Understanding Traumatic Stress of

Students

A Module
for
Parents and Community Personnel

Danafe A. Conopio, RN
Cynthia U. Talens, M Chem Ed.
UST GRADUATE SCHOOL

March 2015
How to Use This Module

1. Take the pretest. This will determine if you will take this module or not.

2. Check your answers using the pretest feedback.

3. Check the category where you belong. Use the table below:
Scores Interpretation Decision

20 Excellent Exempted, skip this module

18-19 Very Good Exempted, skip this module

15-17 Good Study this module

12-14 Satisfactory Study this module

11 and below Needs improvement Highly recommended to

study this module

4. This module is divided into 4 lessons. Each unit is presented as a separate booklet.

5. Pages are numbered according to the module and unit.

Example: 2 1 1

↓ ↓ ↓

Module 2

Lesson 1

Page 1

6. On the inside front cover of every unit, you will find the content for that unit.

7. On the first page of each unit, you will find the general objective and specific objectives for that
unit.

8. There is a specific color for each lesson in the unit.

9. Each lesson has the following parts as signified by each icon:

9.1
These are the general and specific objectives of the lesson.

9.2 Learning activities

9.2.a This contains new information that will enrich your ideas.

9.2 b A part of the input which means you will read

something.

9.2 c Part of the process wherein the teacher is

explaining the lesson.

9.2 d A part of the output wherein you will answer /write

 something.

9.2.d Output or practical exercises which means you

will do or answer something.

9.3 Feedback part wherein you will answer something.

10. Read each lesson carefully in the sequence in which it is presented. After going
through the INPUT, answer the practice exercises found at the end of each
lesson. Look at the feed back to practice activity only after you have
completed the practical task.

11. DO NOT MARK THIS MODULE IN ANY WAY. You will be given separate
practice task sheets by your resource person. WRITE ON SEPARATE
SHEETS.

12. Check your answers by referring to FEEDBACK.

13. Begin working on the next unit in the module only after you have completed the
previous unit and you are confident that you have achieved the objectives of the
unit.

14. When you have successfully completed the three lessons in this module, do the
POST TEST. After you have done the post-test, compare our answers with the
feedback provided. You must score at least 80% before proceeding to work
through any more modules in the series. If you score less than 80%, go through
this module again.
Introduction

Since the suspension of the agreement and shut down of the peace talks between the Philippine
government and the Moro Islamic Liberation Front (MILF) in 2008, the children in Mindanao has not only
been exposed to natural disasters, but also to the continuous conflict against soldiers and rebels [Kok09].
As if conflict is not traumatic enough, these children are also exposed to natural disasters, bullying,
domestic violence, and sexual abuse that inflicts the reaction known as trauma [CCh02]. However,
because children still do not have the ability to thoroughly verbalize and express their emotions and
reactions to a traumatic event, they are often neglected during the recovery stage and little intervention
is done to attend to psychological needs post-conflict. [The15].

It is the responsibility of the people in the community such as religious groups, teachers,
Barangay officials and the youth to understand the different ways how trauma is expressed by children
and to learn ways how to manage traumatic stress among children. Therefore, this module is designed
for the older members of the community and academe to help in the proper management of traumatic
experiences that would lead to recovery.

Learning Objectives
At the end of the session, you should be able to:
 Define and understand the meaning of trauma and types of responses to trauma
 Identify behaviors/responses of children from different age groups to trauma
 Discuss the dos and don’ts of parents and teachers towards children after a traumatic event
 Explain the proper behavior of the community to children after a traumatic event
Contents:

Lesson 1. Definition of Trauma.

a. Types of Responses to Trauma

Lesson 2. Behaviors/ Responses experienced by children of different age groups to trauma

Lesson 3. Things that parents do after traumatic event.

a. Emphasize love, moral support and eliminate guilt.

b. Must do things
c. Things to avoid
d. Other tips

Lesson 4. Things that community members do after traumatic event.

b. Pay attention to children

c. Reduce effects of other stressors, such as
d. Monitor healing
e. Remind children that adults

Lesson 1. Trauma.
 Intended Learning Outcome

1. Define trauma.
2. List down traumatic events.
3. List down the behaviors of a child under trauma.

There are many misconceptions about the understanding of the meaning and definition of
trauma which probably roots to the different ways trauma can be defined and explained [Enc15]. But,
the American Psychological Association [Ame15] defined trauma as “an emotional response to a terrible
event like an accident, rape or natural disaster.” Specifically for children, “Child traumatic stress occurs
when children and adolescents are exposed to traumatic events or traumatic situations that overwhelm
their ability to cope” [The15]. The Diagnostic and Statistical Manual of Mental Disorders [Ame00]
provides a list of possible traumatic events, such as, combat, sexual and physical assault, robbery, being
kidnapped, being taken hostage, terrorist attacks, torture, disasters, severe automobile accidents, and
life-threatening illnesses, as well as witnessing death or serious injury by violent assault, accidents, war,
or disaster, including childhood sexual abuse.

How can you now define trauma in your own words?

 As an adult member of the family or community, you need to realize that there are a
number of possible traumatic events experienced by children. To name a few; being robbed of
cellphone, loss of property because of fire, witness to an accident and others.

As a parent or a member of the community, can you list down some events that can be
traumatic for a child?

Types of Responses to Trauma

According to Antai-Ontong (2003) responses to trauma are generally behavioral and biological. Clients,
not only children, under trauma often experience flashbacks, intrusive thoughts, “being in a daze”
numbing, anxiety, startle reactions, nightmares and fatigue. Longer term reactions include unpredictable
emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea.
While these feelings are normal, some people have difficulty moving on with their lives. Psychologists
can help these individuals find constructive ways of managing their emotions [Ame15].

Reading Material
(Souce: http://www.nctsnet.org/sites/default/files/assets/pdfs/ctte_facts.pdf)

Examples:

Consider Ricky. Ricky, a three-year-old boy, cries inconsolably when his mother drops him off at school in
the morning. His teachers thought his crying would stop when he became more comfortable in the
classroom; however, he continues to cry every day and does not interact with his teachers or play with
his peers. Ricky also has a speech delay and gets very upset when the other students are loud or when
his daily routine is interrupted. One day the teacher asked Ricky to talk about his drawing, and he said,
“Daddy hurt mommy.” Ricky’s mother was later observed to have a black eye and bruises that were
consistent with assault.

Alexa, a four-year-old girl, has been kicked out of two other preschools and is about to be expelled from
her current school. She curses at teachers, hits, kicks, and scratches other students, and bangs her head
on the table when she is frustrated. Alexa’s behaviors are most difficult when transitioning from one
activity to another. When the teacher meets with Alexa’s father, the father reports that Alexa’s mother
uses drugs, that Alexa has seen her mother arrested by the police, and that Alexa’s mother often does
not come home at night.

Children respond to trauma with different behaviors. It varies from individual to individual.
There are those who just sit and stare at nothing, others are restless, while others experience bad
nightmares.

Identifying Traumatic Grief in Students Children at different developmental levels may react differently to
a loved one’s traumatic death. But there are some common signs and symptoms of traumatic grief that
children might show at school. Teachers may observe the following in the student:

• Being overly preoccupied with how the loved one died

• Reliving or re-enacting the traumatic death through play, activities, and/or artwork
• Showing signs of emotional and/or behavioral distress when reminded of the loss
• Attempting to avoid physical reminders of the traumatic death, such as activities, places, or
people related to the death
• Withdrawing from important aspects of their environment
• Showing signs of emotional constriction or “numbing”
• Being excessively jumpy or being easily startled
• Showing signs of a lack of purpose and meaning to one’s life

Observe a child who just survived a traumatic experience and list down his/her behaviors
that suggest that he/she is experiencing trauma.
Lesson 2. Behaviors/Responses experienced by children of different age groups to trauma

Children age 5 and under:

 Facial expressions of fear
 Clinging to parent or caregiver
 Crying or screaming
 Whimpering or trembling
 Moving aimlessly
 Becoming immobile
 Returning to behaviors common to being younger
 Thumb sucking
 Bedwetting
 Being afraid of the dark.

Children age 6 to 11:

 Isolating themselves
 Becoming quiet around friends, family, and teachers
 Having nightmares or other sleep problems
 Refusing to go to bed
 Becoming irritable or disruptive
 Having outbursts of anger
 Starting fights
 Being unable to concentrate
 Refusing to go to school
 Complaining of physical problems
 Developing unfounded fears
 Becoming depressed
 Becoming filled with guilt
 Feeling numb emotionally
 Doing poorly with school and homework
 Loss of interest in fun activities.

Adolescents age 12 to 17:

 Having flashbacks to the event (flashbacks are the mind reliving the event)
 Having nightmares or other sleep problems
 Avoiding reminders of the event
 Using or abusing drugs, alcohol, or tobacco
  Being disruptive, disrespectful, or behaving destructively
 Having physical complaints
 Feeling isolated or confused
 Being depressed
 Being angry
 Loss of interest in previously enjoyable activities
 Having suicidal thoughts
 Guilt feelings
 Thoughts of revenge

Watch video: Children of War (Source: The National Child Traumatic Stress Network)
Discussion Questions
1. What did you learn about refugee children? Did the youth in the play remind you of students
you have taught in your classrooms or have known in your school?
2. What challenges has your school faced in addressing the needs of refugee students? How
has your school met these challenges?
3. Do you know of resources in your community that can provide specialized help for refugee
children?

Lesson 3. Things that parents can do after traumatic event.

After the incident, first and foremost, parents and immediate family members should identify and
address their own feelings to facilitate helping others. Explain to children what happened and let them
know and emphasize the following:
 You love them
 The event was not their fault
 You will do your best to take care of them
 It’s okay for them to feel upset.

Do the following:
 Allow children to cry
 Allow sadness
 Let children talk about feelings
 Let them write about feelings
 Let them draw pictures about the event or their feelings.

Don’t do the following:

 Expect children to be brave or tough
 Make children discuss the event before they are ready
 Get angry if children show strong emotions
 Get upset if they begin bedwetting, acting out, or thumbsucking.
Other tips:
 If children have trouble sleeping give them extra attention, let them sleep with a light on, or let
 them sleep in your room (for a short time).
 Try to keep normal routines, for example, reading bedtime stories, eating dinner together,
 watching TV together, reading books, exercising, or playing games. If you can’t keep normal
 routines, make new ones together.
 Help children feel in control when possible by letting them choose meals, pick out clothes, or
 make some decisions for themselves.

Aside from the suggestions above, how can you, as a parent, contribute in the recovery of a
child who is under trauma/stress and grief?

Lesson 4. Things that community members do after traumatic event.

Helping children can start immediately, even at the scene of the event. Most children recover
within a few weeks of a traumatic experience, while some may need help longer. Grief, a deep
emotional response to loss, may take months to resolve. Children may experience grief over the
loss of a loved one, teacher, friend, or pet. Grief may be reexperienced or worsened by news
reports or the event’s anniversary.
Some children may need help from a mental health professional. Some people may seek other
kinds of help from community leaders.

Adult helpers should:

2. Pay attention to children
 Listen to them
 Accept/do not argue about their feelings
 Help them cope with the reality of their experiences.
3. Reduce effects of other stressors, such as
 Frequent moving or changes in place of residence
 Long periods away from family and friends
 Pressures to perform well in school
 Transportation problems
 Fighting within the family
  Being hungry.
4. Monitor healing
 It takes time
 Do not ignore severe reactions
 Pay attention to sudden changes in behaviors, speech, language use, or strong emotions.
5. Remind children that adults
 Love them
 Support them
 Will be with them when possible.
Parents and caregivers should also limit viewing of repetitive news reports about traumatic events.
Young children may not understand that news coverage is about one event and not multiple
similar events.

Aside from the suggestions above, how can you, as a member of the community, contribute
in the recovery of a child who is under trauma/stress and grief?

References

American Psychological Association. (2015, March 3). Retrieved from American Psychologican
Association Web site: http://www.apa.org/topics/trauma/

Antai-Ong, Deborah. (2003). Psychiatric Nursing: Biological and Behavioral Concepts. Thompson
Learning
Association, A. P. (2000). Diagnostic and Statistical Manual of Mental Disorders. Arlington: American
Psychiatric Publication.

Bhargava, A. (1994). Modelling the Health of Filipino Children. Journal of the Royal Statistical Society,
417-432.

Chemtob, C., Nakashima, J., & Carlson, J. (2002). Brief Treatment for Elementary School Children with
Disaster-Related Posttraumatic Stress Disorder: A Field Study. Journal of Clinical Psychology,
99-112.

Encyclopedia Brittanica Company. (2015, March 3). Retrieved from Merriam-Webster Web site:
http://www.merriam-webster.com/dictionary/trauma

Kok, F. (2009). Cycle of Conflict and Neglect: Mindanao's Displacement and Protection Crisis.
Switzerland: Internal Displacement Monitoring Centre, Norwegian Refugee Council.

The National Child Traumatic Stress Network. (2015, March 3). Retrieved from The National Child
Traumatic Stress Network Web site: http://www.nctsn.org/content/how-early-childhood-trauma-
unique