Helping Kids Through Trauma and PTSD

We all deal with stress everyday. Rushing to get to school in time, making ends meet during a recession, dealing with a particularly annoying in-law — stress is a part of life. And in most occasions, the stress we face is manageable.

But some sources of stress can be incredibly intense, overwhelming and beyond our physical and/or emotional resources to deal with. When this happens, the stressful event is said to be traumatic. All parents want to protect their children from things that can unsettle or harm them. But sadly, there are many things in life that even the most conscientious of parents can’t control. Our children may witness or experience traumatic events despite our best efforts to shield them. When this happens, they may have difficulty bouncing back. Sleep disturbances, sadness, anger and fear may plague a traumatized child long after the traumatic event has ended.

What is a Trauma?
Trauma is a psychological reaction to highly stressful events, particularly those that threaten life or safety. When an experience is considered traumatic, it means that the coping resources of the person witnessing or experiencing it are not enough to deal with the impact of the event, and some degree of psychological shock or breakdown occurs. Events that most people consider traumatic include vehicular accidents, crimes, natural disasters and physical or sexual abuse. Although parents may think that trauma results only from catastrophic events like war or rape, it can actually occur as a result of more normal and common events. For instance, a child can be traumatized by being chased by a dog, by a harsh reprimand from a teacher, from a threatening bully, or from being laughed at while giving an oral report. What makes an event traumatic differs from person to person, as individual coping abilities must be taken into account. Personality factors, psychological profile and past history all play a role in producing a traumatic reaction.

A trauma response often includes symptoms like reliving the event over and over again (by obsessing about it; experiencing intrusive thoughts that interrupt thoughts and activities), panic attacks, nightmares, numbness & fog responses, avoiding people, places and things that trigger a memory of the event, depressed and/or angry mood and increased nervousness (startle response).

Trauma can initiate a syndrome that shows up long after the traumatic event or events have ended. Like an initial trauma response, it affects physical and emotional functioning causing nightmares, hypervigilance, panic attacks, intrusive memories, numbness and other symptoms; the syndrome is called PTSD or Post-Traumatic Stress Disorder. It can occur weeks, years or decades after the traumatic events have passed.

Those who have some level of anxiety to begin with and those who have suffered several previous traumatic incidents are more likely to develop PTSD than other people. Lack of a support system or lack of adequate emotional support right after a trauma, also increases the chances of developing PTSD later on.

What is the Best Way to Handle PTSD?
PTSD is a mental health disorder that can be effectively treated. Self-help is part of the process for teens and adults, including finding support groups, reading up on PTSD, engaging in effective stress-management routines (including regular exercise, relaxation techniques and routines for self-care), utilizing alternative treatments to strengthen the nervous system (such as herbal remedies, Bach Flower Therapy, Aromatherapy, homeopathy, accupuncture and so forth). Parents can help incorporate calming strategies into a child’s routines.

Parental support is critical when a child is dealing with trauma. Unlike adults, younger children don’t yet have the ability to understand what they are going through. Not only is the original event traumatic, but their trauma symptoms too, can be traumatic. For instance, physical symptoms like tremors and nightmares, mental symptoms like obsessions and hallucinations, and emotional symptoms like fear and anxiety can be overwhelming for a child to be experiencing.

The first line of business is to help children manage their emotions. Encourage them to talk about their feelings. A traumatized child may talk about the same thing over and over again, and this is okay. The content of the sharing is less important than the process of getting things out. If a child finds difficulty in expressing what he is going through verbally, either because of age or because of the trauma, then consider non-verbal ways of venting emotions. Letting it all out can also be done using drawings and pictures, clay sculptures and toys, play-acting, and storytelling.

Second, give your child a rational explanation of the traumatic event, that is appropriate to his or her age. The more information the child has, the less he or she is likely to generalize the event to other situations. For instance, knowing that a car crashed because it skidded on the snow can help a child feel safe in cars with good snow tires and in cars driving on dry roads. Without this information, the child may conclude that all cars are dangerous at all times. (While this is in fact true, the healthy state of mind is one of sufficient denial that a person can comfortably drive and be driven at all times. Phobic and traumatized people, on the other hand, over-exaggerate the likelihood of a catastrophic event occurring again, such that they can’t live in a normal way.)

When a child is suffering rather mild symptoms, parents may find that self-help interventions are sufficient. For instance, learning how to do EFT (emotional freedom technique) with the child may complete calm the youngster’s nervous system. However, parents may prefer to take their child to a child psychologist who practices EFT or EMDR. Both of these techniques are used to rapidly heal the trauma of one-time events. If the child is experiencing many symptoms of trauma, it is essential that parents DO NOT try the self-help approach. Instead, they should take their child to a mental health professional who is specifically trained in the treatment of PTSD.

The Bach Flower Remedy called “Rescue Remedy” can help reduce temporary and chronic symptoms of trauma and is especially effective for home-management of symptoms in between psychotherapy sessions. If you are aware that the child has just suffered a traumatic event (like watching someone get badly injured or being personally assaulted, injured or threatened), offer Rescue Remedy immediately. It may help prevent a traumatic reaction from setting in.

However, the fastest and most effective way to end the debilitating symptoms of PTSD is to get the proper professional help. Not all mental health professionals are equally trained in the treatment of PTSD. Make sure that your practitioner is! Therapeutic interventions include EMDR (Eye Movement, Desensitization and Reprocessing), EFT and other forms of Energy Psychology, TIR (Traumatic Incident Reduction),  and other specific tools for the treatment of trauma.

The good news is that children respond well to treatment of trauma. They can experience a complete healing of their symptoms and a return to “normalcy.” In fact, child are often even happier, calmer and more mature after trauma therapy than they were before the traumatic event(s) occurred.

Suicidal Feelings

A certain number of people kill themselves each year, most of whom were suffering from severe depression. Fortunately, 90% of people with depression are able to live full lives while managing their episodes of depressed mood. Only about 10% will end their lives (this number depends on where a person lives – countries vary in their availability of effective treatments and support for depression, so there is a wide international variability in suicide rates).  The pervasive sad mood that comes with depression, as well as the increased tendency among the depressed to obsess on negative thoughts, makes them susceptible to the hopelessness and irrationality characteristic of the suicidal person. People do not “choose” suicide; they fall victim to it as part of their illness.

What are the Implications for Parents?
The link between suicidality and depression should serve as alarm bells when helping our children deal with mental health issues. If we have a loved one who is suffering from depression, it is always prudent to watch out for signs of suicidality. A depressed child is at risk for succumbing to suicidal thoughts; it is up to parents to help prevent this. Vigilant parents can be familiar with the warning signs of suicidality and take action. Moreover, they can do everything possible to get their child the right kind of help. In addition, they can work hard to reduce the other stressors in the child’s life – like school work (negotiate accommodations with the school) and conflict in the home. In fact, when the parents work on their own marriage and parenting skills to increase peace in the home, this can help tremendously.

What are the Warning Signs?
According to the American Academy of Child and Adolescent Psychiatry these signs are:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent behavior or running away
  • Substance abuse
  • Neglect of personal grooming
  • Personality change
  • Difficulty concentrating, persistent boredom
  • Drop in academic performance
  • Marked personality change
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in previously enjoyable activities
  • Speaking positively about death or romanticizing dying (“If I died, people will appreciate me more.”)
  • Writing about death, dying, or suicide
  • Engaging in reckless or dangerous behavior; being injured frequently in accidents
  • Giving away or discard favorite possessions
  • Saying permanent sounding goodbyes to friends and family
  • Seeking out weapons, pills, or other lethal tools

A child or teen  who is planning to commit suicide may also:

  • Complain of being a bad person or feeling rotten inside
  • Give verbal hints with statements such as: “I won’t be a problem for you much longer.”, “Nothing matters.”, “It’s no use.”, and “I won’t see you again.”
  • Become suddenly cheerful after a period of depression
  • Have signs of psychosis (hallucinations or bizarre thoughts)

The risk of suicide is high among those who have attempted suicide before, know someone who has killed themselves, and are pessimistic about the chances of getting relief from chronic depression. Also, teens who have a family history of mental illness and suicide are more likely to attempt suicide as are teens who have clinical depression or who suffer from active addiction. Teens who’ve already made a suicide attempt have a higher chance of committing suicide successfully. Vulnerable teenagers who suffer a serious loss (like the breakup of a romantic relationship) may try to stop the pain with suicide. A history of physical or sexual abuse, incarceration, alienation from parents and refusal to access mental health services all increase suicidal risk. Males have a higher “success” rate for suicide than females, but females make many more suicide attempts than do males. Also take note if your depressed child suddenly seems unusally happy. Sometimes this switch in attitude happens because a child has decided to end his suffering and he is actually experiencing a state of relief. Remember that depressed mood is a serious and potentially life-threatening condition and should always be professionally treated.

The American Academy of Child and Adolescent Psychiatry recommends taking a child’s suicidal statements seriously. If a child or adolescent says, “I want to kill myself,” or “I’m going to commit suicide,” ask him what he means. Don’t be afraid of saying the word “suicide.” You won’t be giving the teen an idea that he hadn’t thought about. Instead, you’ll help him or her think things through. Ask about depression, anxiety and unhappiness. Don’t just tell the child no to talk that way.  Show interest and concern and get your child to a qualified mental health professional (such as a psychiatrist or clinical psychologist).

Suicidal Behavior in Teens
Teenagers are a vulnerable group. They experience tremendous pressure from all sides: from inside their changing bodies, from their parents, from their schools and from their peers. No one can be perfect in every area and so everyone is doing poorly in something. But teenagers can feel isolated with their failures and setbacks, lacking the perspective that older people have that “we’re all in this together.” Teenagers are intent on fitting in, looking good, being acceptable. If the only group they can fit into is a violent, drug-ridden street gang, then that’ll be the group they might very well join, especially if they have little support elsewhere or few sources of success and strength.

Because the pressure is so intense, many teens do not cope well. Their survival strategies depend to a large extent on their genetic make-up and the strategies they learn at home. Some teenagers have “hardy” genes that help them survive and thrive under stressful conditions. They can laugh their way through almost anything or simply tough it out. Others are genetically vulnerable to bouts of depression. However, the depressed teen is more at risk than depressed adults. Teens are very focused in the present. They have trouble imagining that in a few years life can improve tremendously. Their impulsivity can lead them to put an end to it all right now because they just can’t see any way out.

What You Can Do
Parents can also help buffer teens from stress by keeping the doors of communication open. Make it easy for your kids to talk to you. Keep criticism to a minimum; instead, give praise and positive feedback generously. Have fun with your teenager and try to make your home pleasant, comfortable and safe. Keep conflict down with your spouse. Avoid drama. Take care of yourself and create a healthy model of stress management strategies for your kids to learn from. Create a positive atmosphere. Have a dinner table several times a week and use it to have discussions on politics, human nature, interesting things in the news or whatever—keep talking with your kids. Make your values clear. Bring tradition and ritual into your home.  Accept all feelings without correction or disapproval. Ask for behavioral change gently and respectfully. Never yell at your teenager. Never insult, name call, use sarcasm or any other form of verbal abuse. Instead, be sensitive to your teen’s feelings at all times. Discipline when necessary but only after you’ve warned a child that discipline will occur and only with mild discipline—never affecting the teen’s social life (see Raise Your Kids without Raising Your Voice for safe and effective ways of guiding teenagers).

If your teen demonstrates any of the symptoms of depression or suicidality, talk to him or her about what you are observing and arrange an appointment with a mental health professional. You can call suicide helplines in your area to get information about how to help your child. You can take your child for a mental health assessment. If your child is uncooperative, seek mental health guidance yourself. Since a suicidal person feels isolated and hopeless, any steps that family members take to address the situation can be powerfully preventative. Remember, too, that many parents have walked this road before you. Access on-line and community support if your child has been threatening suicide.

Sexual Harassment

Sexual harassment is typically thought of as something that happens between a boss and an employee, or committed by a drunk in the bar. But recent reports have shown that sexual harassment in schools is on the rise. A national survey of American public schools report that as much as 80% of female students and 60% of male students have experienced sexual harassment while in school! Worse, most of the time these harassments occur right out in the open, in full view and/or hearing of other people.

What is Sexual Harassment?
Put simply, sexual harassment is any unsolicited and unwanted sexual advance or attack against one’s gender and sexuality. Behaviors considered as sexual harassment exist in a range, from making sexual jokes or comments, to giving looks that may be construed as lewd or suggestive, to inappropriate touches and forcing someone to engage in sexual behavior.

Sexual harassment can happen face-to-face or indirectly. Abuses within internet chatrooms, spreading nasty rumors, and vandalisms that contain explicit sexual content targeted to a particular person are all considered indirect ways of sexual harassment. Both direct and indirect ways of sexual harassment can cause severe stress and trauma to its victim, and must be taken seriously.

What can Parents Do?
There are many things that parents can do to prevent sexual harassment from reaching their children.

Prevention is always better than any steps taken after the fact, so it’s best if parents take a proactive role in combating sexual harassment.

Parents can start by educating their kids on what sexual harassment is, and its impact to its victims. For instance, parents must take a hard stance against making inappropriate jokes and comments, even if there are those who would say “boys are just being boys” or “it’s all just good-natured teasing.” Sensitizing children on the offensive nature of sexual jokes is a good start in preventing sexual harassment from spreading. Similarly, children must always be taught to respect people’s sexuality. Calling someone a “faggot” or a “dyke,”  a “whore” or other insulting sexual names is not to be tolerated under any circumstance. By teaching kids not to hurt others in this way, parents help put an end to the cycle of victimization.

However, parents also have to teach their children how to respond to sexual harassment in the case that it happens to them. This can help prevent trauma.  When a child knows what steps to take, he or she feels empowered and supported. For instance, teach your child to report harassment to the principle or guidance counselor immediately.  Kids can also be taught how to stand up to bullies of all kinds, including those who bully through sexual harassment. Bully-proofing can be brought into schools as a program for the student body – speak to the guidance department about arranging this. Kids should also be taught how not to invite abuse and harassment through their own behaviors. For instance, if a girl dresses very provocatively instead of more modestly, she is communicating that she wants to be noticed sexually. Although she is not responsible for being victimized by harassment, she is certainly responsible for inviting sexual attention. Teach your kids how the opposite gender reacts to cues (i.e. how boys are stimulated by revealing clothing and so on).

Parents can ask their local librarian for help in selecting age-appropriate materials on this subject to bring home for their kids. When children learn from books it can be extra powerful – it means that the information they are receiving is not just Mom or Dad’s nervous over-reactions.

Sometimes parents can take the advocacy to the school and the community. Many school administrators, teachers and community members are unaware of how prevalent the problem is, and thus they are not as vigilant in identifying and reporting sexual harassment cases. A culture of silence and impunity may exist in a school, so it’s best to launch information campaigns designed to remove the stigma associated with being victimized. Establishing clear channels for reporting harassment and systems of response and referral are also ideal.

Lastly, it’s important that parents make their kids aware of what their rights are. For instance, choosing not give in to peer pressure to harass others is a right and a responsibility. Similarly, one always has a right to say “no” to any unwanted communication or sexual advance. And if they are victimized, or know someone who has been, it’s their right to report the harassment to the proper authorities.

Forcing Sexual Attention on a Peer

No one wants to hear that their child is misbehaving at school, on the sports team or in the neighborhood. A call home from teacher, principal, or coach can make good parents cringe. They feel ashamed of their child as well as concerned for him or her. However, one of the hardest things to hear is a report that one’s child has committed a sexual misdeed. In such cases, parents feel not only shame and embarrassment, but also panic and horror. What kind of monster have they raised?

What are parents to do when they find out that their child has forced sexual attention on a peer?

Stay Calm
Hearing from the school principal — or worse, the police — that your child committed sexual harassment is difficult. You might be tempted to give in to your emotions and lash out at your child — don’t! Instead, take the time to calm down so that you can approach the situation rationally. The issue is too important to treat with drama or hysteria.

Take the Behavior Seriously
Parents of kids who sexually harass others may deliberately or unconsciously water down the gravity of the issue. They might say that their child is just being flirtatious, or is responding to mixed messages from the victim. If you’re a parent sincerely interested in helping your child, do not give in to this temptation. Whether your child was deliberate in forcing sexual attention on a peer, or your child is honestly unaware that what he or she did is wrong, this is one behavior you want to nip in the bud. Studies show that adult sexual offenders begin through inappropriate sexual behavior as teenagers or young children. Shrugging things off today may prove to be costly in the future.

Assess How Much Help Your Child Needs
Each case of sexual harassment is different and must be approached differently. Some cases are more serious than others and will  require professional intervention. Other cases can be addressed by parent education, sensitivity training and logical consequences. It’s important that parents assess the problem correctly so that they can make the most appropriate intervention. Enlisting the help of objective professionals is highly recommended. For instance, a child psychologist is in an excellent position to determine whether the child’s behavior reflects serious mental health issues or more benign inappropriate actions.

What are the things parents and professionals should consider?

First, ask: is this a first offense or is this behavior been going on for some time now? If it’s the latter then you don’t just have a one time incident to deal with but a pattern of misbehavior to address. You may need extra support and professional intervention to help your child towards positive change.

Second, assess: did your child deliberately force sexual attention on his or her friend or classmate, or is your child honestly confused regarding the gravity of his or her actions? If it’s the first case, the situation is more serious, as there is an actual choice to do something that is clearly wrong and harmful. You might be dealing with a conduct disorder or other mental health disorder. If, however, the child is honestly confused regarding the gravity of his or her actions, it’s possible that your child is merely poorly socialized, and has no idea how to behave appropriately in the presence of people he or she finds sexually attractive. In fact, the child may just be modeling negative role models, like swashbuckling TV characters who get away with the kind of behavior that shouldn’t be tolerated in real life.

Lastly, consider your child’s age. To what degree does he or she have an understanding of sex and sexuality? The younger kids are, the less likely it is that their misbehavior was malicious in nature. In addition, it is more likely that they would be confused as to when an action is wanted or unwanted. Older children and teenagers, however, must be charged with greater accountability for their actions, as they are expected to be aware of the impact of their behavior on their victim.

Provide the Help Needed
As mentioned, the intervention must fit the gravity of the problem. If the situation is not alarming – that is, a parent is dealing with a first offense, done without awareness of the wrongness of the deed, by a child too young to understand what sexual harassment is – then parents can deal with the situation at home using education, guidance and a system of consequences. For increasing gravity, increasing degrees of professional help must be solicited.

Education is the lightest intervention. Teach your child that what he or she did is wrong, and why exactly it is wrong. Emphasize that it’s a behavior that you don’t ever want to see repeated again. Sensitivity training can follow; teach your child to understand a peer’s point of view and why ta victim would find unwanted sexual advances not just offensive but traumatic. Contract for logical consequences; make sure your child apologizes to his or her victim and/or victim’s parents. If victims press charges, it is possible that the child may also be made to undergo counseling and therapy, or put in community service. Sadly, a child may also have to go through juvenile court as consequence of his or her behavior.

For serious cases, professional treatment is required. You may also want to consult the local social welfare office for resources on how to help juvenile sexual offenders. There are also non-governmental institutions that assist sexual offenders. Treatment options can range from out-patient weekly therapy session to residential placement and treatment.

Child Pulls Down Another Child’s Pants

When you go to pick up your 4 year-old from daycare, the teacher gives you some unpleasant news: your little pre-schooler has pulled down a playmate’s pants. Embarrassed, your child’s victim cried till his mommy picked him up a little while ago. Meanwhile, your son is still running around the classroom laughing. Even though he was reprimanded immediately and sent to the “thinking chair” for 15 minutes, he doesn’t seem to be remorseful.

How should you react? Is a child pulling down other kids’ pants a serious matter? Is your child a deviant? Has he been sexually abused? Why isn’t he feeling guilty or ashamed of himself?

First off, the good news. When it comes to really young children like toddlers and pre-schoolers, pulling down another child’s pants rarely has anything to do with sexual malice or sexual maladjustment. In all likelihood your child thought that it would be a funny thing to do, and the ensuing laughter by peers probably confirmed his or her belief. Targets of pants-pulling tend to be random playmates; in young children, attacking someone in this way is not generally an act of deliberate aggression against someone they do not like. (This is not equally true for older kids, however. For instance, a 10 year-old who pulls down another child’s pants may very well be targeting an “enemy” or otherwise engaging in angry, bullying behavior.)

This said, it’s still a behavior worth correcting. Correcting the behavior is an opportunity to educate your child about issues of privacy, in a way that is appropriate to his or her age. Most importantly, a child who pulls down a playmate’s pants is lacking in the trait of empathy. To help a child acquire more empathy, use the technique of “emotional coaching” on a regular basis. This skill essentially involves naming a child’s feelings BEFORE solving problems or addressing issues. Naming feelings can take place all day long. For instance, when a child says, “I don’t want to wear my gloves today,” a parent can name feelings BEFORE deciding what to do about the gloves. It might sound like this, “I know. It’s a bother to pull those gloves on and off all the time. It can be annoying, right?” Then the parent can “solve” the glove problem any which way he or she desires. For instance, “You’ve had a cold this week and I really think the gloves are important to help you get better and stay better. I’d like you to put them on anyways.” Or, “You don’t have to wear them, but I’d like you to take them so that you have them in case you get cold.” When you tell a child to stop calling his brother names and the child says, “He broke my model!” you can name feelings FIRST before solving the brother problem. “That must be so frustrating! You really worked hard on that model. No wonder you are upset with him!” Now solve the problem whichever way you want. For instance, “However, you still can’t call him names. You can tell him you don’t like what he did and you can tell me if you need help. You can tell him that you aren’t going to play with him tonight because you’re upset. You just can’t insult him or hurt him, do you understand?” Of course, you may also use discipline to discourage the child from name-calling. You can discipline the child who broke the model and so on. The step of emotional coaching has been shown in large research studies to help improve a child’s emotional intelligence, making him more empathetic to others and more socially aware. This helps prevent misbehaviors like pulling down people’s pants!

The following are some tips on how to deal with a child caught pulling down another kid’s pants:

Find Out Where Your Child Learned to Do It
Start by asking your child where he or she got the idea to pull their playmate’s pants. Did your child see it on television? Then explain that certain things on T.V. are not O.K. (and perhaps try to supervise your child’s T.V. experience more closely till he is a little older). Did someone else in the playground start it, and your child just followed along? Then maybe teaching them about not joining unacceptable behavior is in order. Or was your child dared by an older sibling? Then you may need to have a talk with your other child as well.

Explain Why Pants-Pulling is Wrong
Young children are likely still unaware that their behavior is wrong. Take the opportunity to teach them about privacy, and emphasize why it’s important for kids to respect it. Explain that people wear clothes like pants and underpants because they don’t want to be naked around people who are not in their family (keep in mind that toddlers and preschoolers are often naked in their own homes while they are getting dressed and undressed and when having their baths). Share how pulling down another child’s pants at school or in the park can make that child feel exposed, upset, emabarrassed and uncomfortable.

Ask How They Would Feel if Someone Else Pulled Down Their Pants
To encourage empathy, ask your child how he would have felt if the situations were reversed, if it was HIS pants that were pulled down. How would he feel if other kids laughed at him? More often than not, your child will say that he will not like it. Teach him “The Golden Rule” – do not do unto others that which you don’t want done to you!

Use Discipline
To help reinforce the lesson, tell your child that you do not want this to happen again. Let your youngster know that if you find out that he has done this again, he will have a punishment at home (tell him exactly what punishment you have in mind – for instance, losing dessert, going to bed early, losing T.V. or computer privileges or whatever you think is appropriate and would act as a deterrent).

Understanding Self-Harm

Hurting oneself on purpose seems to be an odd thing to do, yet the practice is growing in popularity among today’s teens. There is a reason for this: self-harm is a “harmless” way to reduce feelings of anxiety and angst. Due to the ease of modern communication among teenagers, word has caught on that this strategy works. It is cheap, easy and always available – unlike other methods of stress relief like drinking alcohol, taking drugs or even accessing counseling services! As a result, this disorder is highly influenced by peer behavior; when children learn that others they know are hurting themselves, they often experiment with this stress relief strategy themselves. Unfortunately, self-harm is a very dysfunctional behavior that often causes feelings of deep shame, helplessness and inadequacy in much the same way as other addictive behaviors do. For instance, bingeing and purging (overeating large amounts of food and then vomitting or using laxatives) also temporarily dispels anxiety but then causes those same painful emotions of shame, helplessness and inadequacy. Some people feel that self-harm is a cry for attention or help. Parents are naturally distressed to learn that their child has been hurting him or herself. Nonetheless, there is some comfort in knowing that self-harming actions are not necessarily related to suicidality. The goal of sufferers is to inflict minor pain, release endorphins and communicate to family members. Suicidal teenagers don’t practice self-harm; they practice killing themselves and sometimes succeed.

What is Self-Harm?
Self-harm is any action taken to cause oneself pain. Some people hit themselves – slapping their head, their face, their limbs or their body. Some people burn themselves. Some bite their skin or pick at it till it bleeds. Some use a sharp object to make small cuts on themselves – most commonly on their arms but also on other parts of the body.

Understanding the Paradox: Why Do People Do It?
When we are pain, such as when we experience a cut or burn, our brain releases natural pain relievers – endorphins – into the body. The chemicals associated with pain relief are also managers of mood. Hence, cutting and other methods of self-harm does bring some form of temporary relief to a person in distress. This temporary relief can get so addictive, that self-harm becomes a person’s first line of defense against emotions he or she can’t handle.

Experts also believe that there are psychological reasons why self-harm makes sense to the people who do it. Many times, cutting becomes some form of displacement. When emotional pain is too much to bear, “transforming” the emotional pain to physical pain makes it more manageable. Engaging in self-harm is also a way of validating that the pain one feels is real. There’s no evidence of inner distress, but seeing scars and burns are an acknowledgment that one is suffering.

In some cases, people engage in self-harm as an unconscious way of punishing themselves or a cry for attention. There are also situations when self-harm is an attempt to “feel something”; too much pain or trauma can numb one’s self. For people who engage in self-injury, self harm is better than feeling nothing.

Is Self-Harm a Suicide Attempt?
Not usually. However, people who self-harm are at additional risk for becoming suicidal. Therefore, parents need to take self-harming behaviors seriously.

While many who engage in self-harm report that they have no plans to kill themselves (they just want the temporary relief self-harm brings), they are always mentally unhealthy. Healthy people don’t hurt themselves. The mental health conditions typically associated with suicide attempts (e.g. clinical depression, Post Traumatic Stress Disorder, severe anxiety) are often the same conditions that trigger self-harm. It is possible that self-harm activities are not suicidal in and of themselves, but if people are left alone to wallow in progressive mental illness, self-harming tendencies can progress to actual suicidality. Parents and mental health professionals are therefore recommended to take the cautious view and always treat the underlying emotions and mental health conditions of those who engage in self-harm.

What can Parents Do to Help a Child Who Engages in Self-Harm?
First off, be alert. Children and teens who self-harms take extra pains to hide what they are doing; you need to be a conscious and attentive parent to spot what’s going on. Symptoms of self-harm includes persistent wearing of clothing that hide common targets of self-harm such as the wrist, the upper arms and the chest; frequent “accidents” that explains injuries, a high need for privacy, implements like cutters, ropes or lighters in the bedroom, and symptoms of depression.

When you’ve confirmed that your child does engage in self-harm, it’s important that you raise the issue with him or her instead of hoping the behavior will go away on its own. Provide unconditional acceptance and a listening ear. And most importantly, arrange an appointment with a licensed mental health professional.

Helping Your Child Cope with Traumatic Events

All parents want to protect their children from things that can unsettle or harm them. But sadly, there are many things in life that even the most conscientious of parents can’t control. Our children may witness or experience traumatic events despite our best efforts to shield them. When this happens, they may have difficulty bouncing back. Sleep disturbances, sadness, anger, fear, or other symptoms of trauma may plague a traumatized child long after the traumatic event has ended.

What is a Trauma?
Trauma is a psychological reaction to highly stressful events, particularly those that threaten life or safety. When an experience is considered traumatic, it means that the coping resources of the person witnessing or experiencing it are not enough to deal with the impact of the event, and some degree of psychological shock or breakdown occurs. Events that most people consider traumatic include vehicular accidents, crimes, natural disasters and physical or sexual abuse.  Although parents may think that trauma results only from catastrophic events like war or rape, it can actually occur as a result of more normal and common events. For instance, a child can be traumatized by being chased by a dog, by a harsh reprimand from a teacher, from a threatening bully, or from being laughed at while giving an oral report. What makes an event traumatic differs from person to person, as individual coping abilities must be taken into account. Personality factors, psychological profile and past history all play a role in producing a traumatic reaction. A trauma response often includes symptoms like reliving the event over and over again (obsessing about it; experiencing intrusive thoughts), panic attacks, nightmares, numbing and fog responses, avoiding people, places and things that trigger a memory of the event, depressed and/or angry mood and increased nervousness (startle response).

How can Parents Help Children Cope with Trauma?
Parental support is critical when a child is dealing with trauma. Unlike adults, younger children don’t yet have the ability to understand what they are going through. Not only is the original event traumatic, but their trauma symptoms too, can be traumatic. For instance, physical symptoms like tremors and nightmares, mental symptoms like obsessions and hallucinations, and emotional symptoms like fear and anxiety can be overwhelming for a child to be experiencing.

The first line of business is to help children manage their emotions. Encourage them to talk about their feelings. A traumatized child may talk about the same thing over and over again, and this is okay. The content of the sharing is less important than the process of getting things out. If a child finds difficulty in expressing what he is going through verbally, either because of age or because of the trauma, then consider non-verbal ways of venting emotions. Letting it all out can also be done using drawings and pictures, clay sculptures and toys, play-acting, and story-telling.

Second, give your child a rational explanation of the traumatic event, that is appropriate to his or her age. The more information the child has, the less he or she is likely to generalize the event to other situations. For instance, knowing that a car crashed because it skidded on the snow can help a child feel safe in cars with good snow tires and in cars driving on dry roads. Without this information, the child may conclude that all cars are dangerous at all times. (While this is in fact true, the healthy state of mind is one of sufficient denial that a person can comfortably drive and be driven at all times. Phobic and traumatized people, on the other hand, over-exaggerate the likelihood of a catastrophic event occuring again, such that they can’t live in a normal way.)

When a child is suffering rather mild symptoms, parents may find that self-help interventions are sufficient. For instance, learning how to do EFT (emotional freedom technique) with the child may complete calm the youngster’s nervous system. However, parents may prefer to take their child to a child psychologist who practices EFT or EMDR. Both of these techniques are used to rapidly heal the trauma of one-time events. If the child is experiencing many symptoms of trauma, it is essential that parents DO NOT try the self-help approach. Instead, they should take their child to a mental health professional who is specifically trained in the treatment of post-traumatic-stress-disorder (PTSD). PTSD is the name for the cluster of symptoms that occur in reaction to a traumatic event. The “p” in this label for “post traumatic” points to the fact that trauma symptoms can suddenly occur months, years or even decades after the original traumatic event(s). The mind/body seems to wait for the “right time” to release the memory of the event(s).

Technqiues like EFT and EMDR can also be used as part of a longer therapy addressing more chronic forms of trauma (such as being subjected to chronic bullying, physical abuse or incest). These and other interventions are specifically designed to heal both the memories and the bodily reactions and return the child to his normal state. In addition, the Bach Flower Remedy called “Rescue Remedy” can help reduce temporary and chronic symptoms of trauma and is especially effective for home-management of symptoms inbetween psychotherapy sessions.

The good news is that children respond well to treatment of trauma. They can experience a complete healing of their symptoms and a return to “normalcy.” In fact, children are often even happier, calmer and more mature after trauma therapy than they were before the traumatic event(s) occurred.

Refuses to Go to a Mental Health Professional

In an ideal world, consulting a mental health professional would be as easy as consulting a medical doctor – and as stigma-free. Unfortunately, many people still feel an element of shame, embarrassment or other type of awkwardness about going to a psychological professional. Some people still think that mental health professionals only deal with people who are “crazy” and understandably don’t want to be an identified member of such a population. In fact, in the “olden days” mental illness was poorly understood and derogatory terms such as “crazy” were used to describe people who we know know were suffering from various biological disorders such as schizophrenia, manic-depressive disorder or delusional disorders. Psychiatrists and clinical psychologists can now help mentally ill people feel and function better than ever before. Moreover, modern mental health professionals assist not only those who are suffering from true mental illness, but also those who are completely mentally healthy. They help almost everyone to function in less stressful, more productive and happier ways, helping  them achieve their full potential in every area. People who access mental health services in order to feel and achieve their best, tend to be more emotionally sophisticated, open-minded and growth-oriented than those who do not. In other words, it is often the most mentally healthy people who consult mental health pofessionals today.

Although YOU may know all this, your child may not. In fact, your child may have the old misconception that going to a mental health professional means that there is something wrong with you. As a result, he or she may not want to see a mental health professional, even though you know that this is exactly what is needed.

If your child refuses to go to a mental health professional, consider the following tips:

Explain to your Child what Mental Health is and what Mental Health Professionals Do
As previously mentioned, there are many misconceptions that float around regarding the mental health profession — and even young children could have heard of them through playmates and peers. It’s important then that you explain carefully that mental health is just one aspect of our health. Emphasize that healthy people access mental health services in order to learn new skills, improve relationships, reduce stress and emotional discomfort, feel better physically, and achieve more in school or life. Be specific too – talk about the various tasks that mental health professionals perform such as psycho-educational assessments, mental health assessments, family counseling (to reduce conflict or help cope with stress), remove and/or manage fear, anger or sadness, and much more.

Your child may not recognize or agree that he or she has an issue that requires intervention. As a parent, you are in charge of your child’s well-being. If your child had an infection, you would insist on medical attention. Similarly, if your child needs help for an emotional problem, it is up to you to arrange it. If the child in question is a teenager, you might have to deal with resistance – be prepared. First try to motivate the youngster with reason – explain the possible benefits of assessment and treatment. If the child still refuses to cooperate, let him or her know that, privileges will be removed. For example, “No you don’t have to go to see Dr. Haber, but if you decide not to come, you will  not have the use of my car until you change your mind.” Think of whatever consequences might help motivate your adolescent to cooperate.

Tell children what to expect at their first session. If there will be art or music or toys, let your child know that the session should be very enjoyable, even while the therapist is learning about the child’s issues and learning how to be help. If it will be a talking therapy, tell the child how the therapist might open the conversation, what sort of questions might be asked and how the child might approach the conversation. Tell the child how to handle tricky situations like not wanting to talk or open up too much or feeling not understood or being fearful. In other words, prepare for everything!

Gently but Clearly Explain Why you are Referring Them to a Mental Health Practitioner
Tell your child why you have scheduled a mental health consultation. Explain that the consultation is meant to help the child and is not some sort of negative consequence! Kids who are caught breaking the law, or even family rules, are often scheduled for counseling in order to find out the reason for the misbehavior. Children who do not do well in school are referred to educational psychologists for assessment of learning disorders or other causes. Depressed or anxious teens may be sent to psychiatrists or psychologists for treatment. If you are having relationship difficulties with your youngster, make sure to participate in the counseling process in some way, either having joint sessions with the child or having individuals sessions just like the child is having, or both.

Negotiate Confidentiality Boundaries Beforehand
A tricky issue for children in therapy is confidentiality. It’s common for some kids to have hesitation talking to a mental health professional. For them, counselors are just their parents’ spies — a way parents can gather information about them. It’s important that parents (and maybe the mental health professional him or herself) clarify beforehand that all issues discussed within sessions are confidential, and that only the generic nature of issues discussed would be revealed to parents. Similarly, the mental health practitioner can specify what will remain confidential and what sorts of information cannot remain confidential, giving the child the opportunity to share or withhold information knowing the limits of confidentiality.

Tell your Kids that They can Terminate a Consultation Anytime
It’s important that kids actually enjoy their therapy experiences. Negative therapy experiences may affect them negatively throughout life as they refuse to get much needed help because of traumatic memories of therapy in childhood! Therefore, make sure that your child LIKES going to therapy or change the therapist, or the type of therapy, or even consider stopping therapy for the time being and trying again later. Usually, mental health professionals are good at establishing rapport with their clients and child and adolescent specialists are particularly skilled at making kids feel comfortable. Nonetheless, if your child remains uncomfortable after a couple of meetings, end the therapy. Adults also need to feel comfortable in therapy in order to benefit and they, too, have the right to “shop around” for a compatible therapist or therapy approach. Since there are so many different types of treatments and so many therapists, there; they will do their best to get your child feeling at ease before they start an actual intervention. But many factors can cause your child to be uncomfortable with a mental health professional. It’s helpful then that your child knows that you are at least willing to consider enlisting a different professional, or terminating sessions if there are significant concerns.