On Halloween: Questions and Answers
— -- EDITOR'S NOTE: Your text goes here
Click on the questions below to find the answer and the expert who provided it:
Immediate and Short Term
1. Should we dwell, or get on with our normal routines? 2. How much information should we share? 3. What about the danger of overexposure through TV or other media? 4. How much should a child be told?5. What if I'm too distraught to talk about it?
6. How do I explain why?7. What immediate behavioral and emotional reactions can I expect?8. Should I keep my children at home if they seem abnormally upset?9. How do I know if my child needs professional help?10. How to answer: "What happened to the people?"
11. Could talking upset my child more?12. Is it better not to talk if my children are not interested?13. How can I get my children to communicate what they're feeling?14. How important is reassurance (about working, flying, etc., at a time like this)?15. What can I do to make my child feel safe?
16. What if I have kids of different ages or who are responding differently?17. How do I start a conversation and understand what my child's thinking? 18. How do I help a child re-establish a sense of control?19. Is there such a thing as too young to talk about this?20. How do I answer, "Are my mommy and daddy safe?"
21. Should I worry about children playing "games" that seem like re-enactments? 22. Do I need to worry if my child reverts to younger behavior? 23. How do I answer my adolescent's question, "Will this lead to a world war?" 24. How can I help my child cope with a shattered sense of national security? 25. What signs should I look for in my children to tell if they've been truly affected by this tragedy?
26. My child has already had serious trauma in the past. Do I need to worry? 27. How do I handle my own anxiety? 28. How to share in a child's emotional state? 29. Can spirituality help? 30. How can I help my teenager to sleep?
31. How can I immediately help a child if they have lost a loved one? 32. How do I answer questions I don't have the answers to? 33. How do I explain to my child why Palestinian children are seen celebrating? 34. What can you tell the children of military families?
Longer Term
1. How can I tell when a grieving child needs professional help? 2. How would I recognize if my child has become depressed or unduly anxious?3. Should we talk about world events at bedtime?4. What can I do if my child has persistent problems?5. What can I do long term to make my child feel safe?
6. How can an adult respond to a child's distasteful behavior?7. How can I help a child long term if they have lost a loved one?8. How can we keep from justifying retributional violence?9. What if my child asks why other people hate us?10. What can I do as a parent if my child is harassed?
11. What can I do as a parent if my child harasses another child?12. What can I do as a parent if I learn my child's friend has been harassed?13. How can I prevent my children from becoming prejudiced?14. Are there any books I can give my child to help him or her understand what has happened?15. How can children begin to understand such complicated issues?
IMMEDIATE AND SHORT TERM
1. Should I allow my children to dwell on the tragedy or should we get on with our normal routines?
Dr. Diane Treadwell-Deering, clinic chief, Texas Children's Psychiatry Service, Texas Children's Hospital:
The less directly affected the child and the younger the child, the more appropriate it will be to move back to the issues of normal everyday life. Most youngsters will follow the lead of the important adults around them. Finding a balance between getting back to life, gathering information about the most recent news and developments, and focusing on these tragic events will be easiest for those of us who are less directly affected by this tragedy.
This includes people who live far away from New York and Washington, or do not have friends, family or colleagues who have been hurt or are missing. Younger children are more prone to focus on the issues directly facing them and will likely move back to those concerns. Limiting television viewing of the events and redirection of children will help them to focus on their own concerns.
However, children who for any reason are more vulnerable to issues of safety and fear or aggression may find it more difficult to put these tragic events into perspective and may find it hard to move back to focusing on their own lives. Older children may be more likely continue to think about the implications of this tragedy. Adolescents may remain concerned about the meaning of evil, or why bad things happen to innocent people. If a child seems to remain preoccupied with these events and is unable to meet his/her responsibilities for school and home, the parent needs to explore with the child how this is affecting the child.
Consultation with a professional may be helpful. Children who are more directly affected, like those who live near these sites, are familiar with these buildings, have neighbors who are hurt or missing, or have parents who work in these areas, will need to spend more time focusing on these issues.
2. How much information and what kinds of information should I share with my child?
Vanessa K. Jensen, head, section of pediatric psychology, The Cleveland Clinic Foundation:
That depends largely on the child's age and developmental level. As a general rule, answer your child's questions simply, directly, with limited detail, allowing them to absorb things slowly and at their own pace. As they understand the information or need clarification, they will ask further questions. Too much information too soon is overwhelming and may lead to an even greater sense of confusion and distress.
As difficult as it is, we need to separate our own anxiety and our need to talk about the devastating things that have happened from what it is that our children need. They need to know that some very awful things have happened, that some very bad people did these things, and that we, as adults, are working hard to find out who did it, and to keep it from every happening again. The older the child, the more detail provided, but avoid dramatization.
Most importantly, they need to know that their parents are "OK" and that the adults in their lives will make sure they are "OK." You don't need to pretend and shouldn't lie, but choose how much to share at any time. If you are sad and your child sees that, it's ok to tell him or her that you are sad about the things that have happened.
You can also let your child know of things that you or your family are doing to help those in need (i.e., prayers, donating blood, volunteering to help others in general). Above all, you can remind your child that you love them and will be there for them.
Dr. Diane Treadwell-Deering, clinic chief, Texas Children's Psychiatry Service, Texas Children's Hospital:
Elementary school-age children will be getting information about these events from many different sources — at home from parents, from viewing television, seeing newspapers, talking about these events at school, overhearing parents of friends talking, even talking with their own friends. It is easy for children of this age to misunderstand or misjudge information that they have heard.
They are not able to sort out exaggeration from opinion from fact from theory. Differing information from different sources can easily become distorted by children as they struggle to make sense of what they are hearing and seeing. Because children are unable to think about these issues in the same way that adults can, their worries often surprise adults.
Children of this age will often worry if something bad like this will happen to them or to their family and friends. They cannot understand why some people do bad things. They certainly cannot understand the complexity of politics and religious and cultural issues that play a role in this tragedy.
It is important for you to know what your child has heard and how he/she understands it. Ask your child, "What have you heard about this? What are you worried about?" Now as a parent, you can explain the facts as we know them in a simple, straightforward way to your child. Now you can address your child's own fears and worries.
It is important to be truthful, but reassuring. It is fine to say you don't know the answer to a particular question your child raises. Again, let the child know that the police and people in the government are working very hard to keep us safe, to find the people responsible for these crimes and to punish them.
Monitor closely what your children watch on television and talk with them about what they see. Help them sort out the information on television.
3. Is it possible to overexpose my children to the tragedy through television or other media?
Dr. David T. Feinberg, medical director, UCLA Neuropsychiatric & Behavioral Health Services:
Yes, children can be overexposed to trauma. Exposure to the trauma should be based on the developmental level of the child. Young children in preschool and kindergarten should have limited or no exposure. School-age children should have limited exposure to graphic images on TV and in the media. They should also only watch TV with an adult with them in order to answer questions.
4. How much should a child be told about the seriousness of a situation?
Charles K. West, professor of family and consumer sciences, University of Mississippi:
So much depends not only on the age, maturity and intelligence of the child but also on the ability of the parent or other adult to deal with his or her own feelings of fear and sadness without letting emotions take over. Most children will simply want to be reassured that there are still stable people and circumstances surrounding them, so it may be more important to get them to focus on what has not changed.
5. What should I do if I'm too distraught to talk about this to my kids?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Even adolescents will look to their parents for models of how do deal with tragic or frightening things. It is OK not to hide feelings but I would advise parents to wait to discuss if they are too distraught. By distraught I don't mean sad or angry, but overwhelmed with anxiety, anger or grief.
However, parents should definitely not hesitate to tell their children: "I am really angry or sad or even worried. But I really want to talk about this with you. But maybe we should wait awhile until we all feel calmer and can think more clearly about what just happened."
Something like this models acceptance of strong feelings and a belief that these feelings can be handled with time. But children do need parents to feel secure, so it is very important that parents do not become so preoccupied with their own feelings that they ignore or find it difficult to take care of their children's psychological welfare.
In other words, a good parent does sacrifice for their children of any age. If this is not possible, adults can seek help.
6. How do I explain why this happened?
Dr. Bradley M. Pechter, child, adolescent and adult psychiatrist, assistant professor of psychiatry, Northwestern Memorial Hospital, Warren Wright Adolescent Center:
Be honest and open with your child. It is OK to express your own surprise and disbelief that people could do such a thing and that we actually don't have a good understanding of why people chose to do this. Remember to assure your child that they are loved and you will do everything that you can to keep them safe.
For preschool-age children, it may suffice to say that "very angry people can do bad and dangerous things." For school-age children, listen to their feelings and understanding of the events and try to clarify misconceptions.
Adolescents will be struggling with more complex issues. They will benefit from hearing your efforts to make sense and cope with this tragedy but, ultimately, will form their own conceptions. Try to keep ongoing dialogue with adolescents and other children because events will continue to unfold and as children develop, they re-examine the same issues with more maturity and cognitive tools.
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Adolescents can understand more. Talk about terrorism from a historical perspective, read about it together in an encyclopedia or on the Internet. Talk about its purpose, which is too immobilize, demoralize and traumatize the population so that it is paralyzed and desperate. Talk about these terrorists, who they are, what their goals are. Do a lot of questioning. Adolescents love to discuss moral issues like what should be done, why would someone kill themselves and others for a cause, etc. Mainly this helps to place the event in context and gives it meaning. This is extremely important and strengthens resilience, especially when an event is so tragic and terrifying.7. What are the immediate behavioral and emotional reactions expected?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Adolescents will tend to react very intensely. This is often gender-specific: Girls will tend to cry and seek comfort; boys will tend to control fear and tears, and may talk tough. All adolescents will be shaken. In particular, in these years kids are very vulnerable to a sense that the adult world is very scary, insecure or immoral.
The worst effect for teenagers after trauma is that the future, which most are optimistic about, seems now very unappealing. This is a premature rupture in their sense of the world as a basically good and reasonable place where you can be happy and successful. This can lead to premature disillusionment, pessimism, and hopelessness. I don't think this will happen on a large scale but again some adolescents will be vulnerable to the worst case and all will be marked by the unexpected and overwhelming quality of the event.
Linda J. Alpert-Gillis, associate professor of psychiatry, pediatrics, and clinical nursing, University of Rochester School of Medicine and Dentistry:
Preschoolers will often react with confusion, fearfulness, separation fears, and acting younger. Concerns about separating from parents is often a major issue which is seen in children not wanting to go to child care, not wanting parents to go to work, and wanting parents to sleep with them.
School-age children may also show anxiety and fearfulness. They may have trouble separating and act younger. They are more likely to evidence physical complaints such as headaches and stomachaches. They may be quieter than usual, be more irritable, or want to talk a lot about the tragedy.
8. Should I keep my children at home with the family if they seem abnormally upset?
Charles K. West, professor of Family and Consumer Sciences, University of Mississippi:
While keeping a child at home may be OK as a very temporary solution, the grieving child can benefit by facing his or her fears in the company of other children. We all need our allies, people we can talk to, grieve with, and who can help us normalize our feelings.
Activities that provide constructive ways of self-expression also are therapeutic. Children usually express themselves best through playful activities, which may include games, singing, drawing — anything engaging.
9. How do I know if my child needs professional help?
Dr. Boris Birmaher, University of Pittsburgh:
First, you have to talk to your child about what happened and prompt them to talk about their feelings and worries. Let them know that you are also concerned, but the situation is under control and the government is taking the necessary steps to prevent tragedies like this from happening again.
Let them know parents are there for them. It is also important, that these issues be discussed at school. Some schools have been avoiding talking about what happened. Kids have been watching the TV and pictures on the Web and newspapers and need clarification of what is going on.
It is normal for a kid, in particular young children, to have nightmares, be afraid and apprehensive the first days. However, if a child continues to have anxiety, sadness, problems with concentration or behavioral problems and these symptoms are affecting their functioning at school and home, parents should consult a professional.
Children who lost relatives or close friends are at higher risk to develop emotional problems and need more reassurance and support. If they develop persistent symptoms of anxiety, depression, or nightmares they need to be seen by a professional.
10. How do I answer my child's question, "What happened to the people in the planes and the buildings?"
Carmel Mahan, child life manager, University of Maryland Children's Hospital:
Be honest and not evasive, as avoidance will only increase children's anxiety. Ask the child what he or she thinks happened, and gauge your reply to the level of information the child conveys to you. For example, your 3-year-old might say, "The building blew up, and the people tried to run away." A 15-year-old may say, "My friend told me who did this to us, and we should go and bomb them."
A very simple explanation is warranted for the young child, but the teenager may need to discuss issues of freedom, tolerance, politics and government related to this tragedy.
11. Could talking about the event upset my child more?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Talking upsets only if it reinforces the fear and helplessness engendered by the terrorist attack. If it emphasizes recovery, problem solving, all feelings experienced including acknowledgement of fear, anger or understanding then it is definitely helpful according to our experience and research.
This fear and helplessness can also be communicated nonverbally.
12. Is it better for me not to talk about what's happened if my children are not interested?
Dr. Lewis R. First, professor and chairman, department of pediatrics, University of Vermont College of Medicine:
If your children are in elementary school or older, they are going to hear about this from other classmates, and what they hear may not be at all accurate. Therefore, it is best if you talk about this with your children before they hear from others, so they understand that there is still a secure sense of safety and normalcy in their lives.
Not telling children who are old enough to understand that a tragedy has occurred will only make them think that you are hiding it from them. This may create new fears like the fact that this might happen to them, that someone they love might be hurt or killed next, that the family will get separated or the children will be left alone — none of these things being healthy thoughts for your kids.
Thus, it is best to take the cues and questions from your children. If your children have no questions, then at least acknowledge what has happened, expressing your feelings about it to them while conveying a continued sense of the family structure being as safe as it can be and family activities continuing as normally as they were before all of this happened.
13. How can I get my children to communicate to me what they're feeling?
Dr. Kenneth Fletcher, associate professor of psychiatry, University of Massachusetts School of Medicine:
Let them make drawings or write stories. Let them get their feelings out. And above all, hold them, pet them, kiss them, comfort them. Tell them that everyone has similar feelings, although the world can sometimes be a scary place, it is still a safe place for the most part. Let them talk about their feelings, help them correct any kinds of thinking that's distorted, for example: Are we all going to die? Are they going to blow up our town?
Older kids, adolescents, should write out their feelings, write out a story about it, anything that helps them express their feelings about it in a safe, controlled way.
Parents also need to worry about being traumatized themselves. And then the added burden of telling their children sometimes makes them more confused and stressed. It's important to give them physical comfort. Spend a little more time with them. If they don't want to talk about it, then don't force them to.
14. How important is reassurance (about working, flying, etc. at a time like this)?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Reassurance is natural and good, but not as effective as open and honest discussion about thoughts and feelings regarding working, flying, death, or the future, especially for teenagers.
15. What can I do to make my child feel safe?
Dr. Bradley M. Pechter, child, adolescent and adult psychiatrist, assistant professor of psychiatry, Northwestern Memorial Hospital, Warren Wright Adolescent Center:
Spend time with your child and reassure them of your love and devotion to their safety. Point out to them that these sorts of things are actually very rare and that most people are still very safe and unhurt. At all ages, spend time with your child and listen to their concerns.
Children often surprise us with their thinking, and this is one of their charms. You may be surprised where they are at with their thinking about the subject.
Lastly, be certain to take care of yourself and model good coping skills. It is perfectly reasonable to be angry, sad or anxious but don't let that impair your judgment, making yourself frightening to the child, unavailable or promoting prejudices.
16. If I have kids of different ages or who are responding differently, how do I talk to them?
Dr. Daniel Creson, professor of psychiatry and behavioral sciences, University of Texas, Houston, Medical School:
Children need accurate information, but they need information in an age-appropriate way. That is to say the words and concepts need to make sense to them. Without adequate information, children of all ages will fill in the missing pieces with their imaginations, and this can be very problematic.
In addition, they need comfort, but not at the risk of inappropriate, if well meaning overprotection. The resiliency of children is truly amazing.
Be there, listen, provide reassurance, and speak with respectful candor.
17. How do I initiate a conversation with my child, and how can I facilitate understanding of what my child is thinking?
Dr. Paula K. Rauch, chief, Child Psychiatry Consultation Service; director, PACT: Parenting At Challenging Times; MGH Cancer Center Parenting Program:
First you have to understand what a child of any age has heard, seen, and integrated from these tragic events. Without that information as a baseline, it is hard to begin any meaningful conversation.
Once the parent has some information about what the child "knows" the process of understanding that better and then correcting misinformation or answering questions can begin. It is essential to help children articulate their "real" questions, which the parent cannot know without asking more questions.
"What got you wondering about that?" "That's a really interesting question, how did you think of it?" It is easy for parents, especially when stressed, to jump to answer questions too quickly and not really know what true concern underlies the child's initial question.
For teenagers, ask what he or she is hearing from friends, teachers and the media. Ask what is the hardest part of the tragedy for the teen to understand or deal with or what is most upsetting. Does the child feel he is hearing too much or too little about these events—from family, from the school, or from the media.
Ask how he or she sees others coping. Ask if there is anyone the teen is worrying about. Often teens will talk more freely about the struggles of a friend. After this discussion of another child, the parent may be able to follow up with questions about the teen's own feelings.
18. Is there anything that I can do to help my child reestablish a sense of control?
Aaron T. Ebata, department of human and community development, University of Illinois at Urbana-Champaign:
There are three things parents can do:
1. Re-establish meaningful relationships, roles, and routines (regular activities).
There will be a sense of normalcy if "life can go on" — or at least parts of life that may have not been affected. Most important are activities the kids are involved in, hobbies and interests, spending time with peers, and daily family rituals and routines. These "3Rs" (relationships, roles, and routines) provide kids with a sense of stability and the resources that they may need to cope with feelings of grief, anxiety, or fear that they may be experiencing. There may be kids whose lives are disrupted so that life will be forever changed — but it is still important to then begin establishing new roles or routines. Creating some kind of ritual of honor or remembrance to lost loved ones may be important in this effort.
2. Help children extract or create meaning out of the tragedy.
3. Help children to act, or engage them in making a meaningful contribution to the relief effort or to efforts that will promote peace or the welfare of others. Help or encourage them to do something, however big or small, to help in the relief effort (e.g., donating money, giving blood, signing up for some volunteer effort in your community), or work on some effort that will help make your neighborhood, school, town, or state a safe and caring place.
19. Is there such a thing as a child too young to talk to about this?
Judith A. Myers-Walls, associate professor and extension specialist, child development and family studies, Purdue University:
Children as young as 2 years of age will have some exposure to this event and may have some reaction. Actually, it is possible that even younger children will see the images on TV, and very young children will sense the stress and concern in the parents. So children may be impacted by it at any age.
Extremely young children — that is, those who are not yet verbal — will not be comforted by words as much as by action. Those children need hugs, closeness, and quiet activities.
They also need parents to laugh and play with them. If parents can maintain a normal routine for the very young children, those children will benefit. When it is not possible for parents to do normal things or follow a normal schedule, it helps to keep some familiar items (a blanket, a stuffed animal, a pacifier) close by.
Young children who are able to use language do not need speeches and long explanations. It is important for parents to help them with their reactions to the event, though. It may be best for parents of preschool children to listen to the children first. Find out what they know or think. Ask them if they have questions.
Tell them that they do not need to talk about it, but they may. If parents try to protect children from the information and never talk about it, the children may believe that it is not OK to talk.
Consider using drawings or puppets with some young children. They may not be able to put their feelings into words, but they can put them in pictures. The parents may learn a lot about the children that way.
20. How do I answer my preschooler's question, "Are my mommy and daddy safe?"
Stephen S. Leff, clinical psychologist, department of pediatrics, The Children's Hospital of Philadelphia; assistant professor, University of Pennsylvania School of Medicine:
If at all possible, we need to give young children much reassurance and support during this difficult time. Explaining that something bad happened far away from the child is important, because very young children are egocentric, and may not understand that what they see on TV will not also happen to them. We need to assure the young child that they are now safe, their family is safe, and their country is strong.
21.Should I worry if I find my children playing "games" that seem like re-enactments of the attack, for example, "bomb the building" or some other thinly disguised version of what happened?
Dr. Glen R. Elliott, director of Children's Center, University of California, San Francisco:
Play is the way children work through issues in life, but "traumatic play" sometimes emerges that seems not to be helpful. The biggest clue is how the children are feeling while in "play."
If they become grim, intense, or angry and seem to play the same scene over and over, that suggests they are stuck with the issues at hand. Interestingly, adults often can help by engaging with them in the play and looking at ways to come up with other endings and happier outcomes.
If the child seems unable to allow any change in the way the game is played and cannot stop playing it, professional help may be useful.
22. Do I need to worry if my child suddenly starts behaving in ways that he or she used to act at a younger age, for example, wetting the bed, thumb sucking, or not wanting to sleep alone?
Dr. Glen R. Elliott, director of Children's Center, University of California, San Francisco:
It's quite common for all of us to turn back to early behaviors when under stress. Keeping that in mind as a parent and explaining it that way to the child can be an enormous relief. For behaviors such as bed wetting, simply explaining what's happening and adjusting to it probably is enough.
For behavior that is more clearly self-soothing, it's fine to make an explicit agreement that an old behavior is "OK" for a few days, until things settle down. Most of these behaviors go away on their own as soon as the child has had a chance to recover from the stress.
23. How do I answer my adolescent's question, "Will this lead to a world war?"
Stephen S. Leff, clinical psychologist, department of pediatrics, The Children's Hospital of Philadelphia; assistant professor, University of Pennsylvania School of Medicine:
Our country has to respond to terrorism in a united and powerful way. We need to help others around the world realize that there are many people out there who will not tolerate acts of hatred and violence. Thus, sometimes to be strong, we need to take a strong stance.
Many countries around the world need to work together to declare a war against terrorism. However, you will still get up every morning, go to school, and do the usual things. And I also will get up every morning and go to work. Our country will do what it has to do to counter this terrible event, and we will be fine.
24. How can I help my child cope with a shattered sense of national security?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
A sense of security and control is essential, and at a time like this all we all look to the government to ensure safety and protection. In addition, teenagers tend to look at all adults, especially parents, for signs of security or insecurity.
Explain and discuss with adolescents what we should do as a country and what the president should do. Also, make sure they know clearly what is being done, the remaining power of this country, and the fact that people and countries can and do learn from mistakes — even disasters like this one, and can become better, stronger, and safer. Tell them that knowledgeable and experienced adults, our leaders, are working carefully to make this country safer than ever before.
25. What signs should I look for in my children to tell if they've been truly affected by this tragedy?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
The signs you should look for include a lack of interest in the world or their future, emotional flatness or numbness, persistent crying or sadness, intense anxiety, jumpiness, fear of being alone, reports of stomachaches, rapid heart rate, panic, increased or sudden irritability or defiance at home or school, a drop in grades or difficulty concentrating.
26. My child has already had serious trauma in the past. Do I need to worry more about reactions to this disaster?
Dr. Glen R. Elliott, director of Children's Center, University of California, San Francisco:
Individuals with a past history of trauma seem to be at greater risk of having trouble coping with new stress, especially if the disasters are somewhat similar, for example, someone who lost a parent or sibling in a fire or a plane wreck.
Their reactions and feelings do not necessarily differ in kind from others but are apt to be much more intense and to result in much lower levels of function. Such children may benefit from early professional help, particularly if they already have a connection with a therapist.
27. How do I handle my own anxiety so it doesn't trigger or deepen my child's anxiety?
Linda Rubinowitz, clinical psychologist, marriage and family therapist, director of the master of science program- marital and family therapy, The Family Institute at Northwestern University:
Children, especially pre-school and school-age children, are highly sensitive to parental distress. Finding ways to cope with your own anxiety before dealing with your child's fear will help as you attempt to calm, reassure and provide a sense of safety for your child.
Here are a few suggestions:
Participate with other adults, avoid isolation. Use support networks, friends, religious and other community groups to discuss your feelings, concerns and experience. Be active, give blood, write letters of support and encouragement to those involved — firemen, police, physicians, the Red Cross, etc. Return to a structured regular schedule. This adds predictability to what has been chaotic. Limit the time you spend focused on terrorism and its aftermath. Give yourself a chance to calm and soothe yourself. Go to a movie, listen to music, take a relaxing shower or bath, exercise, eat some comfort food. Think of five things that calm you. Refer to your list daily and do at least two. Remind yourself that although there are unknowns in the future, you have ways to cope with whatever comes along. List those supports that are available or that you wish you had available. Be active in using supports and or finding the supports you need. Get individual counseling if the anxiety is intense and/or persists. Consider family counseling to help everyone cope if the anxiety throughout the family is intense and persistent.
28. How can parents and teachers share in a child's emotional state?
Dr. Charles K. West, professor of family and consumer sciences, University of Mississippi:
First, by being in touch with their own feelings and how they're being affected by the terror. It's difficult to positively influence another person's feelings when one fails to deal with his or her own emotions.
Second, by asking the child about his or her understandings and feelings concerning what has happened. Let the child tell you, rather than just assuming that you understand. The child's feelings may be different from your feelings.
Third, be receptive and let the child know that if he or she has questions, you will do your best to answer them at a level appropriate to the child.
29. Can spirituality help my child through this process?
Dr. Robert L. Findling, director, child & adolescent psychiatry, University Hospitals of Cleveland/Case Western Reserve University:
In brief, the answer is "yes." If the child wants to grieve with the rest of the family in a spiritual way, that form of grieving should be allowed and encouraged. However, children should always be allowed to grieve in a way that they feel comfortable and spirituality should neither be forced on children nor denied to children.
When the circumstances in a child's life are out of the child's control, the child takes comfort in the ability to exert some form of influence the child's environment. The child should be allowed to take a path in which he or she feels comfortable.
30. How can I help my teenager to sleep?
Lynda Madison, licensed psychologist, director, family support and psychological services atChildren's Hospital, Omaha, Neb.:
Your child will not be able to sleep if he or she is tormented by anxious thoughts of terrorism. While rational arguments might help put things in perspective, such as an attack on your particular neighborhood being an unlikely event, your teen might need to learn to push frightening thoughts to the back of her mind at night.
You can help by offering distracting activities and topics — try reading passages from a book or telling stories of your childhood, whatever might get your child's mind on something else. But your child will benefit most if she can learn to do this for herself. Try suggesting some of these techniques and practicing them during the day, then reminding her to use them at bedtime:
Close your eyes and imagine fixing your eyes on a small object far in the distance, like a windmill in a field or a sailboat on the horizon. Breathe in deeply and hold your breath for a count of 5. Relax your muscles as you let the air out slowly, keeping your mind fixed on the imaginary object. Repeat a line from a favorite song over and over to yourself. Close your eyes and imagine a repetitive motion that bores you. Count sheep, paint a large building with a small paintbrush, or trace the outline of one huge number after another. Count backward from 100 by threes, very slowly. If you reach zero, count down again, this time by fours. Whenever your mind drifts, force yourself to focus again on your visual image.Close your eyes and think of a word ("tap," for instance). Count to three and think of a word that goes with that word ("shoe ") or rhymes with it ("map"). Count to three and do the same with that word ("shoeshine"). Keep occupying your mind with this exercise.
31. How can I immediately help a child if they have lost a loved one?
Cynthia Kaplan, administrative director of McLean Hospital's Child and Adolescent Psychiatry Program:
If a child has lost a loved one it can be assumed that many of the people who make up their primary support network are also in crisis. It is important to talk, nonetheless, with the child's family and ask what it is they would welcome in terms of support.
Depending on the age of the child, help can take many forms, from simply distracting or engaging the child in a neutral activity to talking with the child directly about their grief. Children respond differently than adults, and particularly younger children often show an ability to resume their normal routines at a fairly rapid rate.
Older children may react more like adults and express grief openly, showing disturbances in sleep, concentration and activity. It is important to help children who have lost a loved one to find a way over time to come to terms with their loss. Many times enlisting the help of mental health professionals is important to this process.
The overriding principle here is to follow the lead of the child. If they want to talk and reminisce then do so. If they want to be distracted then help them with that.32. How do I answer questions I don't have the answers to?
Jonathan Sandoval, professor of education, school psychology, University of California, Davis:
Be comfortable in admitting that you don't have an answer to the question. Sometimes that is reassuring, especially for adolescents. Younger children, too, can accept this answer. An alternative is to say that the question is one that you will have to think about and bring the issue up later, after you have had time to think.
Do not feel obliged to answer questions immediately — you can take time to answer after deliberation. It may also be useful to ask the child or adolescent what they think the answer is. Their answer can give you a chance to correct their mistaken understandings, if they have any.
Very young children will want parents to have all the answers. For this reason, adults often turn to a religious explanation or a moral explanation, for example, "the person was bad." Usually this level of answer will satisfy a preschooler.
33. How do I explain to my child why Palestinian children are seen celebrating?
Dr. Donna Copeland, professor in pediatrics, Anderson Cancer Center:
Not everyone sees the world in the same way. Sometimes we hear bad things about people whom we've never seen before. What people tell us is not always accurate. I would guess that those children do not know who Americans are, really, and that we are much like they are, loving our families and wanting the best for them. Those Palestinian children probably think we are different from them and perhaps that we want to harm them. I hope they discover one day that people of the world are very similar and that we would like to be their friends.
34. What can you tell the children of military families about whether their parents may be going to fight a war?
Sharon Manne, director of the psycho-oncology program, Fox Chase Cancer Center:
It is important that the moms and dads of these children talk to their own kids to explain what they are being called upon to do by their president. The men and women who work for our military are very brave and very important in protecting our country. Their children have hopefully been prepared by their parents for the possibility that they will be called to duty, and that they are serving the country in a very important way to keep our country safe.
LONGER TERM:
1. How can I tell when a grieving child needs professional help?
Charles K. West, professor of family and consumer sciences, University of Mississippi:
Seek professional help if a child continues to live in the grips of fear or other emotions that seem to rule his or her life. Many schools have wonderful counselors. There also are other trained professionals, including marriage and family therapists, counseling psychologists and social workers.
2. How would I recognize if my child has become depressed or unduly anxious from the situation?
Dr. Daniel Coury, Columbus Children's Hospital:
Many children will display problem behaviors of irritability, hostility, anger and defiance in the coming weeks as a response to the disaster. I anticipate an increase in the numbers of parents seeking help for behavior problems who will not connect their child's recent behavioral change with these events.
These will be seen in younger children (ages 5-8 years) as increased hitting, fighting with peers and some defiance of adults. In adolescents it will be seen as more defiant behavior, anger and depression. Discussing the events that have occurred in an appropriate context for the child's age at this time will go a long way to reduce these later potential consequences.
3. Should we talk about world events at bedtime?
Lynda Madison, licensed psychologist, director, family support and psychological servicesChildren's Hospital, Omaha, Neb.:
Bedtime is a good time to be close to your child and express your love, but exhaustion and darkness can make everything seem scarier. Be sure to acknowledge your child's concerns and worries, but try to move on to a lighter topic as soon as possible rather than continuing a discussion that is likely to lead to greater anxiety and sleeplessness.
When possible, give a brief answer that says you understand his feelings but also expresses your relative certainty that things are safe at the moment. For example, tell them, "I know you were worried when the president went back to the White House, but he had guards with him, and he wanted to show the world that he is not afraid."
Promise your child that you will address his or her concerns the next day, and then be sure to follow up on them, saying something like, "You were talking about explosives last night. Let's discuss that now, while we're both awake."
4. What can I do if my child has persistent problems?Dr. John N. Constantino, assistant professor of psychiatry and pediatrics, Washington University School of Medicine:
Children are resilient by nature and have their own ways of adapting to experience over time. If, however, the child is persistently depressive or fearful (for more than two weeks after the event), it is probably time to get outside help from people who are well trained to address child mental health issues.
For some children, the problem may stem from something as simple as a scary misinterpretation of a particular TV scene or snippet of a parent's conversation, which a child might be too frightened or embarrassed to share with his or her parents, but might do so with an outside party. Older children and adolescents may be overwhelmed with issues pertaining to their own mortality which they are now forced to confront in ways that they may not yet (developmentally) have been prepared to deal with.
Other youth who may have been disturbed before the event might contemplate perceived similarities between themselves and the perpetrators of these acts, to the point where they become guilty, agitated or fearful about their own mental stability. In this case, immediate attention is warranted.
Warning signs would include extreme withdrawal, brooding in an uncharacteristic way, sustained changes in facial expression, abrupt change in sleeping or eating patterns, or passing comments made about a wish to die or to perform terrorist acts themselves.
Obviously, children who had difficulty with anxiety or depression before the event might be experiencing an escalation in the intensity of those symptoms as a result of what they have seen.
There would be no better time to seek mental health care, especially if those needs have never yet been formally assessed. Depression and anxiety, in children and in adults, is absolutely treatable. There are proven methods of improving these conditions even when children or their families have pessimistic views about the prospects of getting meaningful help in the wake of such heartbreaking events.
5. What can I do long-term to make my child feel safe?
Dr. John N. Constantino, assistant professor of psychiatry and pediatrics, Washington University School of Medicine:
Although there are severe limits on what is known about how to help children through such tragic events, a few points are worth considering.
Children who have an open communication (spoken and unspoken) with close loved ones — and are able to share with them in words or symbols the details and feelings surrounding a trauma — seem to do better in the long run than those who don't have or don't use such resources.
These events shake the very foundation of basic trust that enables human beings (from infancy) to explore and interact with the world around them. Re-establishing that foundation may best be done with close loved ones.
When children are encouraged to put overwhelming thoughts and feelings into words, they gain a sense of mastery over those thoughts and feelings simply by encoding them in language, which they can then control, at least to some extent. Talk, play, share, and remember to make room for normal everyday interactions, by turning off the TV or radio and giving a child undivided attention.
Its also important to put into perspective the magnitude of risk for any individual to be a victim of such a disaster in his or her lifetime. It will still be true that children (and their parents) are much more likely to die in a car accident on a trip across town than to be a victim of such an atrocity.
An important part of growing up is acknowledging (accepting) risk and suffering in all its shapes and forms. For some children, recognizing that they have already mastered and accepted the riskier scenario of a car ride helps place perspective on the proportion of their mental life that fear of such a tragedy should occupy. This can help a child "shave down" such fears to a manageable size so that he or she can move on with his or her own life.
6. What should an adult do if a child is responding (joking, inappropriate anger, xenophobia.) in any way that is distasteful?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Expect it, don't overreact punitively, come back at a later time and point it out and discuss it. Ask them why they said it, what their feelings were when they said it, and give them your opinion about why it is inappropriate or distasteful. If it is too distasteful according to the rules of your family make that clear, as well.
7. How can I help a child long term if they have lost a loved one?
Dr. Robert L. Findling, director, child & adolescent psychiatry, University Hospitals of Cleveland/Case Western Reserve University:
By allowing a child to grieve, that will help long term. There are several key things that should be kept in mind. First, be honest. Tell the child the truth. What they imagine is possible is always worse than the reality. If they want to go to the funeral or wake, let them. Conversely, don't force them to do something they don't want to do.
Second, let them talk if they want. A child should be able and allowed to verbalize their thoughts, feelings, and fears. Similarly, if they don't want to talk, don't make them.
Finally, make the child feel as secure as possible. Be sure that a child knows that they will be cared for, protected and loved even if they have lost the person(s) with whom they are most close.
8. How can we keep from justifying retributional violence?
Donna M. L. Heretick, clinical psychologist and director, Mercy Children's Hospital Youth Focus Program:
At a time when mental health workers, educators, legislators, parents, juvenile justice agents, and other community groups have been trying very hard to address beliefs and behaviors which contribute to violence and aggression by youths in schools and in the neighborhood, much effort has been given to teaching and promoting the importance of positive conflict management, responsible problem solving, and nonviolent options.
It is important to continue to reinforce these values now by encouraging youths to engage in thoughtful discussions to recognize that there are many options for this situation. For example, in anger management and positive decision-making activities, we discuss what the situation is, how we feel, and our impulses for how we want to strike out when angry, frustrated, or afraid.
We then ask the youths to think through all the possible ways they can think, feel, and act, as well as the probable outcomes of each choice. We spend a lot of time on the differences between being assertive vs. aggressive or passive. We also focus on the differences between reactions that are impulsive, irrational, and indiscriminant versus more proactive responses that try to be thoughtful, fair, and just.
We certainly try to get past the ideas of "he made me do it" and "well, he did it to me first, so I did it back to him." We focus on concepts of rules and consequences, which do include punishment for breaking rules. We evaluate options in terms of their probable effectiveness toward solving the root issues of the conflict, not intensifying or prolonging it.
When we can't get at the one that hurt us, we may want to strike out at anyone or anything that seems related to it. We may believe that doing something is better than doing nothing. We may find ways to convince ourselves that we have the right to hurt someone else because we are hurting. We may feel that striking out is somehow honorable, that it somehow shows how much we really care about the victims of the terrorist attacks. We may think that it shows that we are real Americans.
This is never the right answer. It's the same "logic" used by gangs, students who shoot or bully others at school, spouse beaters, or disgruntled employees, and is found in all forms of hate crimes. We cannot use our patriotism, our religion, our race, our ethnicity, our gender, our community, or any other excuse to justify aggression against others who have not been proven to be responsible for the attack, through fair and just means.
9. What do I tell a child who asks why other people hate us?
Jonathan Sandoval, professor of education, school psychology, University of California, Davis:
For many preschool and kindergarten aged children, a simple answer is best. One might simply say that they hate us because they do not understand us and what our country does in the world. I would be clear that it is not us (the child or the family) that is hated, but the government of the country. The hatred is not personal.
Children of this age are most concerned about their parents, their care-givers and themselves. Do not give over-elaborate answers to questions from children; use their questions to gage what they want to know, and confine your answers to their concerns.
Elementary school-aged children will be able to understand hate on a more complicated level. The will understand hate as the result of frustration, envy, struggles for power, and the notions of hating the enemy of an enemy. They will prefer explanations on this level. They will also understand the concept of revenge and want to talk about it. Again beware of being too abstract and complex in your explanation.
Adolescents will be able to understand hatred as a result of ideological differences. They will understand patriotism and be best able to understand how the terrorists have a different world view. They will tend to want to argue the superiority of their own view.
10. What can I do as a parent if my child is harassed because of his or her beliefs, ethnic background, or just because of being different?
Dr. Paul Quinlan, Director of Child and Adolescent Inpatient Psychiatry, Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan:
If this occurs to a child, the parent should sit down with the child and try to gather information about the incident. A calm demeanor and patience will help the child respond. Start by asking, "What happened?" Very young children may not be able to talk about it and should not be forced to talk.
The young child needs to be reassured. The parent needs to look to other sources to better understand what happened in order to protect the child in the future. In those situations, witnesses such as other adults and teachers offer a better chance of learning what happened. School age and adolescent children will give more details from the event than a younger child. A young child should be told to tell the adult watching him or her if this situation happens again. The parent, no matter the age of the child, should contact the school or agency where the incident occurred to inform them and seek help to deal with the incident and prevent future occurrences.
In school age and adolescent children, they should be taught to tell the other person harassing them to stop. Fighting should not be encouraged. A school age or adolescent child is also safer if he or she is with a group. A child who engages in harassment, bullying or scapegoating is intimidated by a group, particularly when the group responds by telling him or her to stop harassing their friend. There is safety in numbers.
11. What can I do as a parent if my child harasses another child?
Dr. Paul Quinlan, Director of Child and Adolescent Inpatient Psychiatry, Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan:
If your child has a pattern of harassing behavior, professional help must be sought. Contact your child's physician for a mental health referral.
If this is an isolated incident, begin with sitting with your child and asking what happened? Calmness and patience on your part will give your child an opportunity to tell what they were thinking. The goal is to help the child to understand that these acts were committed by individuals not by a culture or by his or her peer.
Harassment in any form is wrong. School age children understand the need for rules and it is best explained to them that their actions were wrong and have consequences. Although different cultures have varying responses to an individual who admits their mistake, in our society an apology is expected. Schools have refined their rules to deal with harassment and the child may experience consequences if the event occurred in that setting.
Adolescents and young adults need to hear that there are rules that establish consequences in such matters. It is also important for them to recognize that these tragedies affected their feelings and they reacted poorly. It is not unreasonable for older adolescents and young adults to hear that sometimes there can be more than the effect of the damage inflicted by terrorism. The psychological effect to cause some individuals to retaliate on innocent individuals is bonus for the individuals who perpetrated these terrorist acts. The best way to prevent this form of baiting from happening is to not engage in retaliation in any form.
As in all recommendations above, it is essential for the parent to model these appropriate behaviors and responses for his or her child.
12. What can I do as a parent if I learn my child's friend has been harassed?
Dr. Paul Quinlan, Director of Child and Adolescent Inpatient Psychiatry, Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan:
Offer your support and empathy to the child's parent. Very young children who play together need adult supervision. Offer to help with watching the children. Be aware of what has happened but try to keep the routine of the play similar to previous times. Children of any age are highly adept at reading a parent's emotions. A routine helps them feel safe.
For older children and adolescents, talk to your school age or adolescent child about what happened. See how they react and ask them what they think. Help them to understand that fighting in retaliation to harassment won't work. Standing by their friend and telling the other person to stop harassing their friend will help. Share with them that this is a critical time when all of us feel vulnerable. They too should keep in mind that they can help by spending time with their friend so he or she is not alone.
13. How can I prevent my children from becoming prejudiced?
Dr. Blaise Aguirre, Child Psychiatrist, McLean Hospital:
As children grow up, they become more aware of life outside their immediate surroundings. Exposure to media, school friends and peers, and other adults begin to mould the child's attitudes to life and others. They begin experience expressions and attitudes that might be different from those they experienced at home.
If children begin to show prejudice, it is important first to listen to their point of view to show that you can be open to discussion and to controversy. You then need to let them know you are concerned about what you see as prejudice, and that this conflicts with your beliefs and values as a family. One way to hammer home the point is to ask your child (if age appropriate) to roll play a situation in which they are the victim of such prejudice and ask them how they would feel being in the situation. Ultimately, open line of communication with free expression of ideas between parents and children models tolerance to different perspectives and ideas.
14. Are there any books I can give my child to help him or her understand what has happened?
Dr. Blaise Aguirre, Child Psychiatrist, McLean Hospital:
Little can substitute for a parent's direct involvement in the child's experience of this tragedy.
A book that is useful for preschoolers is: A Terrible Thing Happened — A story for children who have witnessed violence or trauma by Margaret M. Holmes
For parents and professionals, the following is a partial list of helpful texts: 1) Trauma and Recovery by Judith Herman MD 2) The Scared Child : Helping Kids Overcome Traumatic Events by Barbara A.Brooks. 3) Children Changed by Trauma : A Healing Guide by Debra Whiting Alexander 4) Children of Trauma: Stressful Life Events and Their Effects on Children and Adolescents by Thomas W. Miller.
15. How can children begin to understand such complicated issues?
Sharon Manne, director of the psycho-oncology program, Fox Chase Cancer Center:
I am not sure that young children should attempt to understand important political questions. Young children (under 10) just need to feel safe and secure in their worlds. Teenagers may raise more political issues — and these questions may have more to do with justice and hatred and tolerance, like "why did this happen?"
If an older teenager is interested and the parent judges that the child is mature enough to deal with the complex intellectual information then research and reading may be appropriate. It is my opinion that the key issues for children are more related to feeling safe, secure and protected first, and understanding hatred and anger second. Issues of justice are important but only after the child's emotional needs and concerns are taken care of.
Cynthia Kaplan, administrative director of the child and cdolescent psychiatry program, McLean Hospital, and Dr. Blaise Aguirre, child psychiatrist, McLean Hospital, a Harvard teaching hospital, helped review the material in this report.