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The Department of Psychiatry, University of Massachusetts Medical School, UMass Memorial Health Care, is continuing to gather and offer information and expert advice to help parents, families and children deal with the trauma associated with the mass shooting on Friday, Dec. 14, 2012 in Newtown, Conn.

Special thanks for the many thoughtful contributions below, from our own leading faculty members (child & adolescent specialists) in the Department of Psychiatry; the American Academy of Child & Adolescent Psychiatry; the Children’s Mental Health Network; the American Psychological Association; Mental Health America, and others.

Look for updates here as we continue to compile information and offer input from department faculty members.

In the hope of helping families cope with such tragic events the American Academy of Child & Adolescent Psychiatry created the following resources:

Children and Firearms

Children and Grief

PTSD

Understanding Violent Behavior in Children and Adolescents

Disaster and Trauma Resource Center

Tips for Talking to Children about the Connecticut School Shooting

Caring for Kids After a School Shooting

Restoring a Sense of Safety in the Aftermath of a Mass Shooting: Tips for Parents and Professionals

The Children’s Mental Health Network on talking with kids

American Psychological Association tips for speaking with children after a tragedy

 

The Asperger's Association of New England

Department of Psychiatry experts respond to the tragedy

Phoebe Moore is an assistant professor in the Department of Psychiatry and directs the Pediatric Anxiety Disorders Clinic at UMass Memorial Medical Center. Dr. Moore specializes in the treatment of children and families affected by anxiety disorders.

The natural thing for parents to think of first is how to help their children. One of the best things that we parents can do for our children is to take care of ourselves. This event has had a tremendous impact on the emotional life of all parents, so I want to emphasize that parents should prioritize taking care of themselves as well (research supports the idea that self-care in parents is protective for child outcomes in situations such as these). Processing your own feelings with fellow parents, getting emotional support as needed, shoring up your own reserves via restorative activities like exercise/meditation/yoga or community activities like altruism, or seeking treatment if your distress levels are interfering with daily functioning – all of these things can help you find the resilience you need to parent your child effectively in this challenging time.

As a parent, trust your own judgment about how to talk to your child about what happened. Children and teens will vary in how much information they request and how much they want to talk – this will depend both on developmental level and personality. Be sure to let them guide the discussion – ask them specifically if they have any worries or concerns they would like to talk about, rather than guessing about what their fears might be. Validate their feelings and offer coping thoughts if they seem distressed (e.g., “even though this was a very scary event, it is also a very rare and unusual thing to have happen” or “my school, my parents, and my community are all focused on keeping me safe”). Answer questions as honestly as possible; you may need to balance your child’s need for information against your own wish to protect them from specific details. For younger children especially, limit media exposure; for teens who are interested in the coverage, watch with them or review with them what they have learned from traditional and social media, in order to dispel misinformation and assist in emotional processing.

The news of this event will be distressing for all who hear it – time-limited distress, sadness, worry, and need for extra reassurance or time with parents are all normal. Some younger children may incorporate the event into their play – while this is hard for parents to tolerate at times, it is developmentally normal and important for coping. If you are concerned about your child’s distress level or reaction, school mental health personnel and pediatricians are a great place to start in terms of evaluating need for more treatment and/or finding resources for treatment. Some kids who have a history of anxiety disorder or trauma may find this event particularly difficult; if you notice ongoing high distress or anxiety levels, safety rituals such as very high levels of reassurance seeking, or school refusal, seek out treatment resources.

Jessica L. Griffin, PsyD, is an assistant professor of psychiatry and pediatrics in the Department of Psychiatry, and principal investigator for the new Child Trauma Training Center (University of Massachusetts Medical School). A clinical and forensic psychologist, Dr. Griffin is a nationally recognized expert in the identification, evaluation, and treatment of childhood trauma. The only national-level trainer in Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in the Commonwealth of Massachusetts, she provides training and consultation trauma-focused therapy to hundreds of clinicians across New England, and serves as a consultant and instructor to a variety of professionals in the courts system, in law enforcement, schools, and for pediatric groups.

This is an intensely sad, difficult time for our country, for parents, caregivers, families, and children. Tragedies like the shooting at Sandy Hook Elementary underscore the critical need in our country to ensure that professionals (teachers, physicians, and law enforcement) are trained to respond to trauma – and that the mental health field is equipped with effective, evidence-based tools and treatments to serve families experiencing traumatic events.

The new Child Trauma Training Center (University of Massachusetts Medical School), funded by the National Child Traumatic Stress Network (NCTSN), Substance Abuse and Mental Health Services Administration (SAMHSA), represents a tremendous resource to help us address these types of issues and scenarios.

In the aftermath of the Connecticut school shooting, children and families may have a variety of feelings, ranging from anger and sadness, to confusion and fear.

Below are some suggested guidelines for parents and caregivers to follow after traumatic events like the Sandy Hook Elementary School shooting:

• Limit media exposure. This includes not only the television news, but also Twitter, Facebook, and other social networking sites. Too much exposure to the media coverage following these tragedies can lead to misinformation, rumors, and can be further traumatizing and confusing to children, exaggerating events in their minds.
• Children may seek out additional comfort during this time. At the same time, parents too, may have an urge for physical proximity and closeness with their children and families.
• Some children may demonstrate regressive behaviors, such as thumb-sucking or bedwetting. These behaviors are to be expected and children should not be made to feel ashamed for having these behaviors.
• Encourage your children to share their feelings about the event. Parents can model this by sharing their own sadness, but should take care to not demonstrate overwhelming emotions in front of children. If children have questions about the shooting, provide factual details (without graphic detail). For example, if a child wanted to know if people were hurt, you could say, “Many children were hurt. Some children died. This is a very sad time.” Continue the conversation by reassuring children that adults are doing everything they can to make sure that children and their schools are safer and that this event was rare. For example, you could say, “Police, teachers, mommies and daddies are doing everything they can to make sure that you and other children are safe.”

Children are resilient and many may exhibit little to no symptoms following traumatic experiences. Reactions that may occur include sleep or appetite disturbance, nightmares, intrusive thoughts or memories (e.g. “flashbacks”), regressive behaviors, withdrawal, aggression, fearfulness, confusion, distorted thinking, irritability, physical agitation, bodily complaints (headaches, stomachaches), and many others.

Children who had a previous history of trauma or adversity are more at risk for posttraumatic stress reactions following events like the Connecticut mass shooting.

In the aftermath of a traumatic event, it is important for parents to set the tone, providing structure and maintaining routines. If Friday night is pizza night, have pizza night. With time and with parents or caregivers setting the tone, most children will bounce back after traumatic events within weeks to months. If, however, your child continues to demonstrate symptoms that have not improved or have worsened, it is suggested that you seek consultation/help from mental health professionals.

Here are some additional resources for parents and caregivers.

Negar Beheshti, MD, is an assistant professor, psychiatry and pediatrics, University of Massachusetts Medical School and UMass Memorial Health Care, assistant director of the Department of Psychiatry’s Division of Child Psychiatry, director of the Child Psychiatry Consultation/Liaison Service, and director of Child Emergency Mental Health Service.

Violent acts are frightening to people of all ages, especially children and adolescents. Even if the youth has not experienced an event like this first hand, it can still leave them feeling vulnerable, confused and scared. They may struggle with understanding what they are seeing on television or over hearing it discussed by adults. As parents, caregivers and teachers, talking about the event in words that the youth can understand and at a level of detail that will not overwhelm them is important.

In addition, having parents who can model appropriate coping skills is essential to helping the youth feel safe. Falsely minimizing the danger to their children will not end the youth’s worry or concern. Parents should allow and encourage the youth to talk about their fears and feelings; about what they understand. Parents should also share some of their own feelings about the tragedy – sad, scared or even angry – and stress that it is okay to have such emotions after a traumatic event.

If the youth is very young, then lots of affection, like hugs, kisses, and cuddles, as well as verbal support, will be helpful. Monitoring the youth’s television viewing and minimizing exposure to graphic images will help avoid further feelings of fear and vulnerability. However, watching some coverage together, with parents, may allow the opportunity to talk about what the youth is seeing and allows the youth to ask questions and share their feelings in a protective environment.

Depending on the youth’s age, their reaction will vary. Some reactions to watch for in children younger than 12 may be:

• Refusing to return to school and exhibit “cling” behavior where they may shadow their parents around the house due to persistent fears related to the disaster, such as being permanently separated from their parents
• Having sleep disturbances like nightmares and bed wetting
• Appearing more withdrawn and exhibiting atypical behavior problems, such as misbehaving in school or at home

Youth over the age of 12 may exhibit physical complaints such as stomachaches and headaches for which a physical cause cannot be found. They may become defiant, frustrated and irritable at home or school, or become withdrawn from their family and friends.

Professional advice or treatment for youth is probably a good option if you see any of the above symptoms and they persist for an extended period of time after the tragedy. Getting help can prevent or minimize the development of Post Traumatic Stress Disorder (PTSD). Parents can ask their pediatrician or family doctor to refer their child for evaluation and counseling if they are concerned.

Additional Resources

Mental Health America Offers Guidelines to Help in Responding to Impact of Event

To guide discussions about the shooting, Mental Health America offers the following suggestions for parents as they communicate with young people in the area and across the nation:

• Talk honestly about the incident, without graphic detail, and share some of your own feelings about it.
• Encourage young people to talk about their concerns and to express their feelings, and validate the young person's feelings and concerns.
• Limit television viewing. It can be difficult to process the images and messages in news reports.
• Recognize what may be behind a young person's behavior. They may minimize their concerns outwardly, but may become argumentative, withdrawn or allow their school performance to decline.
• Keep the dialogue going even after media coverage subsides. Continue to talk about feelings and discuss actions being taken to make schools and communities safer.
• Seek help when necessary. If you are worried about a young person's reaction or have ongoing concerns about his/her behavior or emotions, contact a mental health professional at their school or at your community mental health center. Your local Mental Health America Affiliate can direct you to resources in your community.

Asperger's Association of New England Statement to the Community Regarding the Connecticut Tragedy December 15, 2012

At the Asperger's Association of New England, we share the horror and sadness of people across the world. The shootings in Newtown, Connecticut, were a terrible and incomprehensible act of violence. We convey our deepest sympathy to the victims, their families and friends, and their community.

Early reports have suggested that the suspect, Adam Lanza, might have been diagnosed with Asperger syndrome or a mental health condition. This has not yet been confirmed. Having Asperger syndrome does not preclude acts of violence, just as having any other condition, or no condition, does not preclude acts of violence. Some people with autism spectrum disorders have co-existing mental health conditions or other complex issues. Nevertheless, violence is not part of the Asperger or autism profile. People with Asperger syndrome or any other form of autism are far more likely to be the victims than the perpetrators of violence. Although it is impossible to conceive of a mass shooting as a mentally healthy act, the vast majority of mental health issues are not associated with violence.

Our overwhelming concern is for the families of the victims through their deep, enduring grief and devastation. We hope too that the conversation around Adam Lanza will be thoughtful and considerate of people who have Asperger syndrome or other forms of autism and their families. When myths and misunderstandings are perpetuated, nonviolent people with the same condition suffer. It is painful and frightening to feel associated by virtue of a diagnosis with someone who has committed such a horrific crime.

Discussing this tragedy is challenging for families and very upsetting for children who have Asperger syndrome. Our staff is available to give advice or support relating to this issue during normal business hours: (617) 393-3824. We are exploring ways to provide additional support around any concerns relating to the terrible loss of these innocent lives. If there is a way that we can support the families and friends of the victims or the Newtown community, we will be here for them.