Tips to help children with post-traumatic stress disorder express their emotions, process their experiences

Often, tender minds of children go through traumatic stressors like loss of a parent, grandparent, pet or physical abuse where children find it very difficult to comprehend what happened with them and further process and express this. Sometimes such situations like a physical/sexual abuse remains undisclosed to the family and a child starts behaving differently due to this trauma but the child may show mood swings, avoidance to school, aggression, agitation, be irritable, depressed, alone or refuse leisure activities and that is when the family or caregivers try to find out the cause and often Play or Art Therapy is suggested to them.

In an interview with HT Lifestyle, Dr Isha Soni, Senior Occupational Therapist and Centre Head at Lexicon Rainbow Therapy and Child Development Centre in Pune, shared, “It is very well said that “Play is the primary occupation of a child.” I firmly believe that the best way to assess a child is not by administering batteries of tests or checklists but to play with a child. In play, one can unravel the most natural abilities and difficulties of a child. In case of post – traumatic stress disorder, what is not possible through a dialogue/counselling by a therapist can be known through use of certain toys, dolls, pretend situations because the child doesn’t feel judged. Through Play Therapy, a child can be assessed as well as healed of the trauma he/she has undergone. It helps to express, identify and resolve their emotions and thoughts and form coping strategies. Play Therapy is a well-known evidence-based practise to heal anxiety and disruptive behaviour.”

Recognising the importance of addressing the emotional and psychological effects of PTSD in children, Dr Himani Narula, Developmental and Behavioral Paediatrician Director and Co-Founder of Continua kids, said, "It is important for children experiencing symptoms of PTSD to seek professional help from mental health professionals who specialise in trauma-related disorders.
Play therapy allows them to use toys, games, and creative activities to symbolise their thoughts and feelings. Whereas, art therapy allows children to communicate and explore their emotions through various art forms, such as drawing, painting, sculpting, or making a collage. Therapy, medication and support from family and friends can assist people in managing their symptoms and achieving healing and recovery."

According to Dr Ritika Agarwal, Consultant, Psychologist at Jaslok Hospital and Research Centre, children may find it difficult to verbally communicate what they're feeling. She explained, “They may not know the right words or be unable to find the right words to express what they've been through and are still going through. Using expressive art therapies gives them an alternative way to understand their emotions, communicate and express those emotions non-verbally, and experience catharsis while feeling safe. Expressing negative emotions through an art form provides the child with a safe environment to release the negative emotions through a positive and enjoyable activity, which in turn can accelerate the healing process and general growth. Expressive art therapies can also help with a range of other concerns and also normal development.”

Bringing her expertise to the same, Dr Meghana Dikshit, Author and Brain and Performance Expert, revealed, “Post-Traumatic Stress Disorder, a term used for war veterans originally, is now used to describe the aftereffects of any trauma that a person goes through. The term PTSD is used for children who have experienced bullying, a dysfunctional home, physical, verbal, or sexual abuse, or any other trauma during their formative, impressionable years. As a result, the young child may go silent, rebel, or develop what we would call as inappropriate behaviour; but it is a call for help and attention made through ‘negative’ behaviour.”

She suggested, “It is important to remember that children sing before they speak, they paint before they write and they dance as soon as they stand before they walk and run. This is the essential nature of a child. It follows then that any therapy for children must remind them of their essential nature; that they chose to dance, paint, and sing their hearts out. The curiosity of the child to explore the environment can be roped in with these art forms, where the sense of control is given back to the child to choose the form of expression to own back their power. What is required is to enable them to express themselves in any way that they feel comfortable, in any form of art and for you to be a compassionate listener.”

Dr Shivani Sadhoo, Certified Counselling Psychologist, highlighted, “Children grappling with Post-Traumatic Stress Disorder (PTSD) mostly find themselves trapped in a whirlwind of intense emotions and haunting memories. However, traditional therapy methods may pose challenges for young individuals to express their experiences effectively. To address this, integrating expressive therapies, such as art and play therapy, emerges as a transformative approach to their healing journey. Art therapy gives children a safe space to externalise their inner world, providing an avenue for visual communication of emotions, traumas, and anxieties that words may fail to capture. By engaging with various art materials, children experience a cathartic release, allowing them to process their experiences while fostering self-expression, self-esteem, resilience, and empowerment.”

She added, “Play therapy, on the other hand, taps into the innate language of children - play. Through imaginative play scenarios facilitated by trained therapists, children reenact and explore their traumatic experiences, gradually regaining a sense of control and creating alternative narratives. This modality promotes emotional regulation, healing, and the development of healthy coping mechanisms. Art and play therapy offer children with PTSD an avenue to express emotions in a non-threatening environment, enabling them to explore and process their traumatic memories. These therapies empower children, nurture resilience, and facilitate the formation of healthier coping strategies. In the end would like to say by, incorporating art and play therapy into the treatment of children with PTSD holds promise. By harnessing the power of creativity and play, these expressive therapies allow young individuals to navigate complex emotions, facilitate healing, and pave the way for a brighter and more hopeful future.”

Pointing out that all children react differently to stresses, Dr Shyam S Lulla, Consultant Psychiatrist at PD Hinduja Hospital and MRC in Mahim, asserted that some may land up with post-traumatic stress disorder and causes can be stress like child abuse or death of someone near or any kind of trauma. He said, “A child is very sensitive, they cannot express their feelings. A child will react by suppressing everything and by suppressing the child will show behavioural changes which needs to be observed as such. The child might start getting nightmares, flashbacks, changes in the sleep cycle, physical symptoms such as diarrhoea. The child might stop communicating and meeting people and loss of interest along with anger or mood changes. A lot of negativity and startle reactions can come in. It can be prevented through various manifestations. Art and play therapy are fantastic because we cannot pick across the child and talk freely like we can with adults. Ultimately, we must make the child go in art and play therapy.”

He gushed, “In play therapy there is a family shown via story and the child is asked to assess the situation and give answers which will give ideas of what is the what is the conflict in the child. Additionally, a great counsellor who is good with kids and has patience not everyone can do this. It is a beautiful way for the child to express their emotions in a non-threatening way and would share in a safe environment. This creative outlet is a form of communication where the therapist must interpret what is happening and understand what the child is going on. There is so much pressure on the child that this kind of therapy is an outlet for the child. We need to find the reasons and help the child cope with the situation and neutralise the emotions which is easier said than done because we do not want the child to carry the unnecessary burden for life. Children are very adaptable, if we handled correctly, we can help in building resilience to this and navigate through it correctly.”

Assuring that the child will ultimately develop a very good therapeutic relationship with the therapist, the mental health expert said, “The therapist must transfer this nature of the relationship to the parents or foster parents. This is like a healing journey for the child and we need to check for every child, since each is unique genetically, we need to check the genetic talent of this child or aptitude and create an outlet on those basis. A proper communication diagnosis, treatment, monitoring, and outlet is very important. Unfortunately, a lot of children do not come and as they grown, we find out a lot of things have been suppressed over the years. This is a very important area to be taken care of especially in nuclear families with both the parents working with less time and attention given to the child. For every child we need to understand the family structure, a care facility near the house, what therapy they can afford and tailor it accordingly to that.”

Art and play therapy help create a great outlet and resolve underline trauma and change the underline attitude. Creating a very trusting environment would really help as other emotion to tackle would be guilt which stops growth in life.