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Part 3: How children and adolescents react to trauma

[April 26, 2007]  The National Institute of Mental Health has brought forth information to assist the nation as we recover from the shock and distress created by the recent Virginia Tech shootings. This information is particularly designed to help in times of unanticipated, great or violent loss, but the underlying principles are useful for any level of grief and healing.

(Part 1: Introduction)

(Part 2: Trauma -- What is it?)

Part 3:


Reactions to trauma may appear immediately after the traumatic event or days and even weeks later. Loss of trust in adults and fear of the event occurring again are responses seen in many children and adolescents who have been exposed to traumatic events. Other reactions vary according to age:4-7

For children 5 years of age and younger, typical reactions can include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also notice children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.

Children 6 to 11 years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, irritability, refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age. Also the child may complain of stomachaches or other bodily symptoms that have no medical basis. Schoolwork often suffers. Depression, anxiety, feelings of guilt and emotional numbing or "flatness" are often present as well.

Adolescents 12 to 17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, and anti-social behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. The adolescent may feel extreme guilt over his or her failure to prevent injury or loss of life, and may harbor revenge fantasies that interfere with recovery from the trauma.

Some youngsters are more vulnerable to trauma than others, for reasons scientists don't fully understand. It has been shown that the impact of a traumatic event is likely to be greatest in the child or adolescent who previously has been the victim of child abuse or some other form of trauma, or who already had a mental health problem.8-11 And the youngster who lacks family support is more at risk for a poor recovery.12


4Osofsky JD. The effects of exposure to violence on young children. American Psychologist, 1995; 50(9): 782-8.

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5Pynoos RS, Steinberg AM, Goenjian AK. Traumatic stress in childhood and adolescence: recent developments and current controversies. In: Van der Kolk BA, McFarlane AC, Weisaeth L, eds. Traumatic stress: the effects of overwhelming experience on mind, body, and society. New York: Guilford Press, 1996; 331-58.

6Marans S, Adelman A. Experiencing violence in a developmental context. In: Osofsky JD, et al., eds. Children in a violent society. New York: Guilford Press, 1997; 202-22.

7Vogel JM, Vernberg EM. Psychological responses of children to natural and human-made disasters: I. Children's psychological responses to disasters. Journal of Clinical Child Psychology, 1993; 22(4): 464-84.

8Garbarino J, Kostelny K, Dubrow N. What children can tell us about living in danger. American Psychologist, 1991; 46(4): 376-83.

9Duncan RD, Saunders BE, Kilpatrick DG, Hanson RF, Resnick HS. Childhood physical assault as a risk factor for PTSD, depression, and substance abuse: findings from a national survey. American Journal of Orthopsychiatry, 1996; 66(3): 437-48.

10Boney-McCoy S, Finkelhor D. Prior victimization: a risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse and Neglect, 1995; 19(12): 1401-21.

11Roth SH, Newman E, Pelcovitz D, Van der Kolk BA, Mandel FS. Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 1997; 10(4): 539-55.

12Morrison JA. Protective factors associated with children's emotional responses to chronic community violence exposure. Trauma, Violence, and Abuse: A Review Journal, 2000; 1(4); 299-320.

The information in this series has been made available through the National Institute of Mental Health.

Articles to come:

Friday, April 27

  • Helping children and adolescents cope with violence and disasters
    Part 4: Helping the child or adolescent trauma survivor 

Saturday, April 28

  • Helping children and adolescents cope with violence and disasters
    Part 5: Post-traumatic stress disorder

Monday, April 30

  • Helping children and adolescents cope with violence and disasters
    Part 6: What are scientists learning about trauma in children and adolescents?

[Text copied from National Institute of Mental Health]

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