The Long-Term Mental Health Needs of Young School Shooting Survivors

Following the Nashville, Tenn., school shooting this week—the third such tragedy in as many months in 2023—one of the many urgent questions confronting the nation revolves around the growing generation of survivors, many of whom are children too young to properly process a traumatic event. When survivors are elementary school students, as the dozens of students at Nashville’s Covenant School are, they won’t necessarily have the language and emotional maturity to express themselves, much less process such trauma.

“Young kids are just beginning to learn how to identify and communicate emotions through language, and to find those words,” says Rachel Masi, a clinical psychologist and director of research at Sandy Hook Promise, a non-profit organization formed to prevent violence against youth.

Yet, even at young ages, “kids are definitely able to experience trauma and grief,” says Melissa Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress, a government-funded network of experts who educate and provide treatment recommendations for managing traumatic stress among children. Reading the different ways that children express those emotions falls to their families and teachers, who might be the first to notice the changes in behavior that are often the most common way younger kids signal that they are struggling.

“When kids don’t have the language to express themselves, they often have physical symptoms such as stomach aches or headaches,” says Masi. “Depression also looks different in children; some might refuse to go to school, or get up in the morning, or even develop increased attachment to their parents or caregiver.”

The question, in such cases, is how can mental health professionals provide the support that these young survivors need?

Masi, who was part of the team that worked with the young survivors and families affected by the shooting at Sandy Hook Elementary School in 2012, says standard strategies for addressing trauma in adults, such as cognitive behavior therapy, can also be helpful with children, with some modifications. Rather than focusing as heavily on conversations and discussions, for example, she will turn to outlets such as drawing to allow children to express their feelings. Play is another way to help children to express themselves, as is focusing on their physical symptoms.

“I often start with asking what is going on in the child’s body…[like] how they know they are hungry.” says Masi. “They will say their stomach rumbles, or makes sounds. Then I ask how their stomach feels when they are worried or anxious, and they will tell me it feels like they have butterflies in their stomach, or that their feet won’t stay still. I help them understand what their emotional experiences look like in the physical realm, and from there work with them to develop language for what they are feeling so they can start to process their trauma.”

And because children aren’t always able to understand or articulate what they are feeling, the adults in their lives bear a greater responsibility in understanding and looking for signs of struggle. Brymer, who also worked with families from Sandy Hook, says it’s important to provide services not just for the children but also for the adults closest to them, to ensure those adults feel comfortable and equipped to provide the support that the children need. Feeling strong support from their adult caregivers can help children affected by trauma to learn how to trust and feel safe again.

For younger kids that means adults also need to be aware that as their children develop mentally, their understanding and processing of their trauma may also need to evolve. Parents may be able to shield the students at Covenant, for example, from the barrage of news reports and the bodycam footage of law enforcement officers storming their school, but as these children get older and gain more independence and access to social media and the internet, that will change. And seeing their trauma play out again may be challenging for them to manage.

That’s also true of any depiction of violence, and especially gun violence, in our culture, says Brymer. Books, movies, and other entertainment aimed at younger children don’t generally contain many references to violence, but as children mature, they are exposed to increasingly intense violence, not only in almost every form of popular culture they consume, but also through the bloody battles that are part of our history. “There is a sensational aspect to violence and trauma [depicted in our culture] that kids who have experienced real trauma and violence don’t appreciate,” says Brymer. “For them, they’ve seen loved ones killed. So it’s not entertaining. Teachers and parents should be proactive with reading and social content to appreciate what the children can handle at a given moment.”

But there is no playbook for that yet, largely because each child’s experience, and ability to process and cope with a traumatic event, is different. And the understanding of how these interventions are helping children who survive a school shooting, both in the short run, but equally importantly over the long term, still isn’t clear. “We really don’t know yet what effect exposure to such trauma will have on children as they grow up,” says Masi. “I think it does impact whether they see their world as safe or not, but we don’t quite know yet. We are living in it and can only give our best guesses and try to prepare them and help them heal as much as possible.”

Part of that processing and recovery goes beyond what individual children and families can do, and that relies on broader societal and political leadership to enact changes to make places like schools safer. “This generation is frustrated because they feel these things keep happening to them, and nothing happens,” says Masi of the young school shooting survivors who are now grown and have become activists for reform in gun control laws. A critical part of helping young trauma survivors rebuild their trust and sense of safety in society is to see positive actions to prevent violent events such as school shootings from happening again. “As adults, we can do more to create that change, to say that ‘Okay, we hear you and your experience is valid and real; you shouldn’t have to be scared to go to school, and we’re going to change it.’ We can give kids tools to empower themselves, but our communities also need to create change to make things better. The more we can do to create real change, the better for these survivors.”