Given that there are cultural differences in how children express their distress, do we have any reason to believe that techniques developed for working with American children will work with traumatized children from other cultures? Research indicates group-based treatment with traumatized children has a positive impact regardless of cultural background as long as the activities have culturally specific content.

Our own experience in the countries where we have worked with teachers and physicians confirms this. The methods we recommend work with children across cultures, but the teachers must work out content specific to the country involved.

Many children suffering from PTSD will have difficulty functioning in a school setting. Teachers describe students as having short attention spans, exaggerated startle reactions and either emotional lability or lack of affect. The child’s ability to concentrate and learn can be increased by incorporating classroom activities stressing relaxation, group support and problem-solving skills.

What can teachers do?

We have found that teachers can quickly learn to use basic stress-management techniques with children. Relaxation exercises can be practiced in brief segments throughout the school day to teach children self-calming. Besides muscle relaxation, they use mental images of a safe place, positive self-talk and social support systems. These small- group projects are designed to improve socialization skills and to draw out withdrawn students.

Teachers also absorb helpful techniques that can be integrated into normal classroom activities. Writing projects or journals become part of a composition class, and the child is given the opportunity to explore his or her reactions to events. Children in art classes can illustrate their feelings as shown in pictures.

Physical education classes can combine expressive movement with games and exercise and give hyperactive children a place to work off excess tension. Role-playing can become part of readingor drama class and allow anger or other problem behavior to be modified or redirected. A number of our team members are experts in the use of play therapy with traumatized children, an activity that teachers are especially interested in using.

The teachers we have trained report they can see significant improvement in their students’ behavior after using the techniques we recommend.

How does working with trauma affect the teacher?

The graphic and painful material that traumatized children discuss or act out affects the teacher. Teachers and other mental health professionals working with trauma victims often develop painful images, thoughts and feelings. This is referred to as vicarious or secondary traumatization. It is especially likely to happen when dealing with serious trauma of children.

Knowing that this is a frequent occurrence, the team runs sessions for teachers on how to take care of their own mental health. When we are training them to use muscle relaxation and safe place with children, we are also having them practice it with themselves and other teachers. During the training we build social support systems among the workers. They know they can discuss what is happening to them with someone who has had similar training and understands the damage and hazards of working with victims.