The Risk of Low-Magnitude Stressors for Children’s Mental Health

Two articles in the American Journal of Psychiatry struck me as pointing out a vital need in caring for children’s emotional health.

The first article was on a recently published study comparing stress in children over 3-7 years of their life, the number of both low-magnitude stressors and extreme stressors and the risk of developing post traumatic stress disorder.  The findings affirmed what everyone expected that extreme stressors carry more risk, but what was surprising was that because low-magnitude stressors are four times as frequent as extreme stressors, they accounted for up to two-thirds of the cases of PTSD and half of the cases of sub-clinical PTSD.

“Relative to low-magnitude stressors, extreme stressors place children at greater risk for post traumatic stress symptoms. Nevertheless, a sizable proportion of children manifesting post traumatic stress disorder symptoms experienced only a low-magnitude stressor.” June 15, 2010 American Journal of Psychiatry

The second article I dug up was a 10 year old study of PTSD in quake victims in China.  This study compared two villages in the same region.  One was 10km and the other was less than one kilometer from the epicenter.  All other factors being equal the two differences between the villages were the level of severity of damage from the quake and the level of care that the village received afterwards.  Surprisingly, it was the village that had less damage but also received less care that showed the greatest number of cases of PTSD.  The village with the greater stressor also received a large outpouring of support – homes were rebuilt, donations flowed in and there was a much greater sense of hope for the future.  In comparison, in the village with less damage there was little help with repairing damaged homes and constant fear of aftershocks.

Earthquake damage in China

The connection between these two studies and the lesson that we need to learn is that even though extreme stressors require professional attention and have greater risk of developing into PTSD, even low-magnitude stressors can affect the emotional health of children.  Indeed, because of the high visibility of some extreme stressors, care is almost guaranteed, while children who were not personally affected but were in the vicinity of the event might be at greater risk of developing emotional disorders (i.e. school violence, outlying areas in natural disasters, siblings and friends of abused children).  Likewise, more common stressful events such as a move, divorce, loss of a pet, failure in sport or classwork, rejection by peer group, especially if concurrent require adequate care as well to prevent stress disorders.

Emotional Health – Five Lessons for Children

Operation Safe’s work with children after disaster in the developing world is aimed at reducing the risk of developing PTSD.  Because of the short supply of professional psychologists in these countries and programs for these children we train volunteers and parents how to care for the emotional needs of their children.  We have found that through the use of stories, games, crafts, songs and friendship we are able to help children who might not have received any care to be emotionally healthy.  I am not a psychologist and recommend that if you have any suspicion that your child is at risk of PTSD that you consult with a licensed professional.  But I strongly advocate for the mental health of children that the following five lessons be instilled in children even before trauma, but especially after either low-magnitude or extreme stressors are encountered.

Teaching Themes to Chinese Children

1.  ”I am Not Alone”

-  One of the most fundamental needs of a child is to know that they are safe.  Usually this means that they are with an adult who cares for them.  After trauma it is common for children to become isolated, to feel that no one else understands what they are feeling or are going through.  In the OperationSAFE program we use the story of “Pete’s Adventure” to help children see that they are not the only one’s who go through emotions such as anger, loneliness, frustration and fear.  We also help children who have lost their homes and normal surroundings find new friends and a new place where they can be safe.

2.  ”Everyone is Important”

- On the second day of the OperationSAFE program we help the children to understand that their story is important.  Many children are like flies on the wall, they listen to everyone else’s story (sometimes becoming more traumatized by the secondary accounts from adults than the original trauma) but are not given the chance to tell theirs.  Children can easily blame themselves for things that happened or assign more importance to parts of the story that others overlook.  As they tell their own story and listen to the stories of other children they are given a chance to heal and adults can help them process events with greater perspective.

Aurora the Whale

3.  ”Follow and Believe”

- In the story of “Pete’s Adventure” just when things seem to be the darkest, Aurora the Whale shows up to encourage Pete and his friends.  She teaches them to follow their heart and believe that things will get better.  One of the biggest factors mitigating PTSD is hope.  Children need to know that the people they depend on believe that things will get better and learn to take each day one at a time.  Adults should speak the truth to children, but always at an age appropriate level and always sprinkled with a healthy measure of hope.  No matter how bad the outlook might be, stress that they are safe now, that you are with them, and that things will get better.

4.  ”Be Strong and Courageous”

- Some symptoms of PTSD are irrational fears and avoidance of things associated with the trauma.  It can be too much to ask a child to just face their fears and be strong, so we focus on the courageous act of asking for help.  All too often children face their fears on their own and never express them to an adult, who then interprets the child’s unwillingness to go to bed, or obey instructions as disobedience.

Colorful characters teach the themes.

5.  ”You are Loved”

- The keystone to emotional health is that the child understands that whatever they might be going through emotionally, they are still loved unconditionally.  Because trauma so often involves loss, it is natural that a child would assume that everything in their life is at risk.  Adults need to make sure that children understand that whatever might happen in the future, and whatever they share with us, they can count on our love to never change.

Don’t wait until a disaster to strike to teach these lessons to your children.  The world is a stressful place and children are exposed more and more to low-magnitude trauma and secondary stress.  We might not be able to protect them from everything, but we can give them a strong mental capacity to handle stressful events in their lives.