• Mental health experts said the recent alleged murder at River Valley High School is “highly potentially traumatic”
• After such an incident, what looks like rebellious or disruptive behaviour in teenagers may be a sign of trauma and stress
• Trauma can be inflicted by a single event or a series of events
• Experts gave tips to parents and educators on identifying and coping with trauma
• They also tell what should or should not be done when supporting youth in such cases

SINGAPORE — After a traumatic event, such as the recent death of a 13-year-old student who was allegedly murdered by a 16-year-old schoolmate in River Valley High School, emotional disturbances may not always be visible in teenagers.

Experts approached by TODAY therefore urged parents, educators and adults to be aware of how trauma may look like in this age group and to know when to seek professional help, especially if changes in behaviour persist.

These may include seemingly irrational and unexplained anger outbursts or disruptive behaviour.

Senior counsellor Celynn Chang, who works with children and youth who have experienced trauma and other child protection concerns, said that at their developmental stage, teenagers aged 12 to 18 respond very differently to traumatic events compared to younger children or adults.

“More often than not, the cognitive and emotional impact of trauma on children and adolescents tends to be expressed through behaviour,” Ms Chang, who is a manager at the Clinical Intervention Centre of Boys’ Town, said.

After experiencing a highly distressing incident, it is not uncommon to feel shock, confusion, anxiety, fear, guilt or even a sense of helplessness and hopelessness. Along with the overwhelming emotions, crying may be a normal response.

However, teenagers may not cry openly or talk about how they feel.

“They usually do not like to show their vulnerability. Traumatic events can make them feel like things are out of control, even if they behave as if they are strong,” Ms Chang said.

“This explains why, for this group, behavioural symptoms are more obvious, such as changes in activity, increased aggression and disruptive behaviour.

“Some may withdraw and exhibit avoidance behaviour. They may appear uncooperative, have unexplained anger outbursts or lose interest in usually enjoyable activities.”  

It is important for parents to know that such behaviour does not mean that their teenage children are being rebellious or becoming “disobedient”, but that it may be a sign of trauma or stress, Ms Chang said.

“Remember: All behaviour is communication and this is especially so for children and adolescents. It is important that we explore and find out what could be the cause of behaviour challenges,” she said.

“In the recent River Valley High incident, refusing to go to school may be a possible trauma response but as parents, we may misunderstand the child as being lazy, when they are really responding out of fear or because they want to avoid the trauma reminders.”

LACK OF KNOWLEDGE ABOUT TRAUMA

Experts from Safe Circle, a newly launched online platform here that aims to improve awareness and support for trauma survivors, told TODAY that trauma is a prevalent but commonly overlooked aspect of mental well-being.

Ms Chang, one of the spokespersons from Safe Circle, said: “There is very limited knowledge of trauma in our community.

“When it comes to trauma or any other mental health issues, the first thing we tend to say is, ‘Never mind, it will be over. After a while, you will be okay.’ That’s a big no-no (when talking to people who have experienced trauma).”

Safe Circle is a grouping of seven agencies with services that cater to children, youth or mental health needs, including Boys’ Town, Acceset, Campus PSY, Caregivers Alliance Limited, Limitless Singapore, Singapore Association for Mental Health and Singapore Children’s Society.

It runs talks and workshops for educators, parents and caregivers as well as professionals who regularly interact with children and youth.

Some member agencies are also equipped to provide trauma-focused interventions.

Mr Asher Low, executive director of Limitless Singapore, a non-profit organisation that provides counselling for youth, said: “With the prevalence of trauma incidents, as a society, understanding how to identify and deal with trauma helps us play our part in helping survivors recover, feel safe and be empowered to find a voice, and make positive decisions and changes in their own lives.”

AFTERMATH OF RIVER VALLEY HIGH INCIDENT

Trauma can affect people of all ages and it can be inflicted by a single event or a series of events that result in an individual being physically or emotionally affected — to the point that it may impair how the person functions, his ability to cope as well as his well-being.

Left unchecked and unprocessed, trauma could delay the healing process or even lead to adverse outcomes later in life.

Ms Chang said: “The recent incident at River Valley High is what we refer to as a single devastating event. It can be highly potentially traumatic — not only for the students, even for the teachers and parents.”

Ms Vyda S Chai, a clinical psychologist in private practice, said that it is not known how many people saw the scene of the crime or anything related to it, but witnessing death and losing a friend can be highly traumatic.

“Everyone processes trauma differently, but our brain is like a ‘Google network system’ and depending on what is stored in your system to help you cope with the information, it may have a profound long-term impact.

“This is especially if the youth does not have the tools, resources and support to work through what has happened,” Ms Chai said.

Mr Matt Oon, founder of digital mental health company Acceset, which provides peer-support training, thinks that the Covid-19 crisis may also make recovery from a traumatic event “slightly more challenging” due to fewer opportunities for physical interactions as a result of safety regulations.

Practitioners believe that healing from trauma starts and happens with supportive relationships, he said.

“Students are resilient in that many of their interactions can shift online. But that human touch and connection might not be fully replicated online as compared to in-person group hangouts.”

IMPACT ON ADULTS

In cases of violence, the most affected group would be direct witnesses and the friends of the victim and the perpetrator.

However, Ms Chang pointed out that teachers and parents, along with teachers and parents of children from other schools may also experience “vicarious trauma” or secondary traumatic stress, as they may closely relate to the students and teachers at River Valley High. 

Mr Oon agreed that the impact of trauma would extend beyond the students.

“It would be difficult to measure and compare the grief of a close friend, a family member, a school leader or an educator close to the victim. Neither can we minimise nor underestimate the impact it has on observers outside of the River Valley High community,” he said.

Ms Chang and Mr Oon recommended that support be given to teachers and other school staff members for their well-being, too.

“In times like this, our focus tends to fall on the students. However, teachers usually feel like they need to put on a strong front and be there for the students, so much so that their well-being is neglected.

“They may experience feelings of guilt and helplessness. They may ask themselves, ‘Could I have done something to prevent the incident from happening?’” Ms Chang said.

Ms Chang added that the parents of the victim may also experience traumatic grief if the circumstances surrounding the victim’s death was sudden, violent, unexpected and inexplicable.

“When death occurs suddenly and violently, (the grieving process) becomes more complicated.”

Ms Chang said that the human body is “built to withstand adversity” and in the immediate days after a traumatic event, it is normal to experience symptoms.

“These symptoms or reactions will likely resolve within a few days or weeks, while some may have some lasting impact. If the symptoms do not decrease in two to three weeks after the event, it may be good to see a professional for further evaluation,” she advised.

Mr Oon of Acceset said: “The best psychological defence we have in response to trauma would be to equip ourselves with the knowledge of trauma and learn how to treat others in a trauma-informed way.”

DOS AND DON’TS FOR HEALING FROM TRAUMA

1. Do not take the teenager’s behaviour personally

Teenagers who have experienced trauma may act out and express anger and frustration.

Ms Chang said: “My experience working with parents whose children have experienced trauma, as well as teachers who work with children in such cases is that they tend to 'personalise' the child’s behaviour. They take it very personally. They feel that the behaviour is targeted at them but it is really a response to trauma.”

Instead of getting offended or upset, allow the child to express his or her feelings without passing judgement.

Rather than ask, “What is wrong with you?”, Ms Chang suggested going along the lines of “What happened?” or “What went wrong? Would you like to share?”

Refrain from dismissing their concerns and saying things such as “Don’t worry, you will be fine”.

2. Monitor social media exposure

In the wake of a traumatic event, it is advisable for parents to limit or screen their child’s exposure to content online and from the media, the experts said.

“While teenagers can better handle the news than younger children, those who are unable to detach themselves from the media may be trying to deal with anxiety in unhealthy ways,” Ms Chang said.

Ms Chai from Think Psychological Services and Think Kids said that social media may “add oil” to the trauma. 

“Some of the information on social media can inflict a lot more damage than support. Some people might start sharing their own opinions about the child in question and fuel anger. It can add on to the trauma being re-lived repeatedly — and that is not helpful in the recovery process.”

She added: “For 13-year-olds, I would be very concerned if they were going on such platforms to read about people’s opinions and get information that are not facts and that are fuelled by anger and unnecessary gory details.”

In any case, the experts stressed on the importance of talking to the teenager about the things he or she has heard or seen.

Instead of sweeping the matter under the carpet, Ms Chang advised parents to tell their children what happened in a way appropriate to their level of understanding and without going into frightening and lurid detail.

“Use language they understand. If you keep accurate information from them, they will fill in the blanks using their experience, available information and their imagination,” she said.

Talking about it also ensures that the child does not jump to wrong conclusions, for example, thinking that the tragedy was their fault.

3. Be patient and non-confrontational

Ms Chang said that it is typical for teenagers to say they do not want to talk. Do not force a conversation, but instead, try to start one while doing an activity together with the teenager so that it feels less intense or confrontational.

“If the child doesn’t want to talk, it’s important to give him or her the space and time.”

Parents may consider peer groups since some teenagers may feel more comfortable talking in groups with their peers. Parents may also encourage conversation with other trusted adults such as a relative, mentor or teacher. 

4.  Build a culture of talking about emotions

Mr Oon said that adults can show by example the process of emotional disclosure and build that into the family culture.

“When children see that it is okay to talk about their feelings and thoughts — and know that it would not be used against them — it makes it easier for them to cultivate this practice and trust to open up rather than bottle it in, absorbing the intense psychological pain on their own.

“It has to be an ongoing commitment, rather than a seasonal or one-off affair because of the recent (River Valley High) incident.” 

Ms Chang said that talking about the traumatic event as a family — which means letting everyone including the children have their say — will overcome isolation and allow everyone to feel supported.

5. Get professional help instead of doing it on your own

Talking to a professional can provide insights into the most effective way to deal with traumatised children. It can also help the child address the trauma and learn effective coping strategies.

Adults who have trouble coping with their own emotions should also seek help and support for themselves.

Ms Chang said: “Children look to their parents or carers to understand a crisis, and find ways to respond and deal with it. They need the adults around them to be able to ‘tune in’ to their fears and distress and to comfort and support them. If you don’t, the child’s fear and distress will increase.”

6. Keep to a predictable routine as much as possible

The predictability of a day-to-day schedule is reassuring for children. But do not push it if they are unable to manage their usual routine such as attending school or performing household chores right after they experience a traumatic event.

“Don’t introduce changes such as new routines or stricter standards of behaviour. Leave that for another time,” Ms Chang said.

Children who feel helpless tend to experience more severe stress symptoms. Letting them feel like they have a sense of control over their life, even in minor decisions, is important especially after a crisis, she added.