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Reactions to Trauma and Suggestions for Intervention Example
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Reactions to Trauma and Suggestions for Intervention Age Behavioral Symptoms Physical Symptoms Emotional Symptoms Intervention Options 1 - 5 Clinging to parents or familiar adults
Helplessness and passive behavior
Resumption of bed wetting or thumb sucking
Fears of the dark
Avoidance of sleeping alone
Increased crying Loss of appetite
Stomach aches
Nausea
Sleep problems, nightmares
Speech difficulties
Tics Anxiety
Generalized fear
Irritability
Angry outbursts
Sadness
Withdrawal Give verbal reassurance and physical comfort
Clarify misconceptions repeatedly
Provide comforting bedtime routines
Help with labels for emotions
Avoid unnecessary separations
Permit child to sleep in parents’ room temporarily
Demystify reminders
Encourage expression regarding losses (deaths, pets, toys)
Monitor media exposure
Encourage expression through play activities 6 - 1 1 Decline in school performance
School avoidance
Aggressive behavior at home or school
Hyperactive or silly behavior
Whining, clinging, acting like a younger child
Increased competition with younger siblings for parents’ attention
Traumatic play and reenactments Change in appetite
Headaches
Sleep disturbances, nightmares
Somatic complaints Fear of feelings
Withdrawal from friends, familiar activities
Reminders triggering fears
Preoccupation with crime, criminals, safety, and death
Self blame
Guilt Give additional attention and consideration
Relax expectations of performance at home and at school temporarily
Set gentle but firm limits for acting out behavior
Provide structured but undemanding home chores and rehabilitation
activities
Encourage verbal and play expression of thoughts and feelings
Listen to child’s repeated retelling of traumatic event
Clarify child’s distortions and misconceptions
Identify and assist with reminders
Develop school program for peer support, expressive activities, education on trauma and crime, preparedness planning, identifying at-risk children 12-18 Decline in academic performance
Rebellion at home or school
Decline in previous responsible behavior
Agitation or decrease in energy level, apathy
Delinquent behavior
Risk-taking behavior
Social withdrawal
Abrupt shift in relationships Appetite changes
Gastrointestinal problems
Skin eruptions
Complaints of vague aches and pains
Sleep disorders Loss of interest in peer social activities, hobbies, recreation
Sadness or depression
Anxiety and fearfulness about safety
Resistance to authority
Feelings of inadequacy and helplessness
Guilt, self-blame, shame and self-consciousness
Desire for revenge Give additional attention and consideration
Relax expectations of performance at home and school temporarily
Encourage discussion of experience of trauma with peers, significant adults
Avoid insistence on discussion of feelings with parents
Address impulse to recklessness
Link behavior and feelings to event
Encourage physical activities
Encourage resumption of social activities, athletics, clubs, etc.
Encourage participation in community activities and school events
Develop school programs for peer support and debriefing, at-risk student support groups, telephone hotlines, drop-in centers, and identification of at-risk teens Adults Sleep problems
Avoidance of reminders
Excessive activity level
Protectiveness toward loved ones
Crying easily
Increased conflicts with family
Hyper-vigilance
Isolation, withdrawal, shutting down Nausea
Fatigue, exhaustion
Gastrointestinal distress
Appetite change
Somatic complaints
Worsening of chronic conditions Shock, disorientation, and numbness
Depression, sadness
Grief
Irritability, anger
Anxiety, fear
Despair, hopelessness
Guilt, self-doubt
Mood swings Protect, direct, and connect
Ensure access to emergency medical services
Provide supportive listening and opportunity to talk about experience and losses
Provide frequent rescue and recovery updates and resources for questions
Assist with prioritizing and problem solving
Assist family to facilitate communication and effective functioning
Provide information on traumatic stress and coping, children’s reactions, and tips for families
Provide information on criminal justice procedures, roles of primary responder groups
Provide crime victim services
Assess and refer when indicated
Provide information on referral resources Older Adults Withdrawal and isolation
Reluctance to leave home
Mobility limitations
Relocation adjustment problems Worsening of chronic illnesses
Sleep disorders
Memory problems
Somatic symptoms
More susceptible to hypo and hyperthermia
Physical and sensory limitations (sight, hearing) interfere with recovery Depression
Despair about losses
Apathy
Confusion, disorientation
Suspicion
Agitation, anger
Fears of institutionalization
Anxiety with unfamiliar surroundings
Embarrassment about receiving “hand outs” Provide strong and persistent verbal reassurance
Provide orienting information
Ensure physical needs are addressed (water, food, warmth)
Use multiple assessment methods as problems may be underreported
Assist with reconnecting with family and support systems
Assist in obtaining medical and financial assistance
Encourage discussion of traumatic experience, losses, and expression of emotions
Provide crime victim assistance Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Mental Health Response to Mass Violence and Terrorism, 2004
Helplessness and passive behavior
Resumption of bed wetting or thumb sucking
Fears of the dark
Avoidance of sleeping alone
Increased crying Loss of appetite
Stomach aches
Nausea
Sleep problems, nightmares
Speech difficulties
Tics Anxiety
Generalized fear
Irritability
Angry outbursts
Sadness
Withdrawal Give verbal reassurance and physical comfort
Clarify misconceptions repeatedly
Provide comforting bedtime routines
Help with labels for emotions
Avoid unnecessary separations
Permit child to sleep in parents’ room temporarily
Demystify reminders
Encourage expression regarding losses (deaths, pets, toys)
Monitor media exposure
Encourage expression through play activities 6 - 1 1 Decline in school performance
School avoidance
Aggressive behavior at home or school
Hyperactive or silly behavior
Whining, clinging, acting like a younger child
Increased competition with younger siblings for parents’ attention
Traumatic play and reenactments Change in appetite
Headaches
Sleep disturbances, nightmares
Somatic complaints Fear of feelings
Withdrawal from friends, familiar activities
Reminders triggering fears
Preoccupation with crime, criminals, safety, and death
Self blame
Guilt Give additional attention and consideration
Relax expectations of performance at home and at school temporarily
Set gentle but firm limits for acting out behavior
Provide structured but undemanding home chores and rehabilitation
activities
Encourage verbal and play expression of thoughts and feelings
Listen to child’s repeated retelling of traumatic event
Clarify child’s distortions and misconceptions
Identify and assist with reminders
Develop school program for peer support, expressive activities, education on trauma and crime, preparedness planning, identifying at-risk children 12-18 Decline in academic performance
Rebellion at home or school
Decline in previous responsible behavior
Agitation or decrease in energy level, apathy
Delinquent behavior
Risk-taking behavior
Social withdrawal
Abrupt shift in relationships Appetite changes
Gastrointestinal problems
Skin eruptions
Complaints of vague aches and pains
Sleep disorders Loss of interest in peer social activities, hobbies, recreation
Sadness or depression
Anxiety and fearfulness about safety
Resistance to authority
Feelings of inadequacy and helplessness
Guilt, self-blame, shame and self-consciousness
Desire for revenge Give additional attention and consideration
Relax expectations of performance at home and school temporarily
Encourage discussion of experience of trauma with peers, significant adults
Avoid insistence on discussion of feelings with parents
Address impulse to recklessness
Link behavior and feelings to event
Encourage physical activities
Encourage resumption of social activities, athletics, clubs, etc.
Encourage participation in community activities and school events
Develop school programs for peer support and debriefing, at-risk student support groups, telephone hotlines, drop-in centers, and identification of at-risk teens Adults Sleep problems
Avoidance of reminders
Excessive activity level
Protectiveness toward loved ones
Crying easily
Increased conflicts with family
Hyper-vigilance
Isolation, withdrawal, shutting down Nausea
Fatigue, exhaustion
Gastrointestinal distress
Appetite change
Somatic complaints
Worsening of chronic conditions Shock, disorientation, and numbness
Depression, sadness
Grief
Irritability, anger
Anxiety, fear
Despair, hopelessness
Guilt, self-doubt
Mood swings Protect, direct, and connect
Ensure access to emergency medical services
Provide supportive listening and opportunity to talk about experience and losses
Provide frequent rescue and recovery updates and resources for questions
Assist with prioritizing and problem solving
Assist family to facilitate communication and effective functioning
Provide information on traumatic stress and coping, children’s reactions, and tips for families
Provide information on criminal justice procedures, roles of primary responder groups
Provide crime victim services
Assess and refer when indicated
Provide information on referral resources Older Adults Withdrawal and isolation
Reluctance to leave home
Mobility limitations
Relocation adjustment problems Worsening of chronic illnesses
Sleep disorders
Memory problems
Somatic symptoms
More susceptible to hypo and hyperthermia
Physical and sensory limitations (sight, hearing) interfere with recovery Depression
Despair about losses
Apathy
Confusion, disorientation
Suspicion
Agitation, anger
Fears of institutionalization
Anxiety with unfamiliar surroundings
Embarrassment about receiving “hand outs” Provide strong and persistent verbal reassurance
Provide orienting information
Ensure physical needs are addressed (water, food, warmth)
Use multiple assessment methods as problems may be underreported
Assist with reconnecting with family and support systems
Assist in obtaining medical and financial assistance
Encourage discussion of traumatic experience, losses, and expression of emotions
Provide crime victim assistance Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Mental Health Response to Mass Violence and Terrorism, 2004