Is your child still traumatized by Pittsburgh?

Within 24 hours of the shooting at the Tree of Life synagogue in Pittsburgh, Judith Cohen’s cellphone was ringing incessantly with offers of help from around the world.

A psychiatrist who specializes in trauma and grief in children and adolescents, Cohen is one of the developers of Trauma-Focused Cognitive Behavioral Therapy, which adapts principles of cognitive behavioral therapy for victims of post-traumatic stress.

“It was not just thoughts and prayers, but practical stuff,” Cohen said of the telephone calls. “Literally within 24 hours I had tons of resources.”

For weeks after the shooting, Pittsburgh’s Jews were in shock, with many reporting fear of going to synagogue or displaying outward signs of Jewish identification. The fear and anxiety extended to children, too.

Trauma experts say these it’s normal. Symptoms of trauma may include sleep disturbance, change in appetite, loss of concentration, loss of interest in social activities and anxiety.

“It’s obvious that you should allow for a certain kind of change for a certain period of time — days, sometimes a week or two,” said Professor Esti Galili-Weisstub, the head of Child and Adolescent Psychiatry at Hadassah Hospital in Jerusalem. “But if it proceeds for three or four weeks — or if it doesn’t improve or if it’s extreme — that’s more alarming.”

With its long history of deadly terrorism, Israel has become a global leader in treating trauma victims. Galili-Weisstub has been at the forefront, consulting and training mental health professionals in the wake of disasters around the world, including the 2017 earthquake near Mexico City, the 2004 East Asian tsunami in Sri Lanka, and the U.S. hurricanes in New Orleans and Houston.

Part of what Galili-Weisstub and her colleagues do in crisis situations is a kind of psychic triage. They also provide training and support to local mental health professionals.

One of the most important responses in the wake of a traumatic incident like Pittsburgh is for the community to come together, according to Galili-Weisstub. “That’s our security blanket in a way: to meet with people and to talk,” she said.

For more serious reactions, psychologists use a number of tools. One of the most common is Trauma-Focused Cognitive Behavioral Therapy. This approach helps those affected gain awareness of what they’ve suffered and understand that trauma symptoms are reversible. Psychologists teach coping strategies and attempt to correct for cognitive distortions — false beliefs that result from trauma, like the idea that one is weak or at serious risk. The final stage aims to recreate the narrative of the trauma in a person’s mind.

“In a person suffering from post-traumatic stress disorder, the traumatic event is still experienced,” said Dr. Fortu Benarroch, director of the clinic for pediatric traumatic stress at Hadassah. “It is not just a memory of something that happened in the past, but is something that they are experiencing and re-experiencing all the time. We want an internal process to be done in order that this experience will be encoded in a different way … just like any memory that we have of bad things that happened to us in the past.”

While children and adolescents directly connected to the Pittsburgh massacre may suffer trauma most acutely, even children farther removed may be traumatized, experts say.

Part of the professional response to an event like Pittsburgh is reassuring people that their feelings will subside. For young children, adult reassurance is crucial. Kids often pick up subtle messages from the media or close relations.

“Children try to give meaning to what they hear,” said Alicia Lieberman, a psychiatry professor at the University of California San Francisco. “And so it’s better for us to tell them, for example, ‘Mommy and daddy are upset because a very bad man hurt people and he shouldn’t have done that. And we are doing lots of things to keep everybody safe.’”

That kind of reassurance was one of the themes of the resource sheets prepared after Pittsburgh by the National Child Traumatic Stress Network, a federally funded effort to improve standards of care for children who experience trauma. The sheets included advice for parents, caregivers, and mental health professionals about responding to grief and trauma, recognizing signs of deeper mental disturbance, and reassuring parents that things will get better.

“Having trouble sleeping, feeling sad, angry, confused, having trouble paying attention, feeling numb or jumpy, not being able to get your mind off it — those kinds of things are pretty typical reactions,” said Cohen. “In this early stage, those are expected. It will take time to get back to normal before it’s considered pathology.” Ultimately, she said, most kids recover fairly quickly.

“I think the core message is: Your kids are going to be OK,” Cohen said. “It takes time. It’s very difficult, but your kids are resilient and so are you.”