The horror of the attack in Manchester on Monday is still incredibly raw. Many children continue to be treated in hospital for severe injuries, and there are thousands more who returned home that evening after witnessing extreme violence and death. A large number of those kids will have memories of the attack which may last a lifetime.
Shoshanah Lyons, a Clinical Psychologist and Clinical Director at Beacon House Therapeutic Services and Trauma Team, explains that the initial impact of witnessing a terror attack on a child is profound. "Once they are out of immediate danger, their mind and body will go through a range of strong feelings – from numbness and shock to overwhelming anger, fear and despair," she says. Children as young as five may also show signs of post-traumatic stress in the aftermath of a terrorist attack, including intrusive thoughts, nightmares and a feeling of being permanently "on edge". Children and teenagers may also fear separation from their parents and become clingy in their need to re-establish a feeling of safety as soon as possible.
On average, a third of children who witness a terror attack will experience the long-term challenge of Post-Traumatic Stress Disorder (PTSD), although symptoms are more likely to be severe for those whose family support is poor.
For children who experience PTSD, Lyons explains that the memory of the attack becomes "stuck in trauma time", and cannot be updated with new information that the child is now safe. "Children who suffer with PTSD are also vulnerable to experiencing low mood, low self-esteem, difficulties with learning and problems in relationships. They are unable to find an inner sense of safety, and they therefore act and feel as if danger is just around the corner," she adds. She also suggests children who are directly exposed to a terrorist attack are more likely to suffer in the long-term if they are exposed to lots of television coverage of the event, which seems almost inevitable given the pervasiveness and volume of the media's response in the aftermath of something like the Manchester attack.
The media coverage of terror attacks also means it's not only children who witness them directly who are impacted by them, but also those who see them on television, as it may be the first time they're forced to wrestle with concepts of violence and mortality. Lyons explains: "Children not directly involved but exposed to the media coverage can experience fear, anxiety, troubled sleep and concern for their safety and that of their parents. Younger children are more vulnerable to the impact of shocking images as they have not got the cognitive ability to make sense of what they are seeing."
After September the 11th, a study conducted among London school children found functional impairment among 15 percent of participants even two months after the attacks. Studies from the Cold War era document a similar increase in levels of anxiety in children due to their exposure to the coverage of terrorism, war and disaster on television and in other forms of media.
Fortunately, there are ways in which we can all help children who have been directly or indirectly affected by a terrorist attack. Dr Sarah Halligan, a reader in Developmental Psychopathology at the University of Bath, explains that it's likely to be beneficial to let children talk about what they've witnessed in the aftermath of an attack. "Although it is good to let children lead in terms of what they share, it is also important to make clear that it is OK for them to talk about bad events," says Halligan.
For those who experience significant or persistent psychological problems after witnessing a terror attack, there are treatments available such as Trauma-Focussed Cognitive Behavioural Therapy (CBT). Lyons adds: "Psychological treatment helps the child 'process' the traumatic memory and make sense of what happened. The earlier the child is offered treatment, the quicker their recovery and the quicker they can get back to enjoying life again."
If you know children who are struggling with the news, the best thing to do is to talk to them, let them ask questions and try to remind them that these kinds of attacks are on the news because they are incredibly rare. Experts advise against trying to shield children from the news; it's better that they watch what's going on with an adult and are able to ask questions in a safe environment.
Even with CBT and good parenting, though, we have to acknowledge the impact that Monday night's attacks will have, not just on those who were the victims of horrific violence, but on the mental wellbeing of all concert attendees and children around the UK.