They might not want to talk about the gunshots or the screams. But their toys might start getting into imaginary shootouts.
The school shooting in Connecticut on Dec. 14 raises the question: What will be the psychological fallout for the children who survived?
For people of any age, regaining a sense of security after surviving violence can take a long time. They’re at risk for lingering anxiety, depression, post-traumatic stress disorder.
But after the grief and fear fades, psychiatrists say most of Newtown’s young survivors probably will cope without long-term emotional problems. “Kids do tend to be highly resilient,” said Dr. Matthew Biel, chief of child and adolescent psychiatry at MedStar Georgetown University Hospital.
And one way that younger children try to make sense of trauma is through play. Youngsters may pull out action figures or stuffed animals and re-enact what they witnessed, perhaps multiple times.
“That’s the way they gain mastery over a situation that’s overwhelming,” Biel said.
Nor is it unusual for children to chase each other playing cops-and-robbers, but now parents might see some also pretending they’re dead, added Dr. Melissa Brymer of the UCLA-Duke National Center for Child Traumatic Stress.
Among the challenges will be spotting which children may need professional help.
Newtown’s tragedy is particularly heart-wrenching because of what such young children grappled with – like the six first-graders who apparently had to run past their teacher’s body to escape to safety.
There’s little scientific research specifically on PTSD, post-traumatic stress disorder, in children exposed to a burst of violence, and even less to tell if a younger child will have a harder time healing than an older one.
Overall, scientists say studies of natural disasters and wars suggest most children eventually recover from traumatic experiences while a smaller proportion develop long-term disorders such as PTSD.
In Newtown, most at risk for longer-term problems are those who saw someone killed, said Dr. Carol North of the University of Texas Southwestern Medical Center, who has researched survivors of mass shootings.
Right after a traumatic event, it’s normal to have nightmares or trouble sleeping, to stick close to loved ones, and to be nervous or moody, Biel said.
To help, parents will have to follow their child’s lead. Grilling a child about a traumatic experience isn’t good, he stressed. Some children will ask a lot of questions, seeking reassurance, he said. Others will be quiet, thinking about the experience and maybe drawing or writing about it, or acting it out at playtime.
Before second grade, their brains also are at a developmental stage some refer to as magical thinking, when it’s difficult to distinguish reality and fantasy. Parents may have to help them understand that a friend who died isn’t in pain or lonely but also isn’t coming back, Brymer said.
When problem behaviors or signs of distress continue for several weeks, Brymer says it’s time for an evaluation by a counselor or pediatrician.
North advises getting children back into routines, together with their friends, and easing them back into a school setting.
Children as young as first-graders can benefit from cognitive-behavioral therapy, Georgetown’s Biel said.
Finally, avoid watching too much TV coverage of the shooting, as children may think it’s happening all over again, Biel added.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.