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9-11 and After: Notes from a Pediatric Neuropsychologist on Helping Our Children and Families During these Uncertain Times 9-11 did not begin like any other day at my office. In fact, it started before I went to the office, watching, like many others, the planes fly through a crystalline blue sky into the World Trade Center. This was followed by the sudden realization that I needed to call to my stepson whose college dorm is only a few blocks from the World Trade Center. I then drove shaking to my office, noting with disbelief and envy the smiling people on their morning walks who were not yet aware of what had happened. When I arrived at the office, which I share with my husband, I noted that my client, aged 9*, and her mother were sitting in the waiting room. My new psychology technician was starting that morning and my husband had put the news on the television. We were all highly distracted. As I tried to decide if we should continue the day as planned, it dawned on me that the mother of my client was also unaware of what had happened. I called her into my office to share the news as far we knew it, so that she could decide if she needed to call family or friends or take any other kind of action. We agreed to go ahead with the morning’s testing, and to keep the news to ourselves. In the meantime the afternoon clients called to ask if we would still be open and were relieved to hear that we had decided to postpone their sessions. One parent expressed a fear of driving to the office. Another simply felt a need to stay home. The following day we opened again. This time with the question of whether testing children on the day after the attacks would yield invalid results due to high levels of anxiety in the children. My intern reported that several members of her school psychology list serve had weighed in on the side of not testing. I took a lets try it and see approach. The testing session that morning went well. What we did notice over the weeks that have followed is that the children may be triggered by something in the evaluation, not apparently connected to the events of 9-11, and will bring it up. Perhaps they are just waiting for the right moment to introduce the topic. Often they have asked, “Did you hear about what happened . . .?” When this happens we take the time to answer their questions and ask about their feelings, and we acknowledge our feelings. Yes, we say, we certainly did hear about it. We agree with them when they say it is scary, bad, etc., and we give them a chance to say what they need to say. To this point in time, none of these conversations have lasted more than a couple of minutes. And although brief, I feel this acknowledgement of the changes in our world helps ground the children, and allows them to continue with the hard work of the evaluation. This brings me to the first and most important point of helping children, especially children with disabilities, cope with our current status of being at war, and with the events of 9-11. And this is that we must give them the time, as much time as they need, to share their feelings, and we should not try to make things too rosy for them. While we can offer reassurance, we should not encourage denial of what has happened. Children are astute observers of the world around them, even if their perceptions are not entirely the same as ours. Listening to their ideas will offer opportunities to correct any significant distortions. For children who are not able to vocalize their feelings well because of a disability it will be important to offer a means of expression. Drawing pictures or playing out what had happened with action figures, or being sure to speak at a level which they can understand will be most important. The corollary of this is that we must also speak honestly about the serious nature of what has happened and share our own feelings and reactions in a way which is understandable to the child we are speaking with. It is likely that your children will have heard bits and pieces of information and will need help in putting them together to make a coherent story. Again gauge the information you provide to the age and mental abilities of your child. This may mean having separate talks with your children so that each child can communicate with you at their own level. Also don’t hesitate to say that you don’t know the answer to some of their questions. It is human not to know everything. Your children will understand this. On the other hand, it would not be helpful to avoid a discussion of the events by responding that you don’t know to all of their questions. It is most likely that the recent events will create a sense of not being safe in our children. Children do not process anxiety and sadness the way adults do. They need to process feelings actively through play and drawing and through repetition. Empathic listening and patience in answering repetitive questions is needed. For children with disabilities this might be even more pronounced. Answering the questions about safety and offering ideas about what your family will do if something happens will be helpful and reassuring to your child. Offering an activity to make the answers more concrete might help. For some children answering the questions about safety and then redirecting them to a positive focus or activity might be a solution. Responding with anger and impatience will not help them to process these difficult issues, and may lead them to keep their fears secret, only to be acted out in apparently unrelated events at another time. Another feature of children who are coping with trauma is their need to gain a sense of mastery. Children even in normal situations have little control over their environments. In a time when the adults appear to have little control, they can feel more out of control themselves. One of the ways they gain a sense of mastery is to play out what has happened, thereby becoming the person in charge of the action. Patience with tolerating play, which might appear violent or ‘wrong’ in some way, will be important. In one newscast over the past weeks a young girl described playing out the destruction of the Taliban and Osama Bin Laden with her toys. This game, which she played often, helped her to gain a sense of control over what had happened and what will happen. For some children the events may have created a fear of loss, especially if their family was directly touched by the loss or threatened loss of someone they know. For children who have already experienced the death of a friend or family member the sense of sadness and fear of loosing other significant people can become overwhelming and incapacitating. Reassurance that you are safe and that you are not going to abandon them will be needed. For children who have behavioral problems which have led to placements outside of the home, or who have been placed in foster homes, issues surrounding abandonment and anxiety about separation may become more pronounced than they had previously been. Again, reassurance and activities, which enhance a sense of connection and sharing, will be most supportive to these children. Talking about death may be needed at this time. If there is a funeral or memorial service it will be important to let your child be a part of it in some way. Fortunately, there are many good children’s books that explain death in appropriate ways for different aged children. Allow your child to grieve and understand that they might not express sadness in the way adults do. It is important for the parents and other adults in your child’s world to provide as stable and nurturing an environment as possible. For some children this may mean not having the news on when the children are awake. This will be especially true for younger children. In general, limiting news exposure will be good for both you and your children. Many of us find ourselves glued to the news as if this will provide some extra protection from the next attack. By being reasonably aware, but not constantly in a state of alert we adults will have the ability to focus on our children and families and even ourselves. Do not be afraid to laugh and have some fun with your children. Read light hearted books together. Watch funny movies together. Garden together. And share together. Create a family fun night once a week, or start a family journal. Volunteering to help others in efforts related to or separate from 9-11 can provide a meaningful way to process many difficult feelings. Joining in the community whether through a church or synagogue, or through a support group for children with disabilities, or what ever other community connections you have will provide both you and your children with a sense of support and safety, and will reduce isolation. Also do not be afraid to take some time out for yourself. If you and your spouse are overly stressed this will not help your children. In fact, it will add to their burden. If you or your spouse or an older child has had difficulty with substance or alcohol abuse this will be an important time to reconnect with support groups and counselors so that the new anxieties of the post 9-11 world do not lead to a relapse. Some children will be more affected by the recent events than others. They may be at risk for Posttraumatic Stress Disorder. The American Academy of Child and Adolescent Psychiatry (Helping Children After a Disaster-AACP Facts for Families #36- http://aacap.org/publications/factsfam/disaster.htm) have posted this list of warning signs that parents should be alert to following a traumatic event:
For parents whose children already have been diagnosed with Attention Deficit Hyperactivity Disorder, Conduct Disorder, Anxiety Disorders, Depression, or other emotional disorders it will be especially important to notice if they appear to have a return of symptoms or a greater number of symptoms and new symptoms. If you have concerns contact their pediatrician, and discuss your observations with their counselors and therapists. In summary, although we are all living in a state of “High Alert” it will be important to provide as empathic, nurturing, loving, fun, reality oriented and structured an environment for our children as we can. In doing this we will nurture not only our children, but also our communities and ourselves.
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