Tuesday, December 18, 2012

Children Can Usually Recover From Emotional Trauma

By on 1:14 AM

On April 20, 1999, Crystal Woodman, 16, was studying for a test in the library at Columbine High School when Dylan Klebold and Eric Harris walked in and began shooting. For seven and a half minutes she hid beneath a table listening to screams, gunfire and the two teenagers’ laughter.

“I thought, ‘I’m not going to live through this,’ ” said the young woman, now Crystal Woodman Miller, in a telephone interview this weekend from her home in Morrison, Colo., 15 miles from Columbine. “I’m 16 and I’m facing the reality of my death.” 

When the two gunmen left the library to get more ammunition, she managed to escape without physical injury.

But the emotional aftermath was debilitating. 

“I experienced nightmares all night, every night for two years,” said Mrs. Miller, now 30. “I was living in a paradox: I wanted to be around people, but I didn’t want people around me.”

Like many trauma victims, she found herself searching for exits and formulating an escape plan every time she entered a room. A friend followed her around with a box of Girl Scout cookies to make sure she ate something. 

For young people exposed to gun trauma — like the students of Sandy Hook Elementary School in Newtown, Conn. — the road to recovery can be long and torturous, marked by anxiety, nightmares, school trouble and even substance abuse. Witnessing lethal violence ruptures a child’s sense of security, psychiatrists say, leaving behind an array of emotional and social challenges that are not easily resolved.

But the good news is that most of these children will probably heal. 

“Most kids, even of this age, are resilient,” said Dr. Glenn Saxe, chairman of child and adolescent psychiatry at NYU Langone Medical Center. “The data shows that the majority of people after a trauma, including a school assault, will end up doing O.K.”

In a 2007 Duke University study that psychiatrists say is nationally representative, only 13 percent of people who had experienced a traumatic event before age 16 developed symptoms associated with post-traumatic stress disorder, and less than 1 percent developed “full-blown” PTSD. Over all, more than two-thirds of the 1,420 children surveyed reported experiencing some kind of trauma. 

“Like recovering from surgery, you could end up with a scar, and depending on the surgery it could be a big one,” said Dr. Don Bechtold, medical director of the Jefferson Center for Mental Health in Wheat Ridge, Colo. “People get better — the extent of what ‘better’ means is relative.”

Today, Mrs. Miller describes herself as a happy, well-adjusted wife and mother, free of the nightmares and depression that haunted her in the months after the shooting. “I’ll never be the same,” she said, “but I eventually realized I can choose to be bitter, angry and hateful or I can choose to forgive and to live my life despite what has happened.” 

The factors that determine how well a child may recover after a trauma run a gamut from personal to environmental. To what extent was the child exposed to the event? Did he actually see a shooting, or hear one? In the Duke study, children were more likely to develop long-term problems if they experienced multiple traumas.

Psychiatrists say a supportive family helps. And natural resilience — people’s likelihood to process their feelings verbally or have a positive attitude toward their future — plays a role, too. 

And while the tender age of the Newtown schoolchildren has yielded speculation that they could be more deeply or irreversibly scarred, research does not bear out the theory, Dr. Saxe says.

“There is no compelling data I know that says there is a greater risk depending on whether the child is younger or older,” he said. “It really depends on the individual. You have to look at the whole host of risk factors.” 

That is not to say a kindergartner will process trauma in the same way as a teenager. “A 5-year-old isn’t likely to talk about it, and certainly not in an adult way,” said Dr. Bechtold, who was part of the initial mental health response team for the Columbine shootings. Preschoolers are “more likely to be fearful, to ask a lot of questions and ask whether they’re safe; they may become clingy or have separation problems.”

Young children exposed to trauma often regress, returning to whiny baby talk or self-soothing habits they had outgrown, like carrying a favorite blanket. 

One reason people tend to overestimate the psychological damage a child may sustain after a school shooting is that they underestimate the prevalence of childhood trauma. In a 1997 study of 12-to-17-year-olds conducted by the Medical University of South Carolina, 8 percent reported experiencing a sexual assault, 17 percent reported physical assault and 39 percent said they had been witness to violence.

“In a way, trauma is part of the ticket of being human,” Dr. Saxe said. “Most of us can look back and note at least one experience where there was a pretty big threat” to our safety. “Most people use that, manage and cope and go on.” 

But the effects of PTSD linger over some families for years.

Marjorie Long, a sophomore at Columbine in 1999, was trapped for hours in a classroom with a dying teacher. Her mother, Peggy Lindholm, responding to an interview request made to Ms. Long, said that news of mass shootings still had the power to shut her daughter down. “She’s really taking this one hard,” she said. 

Because Ms. Long couldn’t bear to be in a classroom, she eventually dropped out of high school. She battled illness, nightmares and addiction. “She was physically sick for a year,” said Ms. Lindholm, whose own divorce soon followed.

Today, Ms. Long, 30, is married, sober and working toward a graduate degree. But she still has trouble with loud noises. 

“Fourth of July really bothers her,” Ms. Lindholm said, “and that used to be one of her favorites.” And she still runs the risk of reliving her experience every time something triggers it. “Now she’ll shut down for the next month.”

For others, leaving it behind is easier. Mrs. Miller, the student who hid under the table in the library, says she can’t put her finger on the day she started feeling better. But like the pain from a bitter breakup, her anxiety and nightmares gradually eased — probably, she says, as a result of time, regular therapy and travel. (She has spent much of the past 13 years speaking and volunteering in countries affected by adversity, like Kosovo and Indonesia, after the 2004 tsunami.) 

On Saturday, having closely followed the news in Newtown, Mrs. Miller said she was deeply saddened, but not depressed or unable to function.

“The shootings in Aurora, this, it doesn’t send me back to reliving it,” she said. “What I feel is an overwhelming sense of grief and sadness for the community and the survivors. But I’m not traumatized.” 

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