Fears life-threatening events (new edition)

The following is an excerpt from the ebooklet Working with children who fear life-threatening events (new edition) by Murray Evely and Zoe Ganim.

Children’s emotional responses will vary in nature and severity. Common emotions or responses following and during a significant adverse event include fear, confusion, anger, loneliness, sadness, and distress.

It is a general principle that if you notice something worrying about a child, your observations or concerns should be conveyed to the parents/carers. Equally, parents/carers should share information about their child’s emotional responses with the teacher, so they are better placed to assist with wellbeing and can make reasonable adjustments to assist learning.

When to seek further assistance

If a child displays a number of the above behaviours for more than one month during or following adverse or life-threatening events, it is recommended that you suggest referral to a psychologist or the family doctor. Referral always requires parent/carer consent.

If the child is left untreated, several disorders that occur following exposure to, or fear of, life-threatening or upsetting and stressful adverse events may develop. These can sometimes remain with the child through adolescence and into adulthood. Diagnosis and treatment will require consultation with a psychologist, mental health practitioner or doctor.

Children who worry excessively

All children worry sometimes. Worrying becomes a problem when it begins to impinge on the child’s life. Children’s worries should be taken seriously. Short discussions can often dispel typical everyday concerns of children and help to prevent the development of excessive, escalating worry.

For further information, a description of behaviours that indicate excessive worry and practical strategies to assist these children see the Psych4Schools ebooklet, Working with children who worry excessively. Children cope best with worries when they are reassured, informed and assisted to be proactive.

If a satisfactory solution cannot be found with the child, the teacher should discuss their concerns with the principal or another senior person in the school. The teacher should also talk to the child’s parents to suggest the child be referred to a psychologist or counsellor. Without effective intervention, persistent worry can become an anxiety condition. Referral to a psychologist or counsellor requires the parents/carers’ consent.

School refusal and heightened anxiety

During and following prolonged school closures in response to COVID-19 lockdowns during 2020, teachers and school psychologists reported a number of students presenting with heightened anxiety, school refusal and intensified behaviours related to pre-existing mental health concerns. As well OCD-type behaviours were observed, particularly anxiety about excessive cleanliness.

School refusal is marked by a significant number of absences from school on an ongoing basis with the child usually remaining at home. School refusal is a more serious condition than separation anxiety. School refusal is associated with a range of family and school factors accompanied by anxiety, sadness or depression, physical symptoms and social isolation. For further information, regarding referral and practical strategies to assist these children see the Psych4Schools ebooklet, Working with children who refuse to go to school (School refusal).

School refusal is most successfully treated if addressed early. The longer the child remains away from school, the greater their anxiety can become and the more difficult it will be for them to return to school. Involvement with one or both parents, a school psychologist or social worker and other school personnel is essential for successful treatment.

Children traumatised by an actual or perceived threat to life or serious injury to self or others

A traumatic event is an event that involves actual or threatened death or serious injury. The threat can be real or perceived as real by the child. Children who experience traumatic events typically suffer from intense emotional, physical, and/or psychological distress. This trauma response to a deeply distressing often sudden and unexpected tragedy or serious injury can overwhelm the child’s ability to cope. Intervention and support are best implemented within the first 24 to 48 hours following the event.

Most children will begin to recover after several days, though for some recovery may take several weeks.

To reduce the likelihood of continuing difficulties and/or the onset of further trauma, support is particularly important during the two weeks following a traumatic incident. For further information about children who have experienced traumatic events, a description of concerning behaviours that indicate a traumatic response, practical strategies to assist these children at school and when to seek further assistance, see the Psych4Schools ebooklet, Children who have experienced or witnessed a traumatic event in the past two weeks.

If the child is left untreated, disorders such as post-traumatic stress disorder (PTSD) can manifest following exposure to actual or perceived threats of death or serious injury. This can sometimes remain with the child through adolescence and into adulthood. Again, diagnosis and treatment will require consultation with a psychologist, mental health practitioner or doctor. And referral always requires parent/carer consent.

For further information about PTSD and practical strategies to implement with those diagnosed with this disorder see the Psych4Schools ebooklet, Working with children diagnosed with post-traumatic stress disorder (PTSD).

Strategies to support the child who fears life-threatening events

Acknowledge the child’s concerns

  • Listen to the child and acknowledge their fears. Reassure the child that given media attention on the issue, it is understandable that they are worried about what is happening and how it could affect them.
  • Normalise the child’s feelings. Let the child know that media exposure or hearing adults talk about worrying events can lead to heightened feelings of worry, fear or apprehension, that this is normal, and that such feelings can be managed and will, or are likely to, subside over time.
  • Use appropriate language and complexity to talk about a child’s fears. Simple short sentences are more reassuring and more easily understood by younger children. While more complex responses can be given to older children, bear in mind that those who are distressed may not be able to adequately process complex information.
  • Use the language of hope and reassurance. Reassure the child, with honesty, that as difficult and disturbing the situation appears, the crisis and related feelings can be managed.

ISBN 978-1-921908-49-1

Copyright © Murray Evely and Zoe Ganim 2020

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