I'm concerned about a 4-year-old in my class. A house fire caused the family to have to relocate, and the child lost many of his toys and other personal possessions. I find myself constantly on the alert for any signs he might show of posttraumatic stress disorder (PTSD). Are there specific things I should look for? And, if I notice these signs, what should I do about them?

Signs of having been exposed to severe stress or having experienced trauma vary from child to child. What we look for is any change in the child's usual functioning. Tummy aches and sleep problems are additional stress signals as are increased fearfulness and anxiety, and increased aggression. A child might also experience nightmares, though this is not as common as the other three reactions.

Often, there are changes in academic performance that indicate possible exposure to unusual stress. In this case, a child who had been learning with ease may all of a sudden seem to be very distracted and unable to absorb concepts very well.

Changes in Play Styles

There's a belief among many that you are likely to see reenactments of the trauma in a child's play, but you are more likely to see a change or shift in the child's style of play. For instance, a child who hasn't been imaginative may begin playing out chaotic, frantic scenes with toys being thrown around-but not necessarily replaying the exact type of trauma he was exposed to. Of course, some children will play out the drama that they were exposed to, the event that scared them. Sometimes they change it, and sometimes you'll see it being played out exactly as it happened. Whatever the behavior of the child, whether it's becoming more shy, more fearful, or more aggressive, it's important to address his anxieties.

Responding to Anxiety

While you have to certainly set limits on aggressive behavior, you want to be especially gentle while you're being firm. The child may already be scared and traumatized. Getting "tough" with him in a punitive way won't help him get through these scary feelings and will only tend to make him want to be more aggressive.

With the child who becomes shy, the situation is a little easier because he's obviously frightened, and you're dealing with his feelings more directly. In both cases, whether you have a child who is clearly fearful or one who's showing anxiety in other ways, you want to do pretty much the same thing:

  • Start with extra nurturing-providing a stronger sense of security.
  • Don't overload him.
  • Offer him a little more time with you.
  • Try to pair him up with other children at activity times who are very calming, nurturing, and soothing.

Encourage the child to talk about how he's feeling, but be very gentle and not intrusive. And if the child seems to want to avoid talking about feelings, just say, "Gee, sometimes even talking can be scary." In other words, don't push it, but allude to the child's avoidance of the issue.

Try also to reassure the child, to the degree that you can, that the particular scary thing he's been exposed to won't happen again. Tell him what steps you're taking to protect him. Point out the steps others have been taking, too, including the police or the government.

Finally, help the child to be active in coping by contributing something. For example, many children have made cards for the firefighters and police officers, thanking them for being so brave on September 11th.

Throughout the process of working with posttraumatic stress, it is essential to coordinate your efforts with those of the parents. Help the parents to follow the same steps described here, and continue to stay in touch and compare notes.