Manchester attack and trauma in young people — Expert Q&A

On the 22nd May 2017, a suicide bombing took place at a pop concert at the Manchester Arena, with the latest reports indicating 22 dead and a further 59 injured.

With the UK ramping up police presence in the streets and increasing the terror alert to from severe to critical, Theresa May noted in a statement that not only was another attack “highly likely, but that a further attack may be imminent.”

With children among those killed and injured, experts are worried about how trauma from the incident might affect UK youth — particularly those who attended the concert.

Our colleagues at the UK Science Media Centre asked a prominent child psychiatrist about how children respond to trauma. Feel free to use these comments in your reporting.

Massey University psychologist and trauma expert, Associate Professor Sarb Johal, has also written a blog post with advice about how to talk to young people about the Manchester and other terror attacks.

Dr. Andrea Danese, child psychiatrist at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience and South London & Maudsley NHS Trust, comments:

“The horrific attack in Manchester has brought up several questions related to its potential mental health consequences, particularly in the many young people involved. Here are some key points about the mental health consequences of psychological trauma in children and adolescents.”

Will most children be traumatised for just a short period, or can we expect to see many who were there now suffering with PTSD etc? Is PTSD the main concern?

“Like adults, many young people involved in this attack will develop new psychological symptoms in the short-term: children may become fearful, clingy, or jumpy; they may worry about the same traumatic event happening again; they may become very moody or easily upset (or, in contrast, they may become detached or numb); or they may develop headache and stomach-ache related to the intense distress.

“Most of these young people will recover from these symptoms in a few weeks at most. However, we can expect that a sizeable proportion of the young people involved (10-30%) will develop more enduring mental health problems related to the trauma, such as post-traumatic stress disorder (PTSD).

“PTSD is characterised by a key set of symptoms. First, the traumatic event is re-experienced persistently, for example through intrusive images, nightmares, or re-enactment in play or drawings. Second, there is either avoidance of thoughts, feelings, or locations related to the trauma – or, in contrast, detachment and numbness. Third, there are negative cognitions related to the trauma – including inability to recall some details, exaggerated blame of self or others, persistent negative thoughts about the world, or inability to experience positive emotions. Finally, there is marked hyper-arousal, which can lead to irritability or aggression, risky behaviours, or difficulties concentrating or sleeping.

“Although PTSD is a key concern after trauma, several other psychopathological conditions are common (or even more common given the higher base rates in the population), including depression, alcohol/substance abuse, conduct disorder, and anxiety disorders. These other conditions can appear together with PTSD (comorbidity) or on their own.”

What’s the long term outlook for children who get PTSD?

“Young people exposed to trauma are at elevated risk of self-harm, and this risk further increases in those who develop PTSD. The development of PTSD is also related to significant functional impairment – making it very difficult for young people to continue with school, work, or other daily activities.

“Despite the risk and costs associated to PTSD, it is often difficult to recognise its symptoms, and only a small fraction of young people may be adequately identified and treated. There is considerable clinical and research interest in ways to improve recognition and treatment provision in traumatised young people.”

For those who do develop PTSD how effective are the treatments? Are we talking psychological therapies, drugs, both?

“According to the National Institute of Clinical Excellence (NICE), the key treatment for PTSD in young people is Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), a type of psychotherapy.

“TF-CBT is initially focused on providing information on the reactions to trauma (psycho-education) and strengthening self-regulation capabilities (emotion regulation). TF-CBT treatment then helps the young people to understand the links between positive activities and mood, and supports their engagement in such activities (behavioural activation).

“Subsequently, TF-CBT focuses on recounting (or in some cases writing or drawing) the traumatic event in order to establish details and meanings of the event (imaginal reliving).

“In some cases, young people with PTSD are also prescribed medications. Pharmacological treatment at present is used to treat comorbid psychiatric conditions (see above).”

Does it affect children differently to adults?

“PTSD can be diagnosed in adults as well as in children. However, the criteria used for diagnosis need to be adapted to the age and developmental stage of the patients. For example, re-experiencing of the trauma is not commonly described with words by preschooler but rather observed through play and drawings.

“What is unique in children is that trauma and PTSD occur at a key developmental stage, when children should be learning to socialise with peers and achieve their educational potential. Disruption of these normative processes owing to trauma-related psychopathology can, thus, have disruptive long-term effects on child development.

“We are currently completing a large epidemiological study in a UK cohort, which we hope will shed more light on the clinical presentation and impact of PTSD in young people.”

See more details on PTSD and its treatment here:

How do young people respond to traumatic experiences?

“Children can respond to these events with emotional, behavioural, and physical symptoms. It is not uncommon for children to become fearful, clingy, or jumpy; to worry about the same traumatic thing happening again; to become very moody or easily upset (or, in contrast, becoming detached or numb); or to develop headaches and stomach-aches.”

What should parents/carers do with traumatised children?

“Safety first. Parents can make clear that the attack is now over. It is generally helpful to stop children from looking at news or social media coverage because the repetition of the scene can be disturbing and confusing.

“Talk about emotions. Parents can explain that it is normal to be sad and upset after such horrific events.

“Help with the facts. Children should not be forced to talk about the attack if they do not want to. However, parents should be open and supportive if their children ask questions or want to talk. Parents should provide honest and accurate information or answers to help their children make sense of what has happened and clarify any misunderstandings about the event.

“Claim back life. Parents can help their children to regain a sense of control over their lives. It is important to keep normal routines and daily activities to minimises the sense of loss and unpredictability. Children may also benefit from learning relaxation techniques.

“Look after yourself. Parents, of course, may also be affected by the event. It is important that parents think about their own response to the attack and seek professional advice when needed.”

When to talk to your doctor?

“Most children and young people exposed to traumatic experiences show some psychological reactions. Fortunately, in most children these symptoms disappear quite quickly.

“Parents should talk to their GP if symptoms limit what their children can do in their everyday life (e.g. if they don’t want to leave the home or their behaviour becomes very worrying).

“They should also talk to their GP if symptoms persist for long (e.g., more than a month). The GP can then refer them to the local Child & Adolescent Mental Health Service (CAMHS). In some case, there may be different local arrangements so that parents can refer their children directly and may get some support from voluntary organisations whilst waiting for an appointment.

“CAMHS will offer to assess the impact of the traumatic events on children’s mental health. When this assessment reveals a psychiatric disorder, CAMHS professional can offer evidence-based treatment for trauma-related symptoms (e.g., post-traumatic stress disorder, anxiety disorders or depression) using psychotherapy. Some children also need medication. Usually there is also support offered for the family.”

Other resources for families.

Declared interests
None declared