My thoughts go out to those in Norway who have been affected by the tragic events in the past days, both in Oslo and Utøya. I can’t imagine the scale of this tragedy, and wish survivors all the strength and time needed to come to terms with the experience and the loss of loved ones. When you are looking for information about helping the youngsters and their families involved, below are some links to resources.

Several important things to do at this moment are:

• to tell children that they are safe and comfort them
• to organize any practical arrangements that are necessary
• if children are still separated from their primary caregivers, to organize their reunion
• to tell them that it is normal to feel distressed after such an abnormal event
• to pick up daily routines to restore a feeling of predictability and control

Perhaps the most important thing to say is that most people who experience a traumatic event are resilient: after some initial distress, they will feel better over time and won’t need mental health care. There is still controversy regarding ‘debriefing’ after trauma (see Bisson et al. below for a description of the discussion). From the current base of evidence it looks like it is not helpful to do debriefing shortly after an event and in my view, a safe rule would be: a child (or parent) needs to feel that it is okay, but not necessary, to talk about the experience.

When you are a parent, one thing we learned in our own research at the National Psychotrauma Center for Children and Youth is that you can’t trick a child: children notice very quickly how you feel, even if you think you hide your emotions. Make sure there is no discrepancy between what a child sees and hears from you: it is okay to say that you feel anxious/angry/… If you feel that you are overwhelmed by the experience, try to find other adults to support you and your child. In general, be attentive to your own needs (as in the airplane instructions: you won’t be able to help your child if you don’t have ‘oxygen’ yourself).

What kind of distress reactions to expect in youths? Common posttraumatic stress reactions in children and adolescents include: nightmares, repetitive intrusive thoughts about what happened, feeling anxious, avoiding thoughts/feelings/people related to the event, concentration difficulties, separation anxiety (not wanting to separate from caregivers/loved ones), over-alertness, irritability, and feeling guilty. Usually, children (as well as adults) show distress in the weeks after a traumatic event, which diminishes gradually.

What is a normal trajectory of recovery? As a rule of thumb we expect to see some improvement in four weeks. If a survivor doesn’t feel better at all after four weeks, it is a good idea to check with your GP or a mental health care professional whether extra services are needed. Of course, if you worry about your child, yourself or someone else before the four weeks have passed, do give a professional a call to discuss your worries.

Resources

General: the Norwegian Center for Crisis Psychology (Senter for Krisepsykologi) has this link in Norwegian, and Atle Dyregrov also made available this pdf: REAKSJONER UTØYA

For young people: I am still looking for a good website in English or Norwegian for you (any suggestions from readers are very welcome), this one was made by Headspace after the Australian bushfires and has some good information.

For parents: these are tip sheets about helping preschoolers, school-age children, and adolescents after trauma, by the U.S. National Child Traumatic Stress Network (NCTSN). Aftertheinjury from Children’s Hospital of Philadelphia may also be very informative.

For professionals: the complete Psychological First Aid guide is very comprehensive. This is the link to the full guide by the NCTSN

Specifically for teachers: for a short overview see my earlier post on supporting children in the classroom after trauma, and see also the toolkit for educators by the NCTSN

Bisson, J., Brayne, M., Ochberg, F., & Everly, G. (2007). Early Psychosocial Intervention Following Traumatic Events American Journal of Psychiatry, 164 (7), 1016-1019 DOI: 10.1176/appi.ajp.164.7.1016 

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