Compiled by Robin H. Gurwitch, Ph.D., Jane F. Silovsky, Ph.D.,
Shelli Schultz, Ph.D., Michelle Kees, Ph.D., & Sarah Burlingame, B.A.
Department of Pediatrics
University of Oklahoma Health Sciences Center

What to Expect After Trauma:
Possible Reactions in Elementary School Students

1) Feelings of anxiety, fears, and worries about safety of self and others (more clingy to teacher or parent)

2) Worries about re-occurrence of violence

3) Increased levels of distress (whiny, irritable, more "moody")

4) Changes in behavior:

a) Increased activity level
b) Decreased concentration and/or attention
c) Withdrawal
d) Angry outbursts
e) Aggression
f) Absenteeism

5) Increased somatic complaints (e.g., headaches, stomachaches, aches and pains)

6) Changes in school performance

7) Recreating event (e.g., talking repeatedly about it, "playing" the event)

8) Increased sensitivity to sounds (e.g., sirens, planes, thunder, backfires, loud
noises)

9) Statements and questions about death and dying

In addition, at home parents may see:

1) Changes in sleep

2) Changes in appetite

3) Withdrawal

4) Lack of interest in usual activities

5) Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears, anger, worries)

6) Regression in behaviors (e.g., baby talk, bedwetting, tantrums)

7) Hate or anger statements

What to Expect After Trauma:
Possible Reactions in Middle School Students

1) Feelings of anxiety, worries, and fears about safety of self and others

2) Worries about re-occurrence or consequences such as war, as well as worries
about school violence

3) Changes in behavior:

a) Decreased attention and/or concentration
b) Increase in hyperactivity
c) Changes in academic performance
d) Irritability with friends, teachers, events
e) Anger outbursts and/or aggression
f) Withdrawal
g) Absenteeism

4) Increased somatic complaints (e.g., headaches, stomachaches, chest pains)

5) Discomfort with feelings, particularly those associated with revenge

6) Increased likelihood to discuss the gruesome details

7) Repeated discussions of event

8) Increased sensitivity to sounds (e.g., sirens, planes, thunder, backfires, loud
noises)

1) Negative impact on issues of trust and perceptions of others, particularly of those that are "different"

2) Repetitive thoughts and comments about death and dying

In addition, at home parents may see:
1) Changes in sleep or appetite

2) Withdrawal

3) Lack of interest in usual activities (e.g., after-school activities, time with friends)

4) Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears, anger, worries)

5) Hate or anger statements

6) Denial of impact

What to Expect After Trauma:
Possible Reactions in High School Students

1) Worries, fears, and anxiety about safety of self and others

2) Worries about re-occurrence or repercussions such as war or school violence

3) Changes in behavior:

a. Withdrawal
b. Irritability with friends, teachers, events
c. Anger outbursts and/or aggression
d. Changes in academic performance
e. Decrease in attention and concentration
f. Increase in hyperactivity
g. Absenteeism

4) Discomfort with feelings, particularly revenge, but also those of vulnerability

5) Increased risk for substance abuse, including drinking

6) Discussion of events and reviewing of details

7) Negative impact on issues of trust and perceptions of others, particularly those that are "different"

8) Increased sensitivity to sounds (e.g., sirens, planes, thunder, backfires, loud noises)

9) Repetitive thoughts and comments about death or dying (including suicidal thoughts)

In addition, at home parents may see:
1) Changes in sleep or appetite

2) Withdrawal

3) Lack of interest in usual activities (e.g., after-school activities, time with friends)

4) Increased negative behaviors (e.g., defiance) or emotions (e.g., sadness, fears,
anger, worries)

5) Hate or anger statements

6) Denial of impact

What to Expect After Trauma:
Reactions in Teachers

1) Increased irritability and impatience with students and staff (decreased tolerance of minor student infractions- remember, they are trying to cope, too)

2) Difficulty planning classroom activities and lessons

3) Decreased concentration

4) Worries and fears that answers or responses to students could make things worse for them

5) Worries about re-occurrence and repercussions

6) Increased concern about school violence (e.g., hypersensitivity)

7) Feelings of discomfort with intense emotions, such as anger and fear

8) Denial that the traumatic event may impact the students

What Can I Do To Help?
Guidelines for Teachers of High School Students

• Reinforce ideas of safety and security, even though many high school students will not verbalize fears around these issues. This may be needed multiple times, particularly in response to changes, loud sounds, or other events that may remind students of the tragedy. After any classroom discussion of the event, end the discussion with a focus on their current safety and a calming activity, such as having a moment of quiet reflection.
  
  
• Maintain a predictable class schedule and rules to provide support and consistency for the students.
  
  
• Listen to and tolerate your students retelling of events. Schedule specific times for discussion during the school day to allow for opportunities to express their thoughts and feelings about the tragedy; however, set limits on scary or hurtful talk (e.g., specific threats of retribution). This may need to be done in multiple classes.
  
  
• Encourage students to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting feelings, listening carefully, and reminding students that these are normal reactions following a very scary event. Discuss students' perceptions of media descriptions of events. Information focused on safety will be important. For example, discuss what the US and other world leaders are doing to address safety. From this tragedy, opportunities for learning and discussion of world events are heightened.
  
  
• Some students might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help students separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates and other acquaintances (e.g., all people of Arab descent). It may be helpful to have discussions about how world leaders can help with reducing hate and preventing future violent acts.
  
  
• Students will often process the information about the events at unpredictable times throughout the day. As they try to develop an understanding for what has happened, they may ask questions that are initially shocking to adults, including questions that have gruesome details. Try to respond in a calm manner, answering the questions in simple, direct terms and help the students to transition back to their activity.
  
  
• Students will often misunderstand the information about the event as they are trying to make sense about what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.
  
  
• Students may ask the same types of questions repeatedly, which can be confusing and/or frustrating for teachers. Understand that students may need to hear the information multiple times before being able to integrate and understand it. Give students time to cope with their fears.
  
  
• Expect some angry outbursts from students. Try to catch students before they "act out", taking them aside, helping them calm down and regain control of their behavior. In addition, redirect students who are being irritable with each other which could escalate to direct conflict.
  
  
• Do classroom activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting pennies or aluminum cans or making origami cranes.
  
  
• Encourage some distraction times, which would include doing school work that that does not require high levels of new learning and enjoyable activities. Help students do activities that allow them to experience mastery and build self-esteem.
  
  
• Expect some brief (temporary) decline in students' school performance. Consider suspending standardized testing and classroom testing for the rest of the week. Also, consider reducing homework as the nation heals and the national routine is stabilized (e.g., parents are back to work, no additional threats).
  
  
• Provide reassurance to students that the feelings will get smaller and easier to handle over time.
  
  
• Protect students from re-exposure to frightening situations and reminders of trauma. This includes limiting teacher-to-teacher conversations about the events in front of students.
  
  
• Maintain communication with other teachers, school personnel, and parents to monitor how students are coping with the demands of school, home, and community activities. Should difficulties coping with the event persist and interfere with students' functioning, consider seeking help from a mental health professional. In addition to helping those who are clearly angry or depressed, monitor students who are withdrawn and isolated from others.
  
  
• Remain aware of your own reactions to students' trauma, as well as your own reactions to the trauma. It is okay to express emotions to your students, such as "I am feeling sad about what happened." However, if you are feeling overwhelmed with emotion, it is important to take care of yourself and to seek support from other teachers and staff.

What Can I Do To Help?
Guidelines for Teachers of Middle School Students

• Reinforce ideas of safety and security. This may be needed multiple times, particularly in response to changes/loud sounds/or other events that may remind the students of the tragedy. After any classroom discussion of the event, end the discussion with a focus on their current safety and a calming activity, such as taking deep breaths, working together on an art project, or having a moment of quiet reflection.

• Listen to and tolerate your students retelling of events, as well as playing out the events. Maintain a predictable class schedule and rules to provide support and consistency for the students. Schedule specific times for discussion during the school day to allow for opportunities to express their thoughts and feelings about the tragedy. This may need to be done in multiple classes; however, set limits on scary or hurtful talk (e.g., specific threats of retribution).
  
  
• Encourage the students to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting the feelings, listening carefully, and reminding the students that these are normal reactions (any of these feelings are okay) following a very scary event. Discuss students' perceptions of media descriptions of events. Information focused on safety will be important. For example, the President of the USA and other "helping people" (e.g., the firefighters, military, police, doctors) are all working together to make us safe (give examples). Review of school safety rules may also be helpful.
  
  
• Some students might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help the students separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates or other people they might know (e.g., all people of Arab descent). It may be helpful to have discussions about how world leaders can help with reducing hate and preventing future violent acts.
  
  
• Students will often process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults, including questions that have gruesome details or focus on death. Try to respond in a calm manner, answering the questions in simple and direct terms and helping the students transition back to their activity.
  
  
• Use simple direct terms to describe what happened, rather than terms designed to "soften" the information, which inadvertently further confuses the students. For example, use the term "died", rather than "went to sleep".
  
  
• Students will often misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves; may believe things happened that did not happen, may believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.
  
  
• Students may ask the same types of questions repeatedly, which can be confusing and/or frustrating for the teacher. Understand that students may need to hear the information multiple times before being able to integrate and understand it. Give the students time to cope with fears.
  
  
• Expect some angry outbursts from students. Try to catch students before they "act out", by taking them aside, and helping them calm down and regain control of their behavior. In addition redirect students who are being irritable with each other which could escalate to direct conflict.
  
  
• Do classroom activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting pennies or aluminum cans or making origami cranes.
  
  
• Encourage some distraction times, which would include doing school work that that does not require high levels of new learning as well as enjoyable activities. Help students do activities that allow them to experience mastery and build self-esteem.
  
  
• Expect some brief (temporary) declines in the students' school performance. Consider suspending standardized testing and classroom testing for the rest of the week. Also, consider reducing homework as the nation heals until the national routine is stabilized (e.g., parents are back to work, no additional threats).
  
  
• Provide reassurance to the students that feelings will get smaller and easier to handle over time.
  
  
• Protect students from re-exposure to frightening situations and reminders of trauma. This includes limiting teacher-to-teacher conversations about the events in front of the students.
  
  
• Maintain communication with other teachers, school personnel, and parents to monitor how the students are coping with the demands of school, home, and community activities. Should difficulties coping with the event persist and interfere with the students' functioning, consider seeking help from a mental health professional. In addition to helping those who are clearly angry or depressed, monitor students who are withdrawn and isolated from others.
  
  
• Remain aware of your own reactions to student's "trauma". It is okay to express emotions to your students, such as "I am feeling sad about what happened." However, if you are feeling overwhelmed with emotion, it is important to take care of yourself and to seek support from other teachers and staff.

What Can I Do to Help?
Guidelines for Elementary School Teachers

• Maintain a predictable class schedule and rules to provide support and consistency for the children.
  
  
• Listen to and tolerate your students retelling of events, as well as playing out the events. Schedule specific times for discussion and play during the school day to allow for opportunities to express their thoughts and feelings about the tragedy; however, set limits on scary or hurtful play.
  
  
• Encourage students to talk about confusing feelings, worries, daydreams, and disruptions of concentration by accepting the feelings, listening carefully, and reminding students that these are normal reactions (any of these feelings are okay) following a very scary event. Information focused on safety will be important. For example, the President of the USA and other "helping people" (e.g., the firefighters, military, police, doctors) are all working together to make us safe (give examples). A review of school safety rules may also be helpful.
  
  
• Some students might express hate toward a large group of people. It can be helpful to validate their strong feelings of anger. However, it will be critical to help the students separate thoughts and feelings about the specific people who caused the tragedy from generalizing it to larger groups of people, including their classmates or other people they might know (e.g., all people of Arab descent).
  
  
• Young children will process the information about the events at unpredictable times throughout the day. As they try to develop an understanding of what has happened, they may ask questions that may be initially shocking to adults. Try to respond in a calm manner, answering the questions in simple, direct terms and helping the students transition back to their activity.
  
  
• Use simple, direct terms to describe what happened. Avoid terms designed to "soften" the information, which inadvertently further confuses children. For example, use the term "died," rather than "went to sleep."
  
  
• Students may misunderstand information about the event as they are trying to make sense of what happened. For example, they may blame themselves, believe things happened that did not happen, believe that terrorists are in the school, etc. Gently help students develop a realistic understanding of the event.
  
  
• Students may ask the same types of questions repeatedly, which can be confusing and/or frustrating for teachers. Understand that students may need to hear the information multiple times before being able to integrate and understand it. Give the students time to cope with fears.
  
  
• Expect some angry outbursts from students. Try to catch students before they "act out," by taking them aside, and helping them calm down and regain control of their behavior.
  
  
• Do classroom activities that will reinforce the message that one person can make a difference to help and heal. Activities can include drawing pictures and sending cards or class projects of collecting pennies or aluminum cans.
  
  
• Encourage some distraction times, which would include doing school work that that does not require high levels of new learning, as well as enjoyable activities.
  
  
• Expect some brief, temporary declines in the students' school performance. Consider reducing homework as the nation heals and the national routine is stabilized (e.g., parents are back to work, no additional threats).
  
  
• Provide reassurance to the students that feelings will get smaller and easier to handle over time.
  
  
• Expect and understand students' regression (acting younger) and other difficult behaviors that are not typical of the students.
  
  
• Protect students from re-exposure to frightening situations and reminders of trauma. This includes limiting teacher-to-teacher conversations about the events in front of students.
  
  
• Maintain communication with other teachers, school personnel, and parents to monitor how the students are coping with the demands of school, home, and community activities.
  
  
• Remain aware of your own reactions to students' trauma. It is okay to express emotions to your students, such as "I am feeling sad about what happened." However, if you are feeling overwhelmed with emotion, it is important to take care of yourself and seek support from other teachers and staff.

What Can I Do To Help?
Guidelines for Parents of Elementary School Students

In addition to the guidelines for teachers of elementary school students (see Teacher Guidelines), the following are ways parents can complement what is being provided in the schools.

• Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to have your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events - even when you think they are not listening, they often are.
  
  
• Maintain the family routines, particularly around sleeping, eating, and extracurricular activities (e.g., sports, church, dance). Be sure the bedtime routine includes safely tucking them in at night. Young children may want a night light again. Make sure your child is receiving a balanced diet and enough rest.
  
  
• Avoid unnecessary separations from important caregivers.
  
  
• Expect temporary regression in your child's behaviors (e.g., starting to babytalk, wetting the bed). Do not panic, as your child is likely to return to previous functioning with time and support.
  
  
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc.
  
  
• Increase patience with your child and with yourself. Give your family time to cope. Find ways to emphasize to the children that you love them.

What Can I Do To Help?
Guidelines for Parents of Middle School Students

In addition to the guidelines for teachers of middle school students (see Teacher Guidelines), the following are ways parents can complement what is being provided in the schools.

• Avoid exposing your child to reminders of the trauma. This includes limiting your child's exposure to the news and other television programs about the tragedy. If you do choose to have your child see this information on the television, keep it brief, watch it with your child, and talk to your child after to clarify miscommunication. Protecting the children from re-exposure includes limiting exposure to adult conversations about the events - even when you think they are not listening, they often are.
  
  
• Maintain the family routines, particularly around sleeping and eating and extracurricular activities (e.g., sports, church, dance). Make sure your child is receiving a balanced diet and enough rest. Extra time with friends who are supportive and meaningful to him/her may be needed.
  
  
• Avoid unnecessary separations from important caregivers.
  
  
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc. Some middle school students benefit from writing their thoughts and feelings in a journal.
  
  
• Address acting-out behavior involving aggression or self-destructive activities quickly and firmly with limit setting. If this behavior is severe or persists, seek professional help.
  
  
• Increase patience with your child and with yourself. Give your family time to cope. Find ways to emphasize to the children that you love them.

In addition to the guidelines for teachers of high school students (see Teacher Guidelines), the following are ways parents can complement what is being provided in the schools.

• Avoid exposing your teen to reminders of the trauma. This includes monitoring your teen's exposure to the news and other television programs about the tragedy. When you can, watch it with your teen, and talk to your teen after to clarify their understanding of the events and the images seen. Be aware that your teens are often listening when adults are discussing the events. Protect your teen from re-exposure includes limiting exposure to adult conversations, however, find time to include them in age appropriate discussions about the events and resulting thoughts and feelings.
  
  
• Maintain the family routines, particularly around sleeping and eating and extracurricular activities (e.g., sports, church, dance). Make sure your teen is receiving a balanced diet and enough rest. Extra time with friends who are supportive and meaningful to him/her may be needed.
  
  
• Avoid unnecessary separations from important caregivers.
  
  
• Provide soothing activities, such as reading books, listening to music, taking a walk, riding bikes, etc. Some high school students benefit from writing their thoughts and feelings in a journal.
  
  
• Address acting-out behavior involving aggression or self-destructive activities quickly and firmly with limit setting. If this behavior is severe or persists, seek professional help.
  
  
• Encourage your teen to delay making big decisions.
  
  
• Increase patience with your teen and with yourself. Give your family time to cope. Find ways to emphasize to your teen that you love them.