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Glenn D. Braunstein, M.D. Headshot

Violent Events Have Long-Term Effects on Children

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If the struggling economy hasn't made it tough enough to keep food on the table and clothes on the family, and if the hectic pace in Los Angeles hasn't made all of us more than a little agitated, what ought we be telling our youngsters to try to calm them and offer them some kind of sense and solace about the continuing violence that dominates the headlines?

Yes, it's true that the number of violent crimes in our country may be nearing historic lows, but parents still must look into their children's anxious faces, comfort them about bad dreams and seek to explain some inexplicable highly publicized recent incidents.

What to do with or say to your kids after a 24-year-old gunman dresses up in SWAT gear and opens fire on a packed Aurora, Colo., theater audience at a screening of The Dark Knight Rises, a mass homicide in which a dozen people, including a 6-year-old girl, die and 58 others are wounded?

How do you start to talk about a white supremacist who guns down seven people at a Sikh temple in Wisconsin, or the shoot-out near Texas A&M that left three dead or the gunplay on the streets of New York near the Empire State building, a crime that left a gunman dead and nine wounded?

The toll of terrible public shootings and mass homicides seems to just build and build and build, from the Columbine school killings to the senseless attack on U.S. Rep. Gabrielle Giffords and others at a grocery store meet-and-greet to the Virginia Tech student slayings.

Gruesome tragedies don't only devastate the lives of direct victims and their loved ones. Witnesses of violence, especially those who are children, also can suffer serious emotional and cognitive effects.

Everyone responds differently to terror. Like adults, some children are naturally resilient. Others can suffer scars that, untreated, last well into adulthood. Among the repercussions most commonly endured by children exposed to violence are: post-traumatic stress disorder, depression, attachment issues, difficulty concentrating, sleep disorders, suicidal thoughts, alcohol and substance abuse and delinquent behavior.

Fortunately, most young people will never witness the sort of mass killings and horrendous tragedies that garner non-stop media coverage, which itself widens the sphere of fear.

However, many children and adolescents do observe other sorts of violence, from domestic abuse in their own homes to bullying at school that doesn't make the 6 o'clock news but is harmful, nonetheless. On average, children experience violence more frequently than adults. Sixty percent of them reported having been exposed to violence in the past year, directly or indirectly (either as a witness or hearing about a crime committed against someone they know), according to a major 2008 study.

Low-income, inner-city youth, like the 300,000 living in Los Angeles' gang "hot zones," are at the greatest risk. According to research, 90 percent of these children and teens have been victims or witnesses of felony-level violence. Their scars run deep. A fifth of youth living in these areas suffer from clinical depression and one third have PTSD. In addition, chronic stress from growing up in a violent neighborhood, home or both produces elevated levels of certain chemicals and hormones that are believed to impair brain development in children. Specifically, the areas of the brain impacted are those responsible for learning, memory, concentration and regulating emotions and actions.

Experts believe this is one cause of the continued disparity on standardized tests between students who live in low-income neighborhoods and those from more affluent ones. A study conducted in Chicago found that children and teens who lived within 10 blocks of a murder — regardless of whether they witnessed it or knew the victim — had reduced scores on vocabulary and reading tests, when a test was taken within a week of the crime.

Though violence is substantially more prevalent in low-income neighborhoods, children from all zip codes may be exposed. In fact, nationwide, more than two million young people are estimated to have PTSD. Most people feel fearful, anxious or disorganized after witnessing violence. Individuals with PTSD continue to feel that way for extended periods of time, ranging from months to years. Their symptoms are debilitating and include emotional numbing and detachment, increased arousal, trouble sleeping and nightmares.

Girls are more prone to develop PTSD than boys and it's more likely to occur if witnesses see someone they know be victimized. One's proximity to the violence is a factor, too. That was evident at Santana High School near San Diego. In 2001 a freshman shot and killed two students. Eight months after the shooting, 9.7 percent of those who'd seen the crime or the students receiving emergency medical treatment suffered symptoms of PTSD, versus 3.4 percent on those who had only seen general chaos, such as people running, or were not on campus that day.

Adolescents suffering from PTSD are more likely than children or adults to show impulsive and aggressive behaviors. Their symptoms, overall though, are similar to adults and may include intrusive flashbacks, feelings of guilt, self-harm and even suicide.

PTSD is reportedly believed to have lead to the suicide of a Columbine High School basketball star who hanged himself a year after the school's infamous 1999 massacre, in which he witnessed a coach get shot and die, and lost two close friends.

In very young children, PTSD can cause regressive behavior like bedwetting and thumb sucking. These children also may stop speaking and become excessively clingy to a parent. They don't necessarily experience flashbacks like adults, but often act out the violent event during play.

Helping Kids Heal

Cognitive-behavioral therapy has proven the most effective treatment for PTSD. With a professional, children recount the traumatic event; they're offered techniques to relieve anxiety. The therapist also corrects inaccurate or distorted information and will challenge youngsters' false beliefs, such as guilt over feeling that they could have done something to prevent the situation, or that the world is unsafe overall. If a child has difficulty opening up, a therapist may start with play or art therapy, which can offer clues about what is going on in the child's mind, either consciously or subconsciously.

Whether children suffer with PTSD or are merely anxious about events they have heard secondhand, parental support is crucial to help them heal. How parents cope with trauma themselves can help resolve or worsen their children's stress. It's key to remain calm because your children take their cues from you.

"Ask your child open-ended questions — you want to understand the pictures he or she has in their head," advises my colleague Suzanne Silverstein, founding director of the Psychological Trauma Center at Cedars-Sinai, which operates in more than two dozen Los Angeles schools. "Make sure they know that you are there for them, that you understand and what they are feeling is normal."

There's plenty of argument to be made about the possible harm of the omnipresent depictions of violence and gore our youngsters take in — on television, in the movies and through video games and electronic devices. In an entertainment industry town like Los Angeles, this is a topic with which it isn't productive to debate the merits of various research studies with conflicting conclusions. Suffice it to say that parental common sense demands that grown-ups must closely monitor and control their youngsters' online, on-screen and real-time activities. Yes, you may need to snap off the TV, snag the video game and stash the laptop when youngsters can't follow your sensible rules about their use or try to take in materials inappropriate for their age. In our mobile society, it's a huge challenge and chore to keep tabs on what your kids are doing and who they're doing it with. But these are the responsible roles of moms, dads, aunties, uncles, teachers, coaches and those who employ older youths.

Monitoring your child's exposure to news coverage is important, too. In a study of 218 children from kindergarten through sixth grade, researchers found that 35 percent were frightened by news reports during a time absent of a major crisis.

Even if you completely ban their exposure to media coverage, it's unrealistic to think your child won't still hear about major incidents.

"We tend to forget that elementary school has kindergarteners through sixth-graders," reminds Silverstein. "So they are in contact with older kids. You don't know how any other kids are being raised or what they are exposed to. It's always better that the information comes from you."

Parents may worry that bringing up a disturbing news event will cause their kids to panic unnecessarily. But, Silverstein says, it's important to start a conversation because they may already be thinking about it or having nightmares. "Tell your child that whoever committed the crime is really sick but most people are not. That the chances of something like this happening is very, very, very small."

Of course, the best medicine is always prevention. We can't stop the trauma caused by natural disasters. But we can stop giving unstable and violent individuals easy access to deadly weapons. Guns were used in 84 percent of teen homicides and 44 percent of teen suicides in 2009.

Surely, we must rethink the laws that permitted Aurora's movie theater gunman to purchase a semiautomatic rifle, 12-gauge shotgun, .40-caliber semiautomatic pistol and more than 6,000 rounds of ammunition.

In addition, all gun owners must be required to store their weapons safely. Far too often, that is not the case. In only less than half of homes with both children and guns, are these firearms stored in a locked place or with a trigger lock and, in addition, stored separately from ammunition. Curbing access to guns has long been a political debate. But in reality, it's about safeguarding public health.

I can hear the howls now of gun advocates, of unhappy adults who think the world needs unfettered media (TV shows, movies, video games) with blasting weaponry and imaginary victims falling left and right and of parents feeling overwhelmed and wondering how much more they can be asked to take on. Each generation gets its one chance to leave a better world for the next, so I can only say that we, collectively, need to do a lot and much better. We can't shelter our children from everything forever. But we've got to do all we can to shut down senseless mayhem, violence and killing and to ensure those who come after us aren't numbed to and harmed by it.