How to help your kids cope with traumatic experiences?

The recent Friday the 13th kidnapping of the two children of Rep. Jules Ledesma, Cristina Julieta Victoria, 10, and Julio Carlos Tomas, five, has rekindled the fear of a lot of parents that nowadays, even their own children are at risk.

A lot of us have viewed on TV the reunion of the two children with their father and his actress-girlfriend, Assunta de Rossi after their release. The children claimed they were blindfolded most of the time and hence were unable to describe their kidnappers. Details about their ordeal and subsequent release were minimal. Many commented that the kids didn’t seem greatly affected by the abduction. I hope so, too, but it may be too soon to tell whether these two kids have not been adversely affected by the kidnapping. Such traumatic experiences do give rise to what is known as Post-Traumatic Stress Disorder.

The fourth edition of Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) defines Post-Traumatic Stress Disorder "as set of typical symptoms that develop after a person sees, is involved in, or hears of an extreme traumatic stressor." The person reacts to this experience with fear and helplessness, persistently relives the event, and tries to avoid being reminded of it. The symptoms must last for more than a month and must significantly affect important areas of life such as family, school and work. DSM-IV defines Acute Stress Disorder as largely similar to Post-Traumatic Stress Disorder except that the symptoms occur within four weeks of the event and last from two days to four weeks.

Remember that the stress causing Post-Traumatic Stress Disorder must be overwhelming enough to affect almost anyone. Some examples of traumatic experiences are being kidnapped, raped or battered, being caught in a crossfire, or experiencing natural calamities like earthquakes or volcanic eruptions and serious accidents like the Sept. 11, 2001 World Trade Center bombing.

From Victims to Survivors– Psychological Intervention in Disaster Management, a book by Lourdes Ladrido Ignacio, MD and Antonio Perlas, MD, MPH provides a chapter on disasters and children. According to the authors, "Experience in disaster management shows the importance of interventions that are especially designed to debrief children from their distress. Effective intervention undertaken in the quickest time possible speeds up the recovery of children, and prevents the development of serious psycho-social problems."

The degree of a child’s reactions will depend on stressors like where the traumatic event happened, who the child was with, the degree of seriousness of danger to one’s life, the closeness to actually witnessing death and destruction, the length of time needed to rescue a child, the loss of a loved one, the time required for the family and the community to reorganize themselves. These could explain why the Ledesma children appeared hardly affected by their kidnapping. Perhaps, they were treated in a more humane manner by their abductors since they were just children.

The reactions of children and adolescents to traumatic experiences may be acute or short-term and chronic or long-term. Based on the clinical data gathered by the Mental Health Task Force of the DOH, the Acute Stress Reactions in Children are physical (bowel and bladder incontinence, headaches, stomach cramps, tremors); emotional (anxiety, fear, sadness); cognitive (poor attention, poor concentration, confusion); behavioral (restlessness, leaving classroom, crying, poor grooming, clinging to parents).

The Chronic Stress Reactions in Children are physical (headache, complaints of various aches and pains); emotional (sadness, irritability, lack of energy); cognitive (poor memory, lack of concentration, poor performance in test); behavioral (refusal to read, write, and recite in class, does not do assignment, disobedience, troublesome behavior, begging, stealing, restlessness, frequent tantrums, lack of respect for elders, use of foul language, vandalism and blank stares).

I participated in the rehabilitation of victims of the July 16, 1990 Cabanatuan earthquake victims, survivors of an orphanage fire in Manila, and some of the victims of the La Salle Ayala de Zobel Fish Coaster Tragedy. For the earthquake victims, one of the interventions we did was to have families and individuals debriefed by the volunteers of our team and other trained facilitators from the community. Copies of a coloring book entitled Ang Lindol (Earthquake), which I designed and illustrated were distributed to children-victims of the earthquake. The coloring book accomplished two tasks–it allowed the children to release unpleasant and frightful feelings and at the same time revealed the coping behavior of the child during and after the earthquake. Through it, teachers were able to pick the schoolchildren who needed to be referred for further psycho-social treatment.

So, to parents of children who have had traumatic experiences, you have to be on the lookout for the symptoms listed in the preceding paragraphs.

What can you do to help your children? The first is to show your concern to your children by being with them. Don’t leave them in relatively unsafe areas or with strangers. It is very important that you talk and listen to them. Explain to them that what happened to them is definitely not their fault. Try to help them accept what has happened as an unfortunate event beyond anyone’s control.

For younger children like the Ledesma kids, making them draw and talk about the traumatic event would be very helpful. If your children are always crying or have somewhat regressed, i.e. starting to thumbsuck, have become irritable or even have started to bedwet, please don’t scold them. Teach them to tell you what they feel. Be more patient with them, especially in instructing them about what they should do. Try to return them to their usual routine at the home and school setting.

Praying helps a lot during extreme distress. So thank God your children are alive. Life must go on for you and your children.

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The Philippine Board of Psychiatry (PBP) is accepting application for the Diplomate Specialty Board Exams in Psychiatry. Deadline for application is Oct. 10, 2002. Written exams will be on Oct. 26, 2002, 8 a.m. to 12 noon at the UST College of Med. Bldg. For inquiries, call Jing Mistica at the PPA Office tel. no. 635-9858 or PBP Secretary, Dr. Jao at tel. no. 633-3893.

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(In case you have other problems, particularly about love, looks and relationships, you would want me to discuss in this column, do send your letters to The Philippine STAR c/o Allure Section or send them directly to Suite 506 Medico Bldg. Lourdes Street corner San Miguel Avenue, Pasig: fax no. 631-3877.)