or both • Decline in emancipatory struggles over parental control • Poor concentration • Guilt • Fear of loss • Anger at the perceived unfairness of a crisis occurring in their lives • Tendency to blame others for negative events that befall them

Most of the activities and interests of adolescents are focused in their own age-group peers.

Adolescents tend to be especially distressed by the disruption of their peer-group activities and by their lack of access to full adult responsibilities in community efforts.

The following responses may be helpful:

• Encourage participation in the community and in individual responses such as letter writing. • Encourage discussion of feelings, concerns, and shared information with peers and extrafamilial significant others.

• Temporarily reduce expectations for specific levels of both school and general performance, depending on individual reactions.

• Encourage, but do not insist on, discussions of crisis-induced fears within the family setting. Childhood Crisis and Referral

A wide range of normal reactions surround crisis. Usually, the reactions can be dealt with by support at home and at school, but this is not always the case. Sometimes a teacher needs to recommend professional help. In making such a referral, it is important to stress that it is not a sign of the parents’ failure if they find that they cannot help their child by themselves. It is also important to note that early action will help the child return to normal functioning and avoid more severe problems later.

Students who have lost family members or friends, either temporarily or permanently, or feel that they

were in extreme danger are at special risk. Those who have been involved in individual or family crises in addition to the crisis they are currently experiencing might have more difficulty dealing with the additional stress. Counseling may be recommended as a preventive measure when these circumstances are known to exist.

Referral is recommended when symptoms that are considered normal reactions persist for several

months or disrupt the student’s social, mental, or physical functioning. Consider referring the family for professional help if the children react in these ways:

• Seem excessively withdrawn • Do not respond to special attention and attempts to draw them out

Consider referral to a mental health professional if students react in the following ways:

• Are disoriented; for example, are unable to give their own name and address or the date • Complain of significant memory gaps • Are despondent and show agitation, restlessness, and pacing • Are severely depressed and withdrawn • Mutilate themselves • Use drugs or alcohol excessively • Are unable to care for themselves in such areas as eating, drinking, bathing, and dressing • Repeat ritualistic acts • Experience hallucinations, such as hearing voices or seeing visions • State that their body feels “unreal” and express the concern that they are “going crazy” • Are excessively preoccupied with one idea or thought • Have the delusion that someone or something is out to get them and their family • Are afraid that they will commit suicide or kill another person • Are unable to make simple decisions or carry out everyday functions • Show extremely pressured speech or talk overflow • Exhibit chronic disruptive behavior • Make self-destructive decisions

Crisis Mitigation in the Classroom

Creative classroom activities help teachers seeking ways to deal with the stress and tension a crisis and its consequences create in students. The following activities are vehicles for expression and discussion for students and are important steps in helping children handle the stress they are experiencing. You can use these activities to stimulate your own ideas and adapt them to meet both your students’ needs and your teaching style.

In preschool:

1. Make available some toys that encourage play enactment of the child’s concerns. Such toys might include airplanes, helicopters, toy police officers, toy soldiers, rescue trucks, ambulances, building blocks, puppets, or dolls. Playing with these toys allows the child to ventilate feelings about what is occurring or has already occurred.

2. Children need a lot of physical contact during times of stress to help them reestablish ego boundaries and a sense of security. Introduce games that involve physical toughening among children within a structure. Examples include “Ring Around the Rosy,” “London Bridge,” and “Duck, Duck, Goose.”

3. Provide extra amounts of drinks and finger foods in small portions. This is a concrete way of supplying the emotional and physical nourishment children need in times of stress. Oral satisfaction is especially

necessary because children tend to revert to more regressive behavior in response to feeling that their survival or security is threatened.

4. Have the children make a mural on butcher paper, using topics related to what is happening in the world and in their community. This is recommended for small groups, with discussion afterward facilitated by the teacher or other skilled adult.

5. Have the children draw individual pictures about the crisis situation and then discuss the pictures in small groups. This activity allows children to vent their experiences and to discover that others share their fears.

6. Make a group collage and discuss what the collage represents, how it was made, and the feelings it evokes.

In elementary school:

1. For younger children, make toys available that encourage play to express concerns, fears, and observations. These toys might include ambulances, planes, tanks, helicopters, toy police officers, rescue vehicles, fire trucks, building blocks, and dolls. Play with puppets can provide ways for older children, as well as younger children, to ventilate their feelings.

2. Help or encourage the children to develop skits or puppet shows about what happened during the crisis. Encourage them to include anything positive about the experience as well as frightening or disconcerting aspects.

3. Have the children create short stories about the crisis and how it was managed. These stories can be either written or dictated to an adult, depending on the age of the child.

4. Have the children draw pictures and discuss them in relation to the crisis. It is important that the group discussion end on a positive note if at all possible. Mastery and having a vehicle for expressing concerns are equally important.

5. Stimulate group discussion about crisis and its consequences by showing your own feelings and fears. It is very important to legitimize children’s fears and to help children feel less isolated. It is equally important to give them a sense of structure, balance, and control over their own activities and life.

6. Have the children brainstorm their own ways of handling their concerns. Encourage them to discuss the results with their parents.

7. Encourage class activities in which the children can organize and build projects such as scrapbooks to give them a sense of mastery and ability to organize what seems chaotic and confusing.

8. Encourage the children to talk about their own feelings about the crisis.

9. Have children brainstorm ways to be supportive of the family after the death of a classmate or a family’s loss of a home because of a natural disaster. Have the students take steps to follow up on their plan.

In junior and senior high school:

1. Conduct a group discussion of the students’ experiences concerning the crisis situation and the events surrounding it. This is particularly important to adolescents because they need the opportunity to vent as well as to normalize the extreme emotions that arise in them. A good way to stimulate such a discussion is for you to share your personal reactions. The students might need considerable reassurance that even extreme emotions and “crazy” thoughts are normal under these circumstances. It is important to end such discussions on a positive note. Such discussion is appropriate for any course of study because it can hasten a return to more normal functioning.

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