Traumatic stress in children: Can you spot the signs?

She will never forget that day, Thursday, March 6, 1997. The previous night, Khadija Ali’s mother did not return home from work.

She recalls how her visibly disturbed father struggled to make them dinner and reassure her and her elder brother, Mohamed, that all was well as he tucked them into bed.

The next day, Khadija, then five years old, woke up to shouting and screaming outside their home in Mariakani, at the coast.

“When I rushed outside, I saw several policemen, which made me very scared. My grandmother and aunties were crying and screaming and I knew something was terribly wrong,” she says.

Before she could digest what was going on, two policemen grabbed Khadija and her brother and pushed them into a waiting car.

“My brother was crying quietly but I remember being very violent and telling the strong policeman to leave me alone. I tried to reach out to my grandmother but the police wouldn’t let me. They just sped off,” she says.

Khadija and her brother would learn much later that their father had killed their mother.

NO ONE CARED TO EXPLAIN

They were taken to Vihiga, western Kenya, where her mother’s parents lived. Khadija says no one cared to explain to them why they had been taken away from the only home they knew or where their parents were. In fact, talking about their parents was considered taboo.

To make matters worse, they were given new names and admitted to a new school. She says she felt lost, traumatised, and lonely.

“My grandmother told me that our father had also died, but she did not tell us why he had died or where he was buried.

She just told us never to speak about him or ask about him again,” Khadija says.

It was only 15 years later that she learnt that her father was alive, though serving a life sentence for killing their mother.

“I could no longer cope with the hurt and feeling of betrayal I had carried with me all those years, and decided to kill myself.”

Fortunately, she was rushed to hospital in time. It was then that she started seeing a counsellor who encouraged her to take the bold step of meeting her father.

“It was not easy, coming face to face with my father, but it was the start of my healing process,” she says.

Traumatic experiences are inevitable and are bound to happen to every one of us at least once in our lifetime.

Children are especially hit hard, and most suffer in silence because adults are usually at a loss of how to help them or are too wrapped in their own grief to notice that the child is suffering too.

Dr Gladys Mwiti, a consultant clinical psychologist, confirms that children are as affected by traumatic stress as adults are, if not more.

Traumatic stress in children, she says, is caused by any event that threatens the safety and stability of a child — for instance constantly witnessing his or her parents fight or even witnessing an extremely violent act, such as the recent Westgate Mall killings.

Other causes of traumatic stress include death of a parent, sexual and physical abuse, and car accidents.

“Even listening to adults describing things in gory details could cause traumatic stress. Children’s brains are very sharp and their imagination is very active,” warns Dr Mwiti.

She adds that even newspapers with explicit pictures can affect them, therefore avoid taking them home.

SIGNS
The most common tell-tale signs of childhood traumatic stress include inactiveness, being emotional, withdrawal (both emotionally and socially), nightmares, poor eating habits (loss of appetite), and repetitive playing.

“Repetitive playing is especially dangerous. It mostly happens with children who have been bereaved. If you see a child doing something over and over again, it means that they are stuck somewhere in their psyche and there is something that they are unable to internalise,” says Dr Mwiti.

Clingy behaviour is also common among children suffering from traumatic stress. According to Dr Mwiti, if a child begins to cling to strangers, it is because there is something in that person that reminds them of the safety they once had but was stolen from them.

Traumatised children also show regression — where a child moves back to an earlier stage and starts exhibiting behaviour such as bedwetting and thumb-sucking.

These children go back to an earlier development stage because they feel so unsafe being 10 years, they want to go back to when they were three years old. This is why they start exhibiting such habits,” says the expert.

While traumatic events and experiences cannot be prevented, parents can play an active role in helping their children overcome traumatic stress.

According to Dr Mwiti, children usually take cues from the adults around them, particularly those that are emotionally close to them.

It is for this reason that the first step in dealing with a traumatised child is to create a safe place for him and ensure that his environment is secure.

This means that the adults around them, for instance parents, must not show that they are stressed because this easily rubs off on the child.

Says Dr Mwiti: “Research shows that stress is contagious. This means that the more a parent is depressed, the more a child is stressed because children take cues from their parents.

If you want to help your child deal with what is troubling him, you have to first deal with whatever is stressing you,” she says.

RESPOND TO IMMEDIATE NEEDS OF A CHILD

Psychologists also advise parents to respond to the immediate needs of a child and ensure that their environment is secure by maintaining the routine the child is used to.

“If they go to school at 8am, they must stick to that routine, whether Daddy died or not. If you change the routine, it confuses them,” says Dr Mwiti.

Dealing with bereaved children requires a lot of patience and honesty on the part of the adult helping the child, particularly those who have lost their parents at a very young age.

Children as young as three years are attached to their mothers and will always sense if that attachment is disturbed.

“Tell them the truth about death. Don’t lie to them that their father went on a journey, for instance. When you tell them the truth, they digest it, and even if they don’t understand immediately, they will always come back with questions, which you should be ready to answer.”

How art therapy heals traumatised children.

Art therapy is the use of images to pass a message from the inner world. It can also take the form of play, drama, paintings, and music.

Children who have gone through traumatic experiences are asked to express their feelings through art.

Maximilla Okello is a teacher working with children who were affected during the killings in Bungoma County early this year.

Some of these children saw their parents and other close relatives being hacked to death.

ART THERAPY

She uses art therapy to help the traumatised children, a method she says has been instrumental in helping the children through their healing process.
“A child may lack the words to express what they’re going through, but through art therapy, they are able to draw or paint their recurring thoughts and nightmares,” says Maximilla.
She explains that this therapy is carried out in three phases, with the first phase aiming to create stability in the child’s environment.

“We tell them to draw the places they feel secure in or the best moments in their lives. Here, children are likely to draw happy faces and paint them using their favourite bright colours.

They also draw themselves playing because play makes them happy,” says Maximilla. The second stage requires the children to come face to face with their emotions by having them draw people they hate or people who hurt them.

“This is the phase of remembrance, mourning, and reconstruction. Grieving is an important aspect in dealing with trauma. Children draw people they are angry with. And in this case of Bungoma, most of them drew images of hooded adults with machetes and knives — people whom they believe harmed and hurt them,” says Ms Okello.

Their images or paintings might not be exactly artistic, but looking at them, one can pick out several elements of pain, betrayal ,and hurt. For instance, one child drew a person with an animal’s head, which Maximilla says can be translated to bring out the animosity and wildness of human beings.

“Children may also use inharmonious lines with a mixture of various dull and ugly colours such as black to portray their disharmony and pain,” she explains.
The last step sees the children through recovery and peace of mind and this can only happen when a child has completely had closure in regard to the traumatic experiences they went through. At this stage, children begin to show signs of stability, their nightmares go away, and they begin to act and play normally. The entire process takes at least six weeks before a child is completely healed from traumatic stress.
“Art therapy allows a child to become an active participant in their healing process and they are able to fit back in society, having put what happened to them behind them,” says Maximilla.

Parents can also play a role in helping a traumatised child by encouraging their children to take up art, music, and sports as hobbies.

They should also be careful with the kind of television shows their children watch. They should especially ensure that the children do not watch aggressive and violent programmes.