CHILDREN AND ADOLESCENTS CONFRONTING FEARS
A guide for parents and teachers
Edited by Barbara Forresi
With the collaboration of: Simonetta Di Pinto, Barbara Fabbri,Annarita Lissoni, Francesca Massa, Giada Pisani
- The national advice center
- Regional centers
- Development of innovative projects: "Tetto Azzurro" and the emergency team
- The training sector
- The study center
- International experience and collaboration
INTRODUCTION
"A long time ago
in the closet of
my room, there hid
a bad dream..." 1
And it is with these words that one of the many stories for children begins today, a story used to help these little readers, with or without the presence of an adult, to confront the vast world of fear, which we will shortly examine, differentiating by age, as well as the child's method of confronting fear.
The story continues with the figure of a child who closes the door "well", but this is not enough to resolve the problem, given the other figure with its head down, moving quietly; the child tells us "I used to be afraid to turn around and look...." . Under the covers, he seems to find a bit of comfort, but his staring eyes already know the next move: to hide his head and not see... And it is at this point, when fear seems to have won, that the protagonist decides to change his attitude and confront "that damned bad dream....for once and for all". Suddenly, we see him sitting on the bed, and switching off the light to avoid the appearance of the bad dream; he bravely waits, with every intention of confronting it.
Finally, the famous monster appears, and despite its great size, it is enough for the reader to see its laughable, ridiculous presence to be calmed, and even more so, on seeing the protagonist's little face lighting up and the certainty with which he says his liberating sentence:
"Bad dream, get out! Get out......!" . The story continues with the monster crying desperately, and the child asks it to be quiet so it doesn't wake the rest of the family; eventually, when the child cannot calm it down, he decides to invite it into his bed2. Fear may be defined as a primary defensive emotion developed by the individual in circumstances of real danger or subjectively perceived as: different from anxiety, which is generic, with fear directed at objects, people or specific circumstances (similar to that described in the story: finding yourself in the dark). It can arise in relation to future events (dreading something happening) or memories of past events which were particularly traumatic or painful. It is not necessarily linked to real events, it can instead come from fantasy, above all in young children.
These fears are frequent, common occurrences in children's lives. They accompany children during their stages of growth, entering into their normal mental development: even the most protected children, who are carefully sheltered from all dangers or traumatic information, can show signs of some fear during their development, perhaps the fear of an animal, the dark, monsters, witches or thunderstorms.
We know that in children, as in adults, fears change based on age: if, in childhood, one is confronted with an "irrational" type fear (e.g. "monsters" and "ghosts"), then, as we grow, these fears become more and more complex and articulate, coming closer to our social and relational sphere (e.g. fear of appearing inadequate). Even children's attitudes are different when confronted with fear: some speak about it explicitly, wildly complaining (and obtain consolation and support from parents), while others disguise their fear as if they are ashamed.
Other than this typology basis, fears can be distinguished based on intensity, and therefore the degree of difficulty and discomfort they provoke. Normally, fears tend to disappear with the passing of time: gradually, in fact, children develop perceptive and emotional capabilities which allow them to overcome their fears, limiting the negative effect on the child. As in the story which we have mentioned (referring to fear of the dark and monsters in the primary and secondary stages of childhood), the growing child learns and confronts fears in an autonomous way: they learn that parents can distance themselves, but they always come back; they learn that ghosts and monsters aren't real, etc.
A lessened of fear, however, requires attentive, supportive parents: it becomes as fast as parents, teachers, instructors understand and respect it, supporting the child with kind words and affection. Of course, attitudes of indifference, denial and mockery cannot be supported, or even worse, the use of forceful or intimidator methods which instead contribute to reinforcing that very fear.
If the majority of child fears can be defined as "physiological", therefore a momentary and typical part of normal physiological development, some can become "pathological", when they assume the dimensions and intensity which can inhibit normal life and become an obstacle in the child's ability to mature, therefore hindering development.
When a fear persists, or when it starts to interfere with a child's daily life, then we are dealing with a phobia - the unjustified fear of an object or circumstance, contract with which can cause an intense distressing reaction - which requires intervention by an expert in child problems: an example would be a child who has a fear of dogs and who is terrified of the idea of leaving the house, although there are no dogs close by.
Fear and phobia are in no way similar. The first is a useful, necessary emotion, because it allows preparation for real danger, how to organise and defend yourself; instead, a phobia is an obstacle in life and the origin of extreme, inappropriate reactions, aiming to avoid all contact with the object which causes the anxiety.
It is possible to distinguish two large categories of phobia:
- Specific, which can cause reaction to objects, animals or restricted, easily identifiable circumstances. As in adults, we are dealing with a very intense fear of specific objects (animals; natural environmental elements such as thunderstorms, altitude, water; blood or injuries) or specific circumstances (such as the dark, enclosed spaces, public transport, crossing a bridge, using a lift, travelling by plane or by car, etc.). The majority of cases of specific phobia stem from childhood.
- Social, provoked by the exposure to certain types of circumstances or social performances, which often determine avoidance behaviour: examples would be speaking in public, eating in public, playing an instrument in public, etc. They are typical of teenagers and generally arise between the ages of 11 and 18.
It is therefore possible to sustain that some age groups are inclined to develop certain phobias more than others. It is further necessary to remember that the distinction between fear and phobia is much more complex and is not only influenced by the child's level of maturity, but also experiences witnessed, education and the level of intellectual development reached. The phobia establishes itself when fear exceeds the adaptive and evolutive capability of the child, who also lacks strong background support. Other than a child's perception, the evolution of fear therefore depends on the answer given by adults and external events. In moments of crisis or particular stress - at home or at school - these fears can intensify or reactivate: changing school, the birth of a sibling and moving to a new area can all bring about new fears, or reawaken old ones.
There are numerous questions asked by parents and teachers to Telefono Azzurro relating to child and teenage fears. Even more so, following dramatic or traumatic events (e.g. an earthquake) or when the international climate is fraught with tension and an imminent war, threatening the individual's sense of stability and safety.
Following September 11th, for example, the requests for help, from adults and children, which were provoked by fear, almost tripled, and advice given on these issues registered a peak, passing from 3.4% of particularly relevant cases in 2000 to 6.2% in 2001, and 8% in 2002. Mainly females asked for help (59.1%), aged between 11 and 14 years old (49% of cases compared to 38.6% relevant to children up to 10 years of age and 12.4% relevant to young people aged between 15 and 18 years old). Proportionate to source, the most frequent callers are from the South of Italy, in particular Sicily (17.9%), from Campania (15.7%) and from Puglia (12.1%).
Parents and teachers ask "Telefono Azzurro" experts how is it possible to respond to children's fears, reassuring them, instilling their trust in an adult world capable of protecting them, when these very same adults feel insecure, confused and often frightened.
This booklet, which will be published at a time of particular uncertainty and international tension, intends to help parents and teachers understand childhood and teenage fears, by responding to many questions which have been asked to "Telefono Azzurro" over the years. With this purpose in mind, a series of useful suggestions have been identified to help understand how to choose the most appropriate methods and attitudes to confront childhood and teenage fears, which are at times explicit, but often "hidden" and difficult to identify.
Therefore, in the pages that follow we will try to understand what fears can present themselves in children and teenagers, distinguishing them by age. Then we will analyse "what to do" and "what not to do" as parent, teachers, and instructors to help young people confront and overcome their fears. With this purpose in mind, we have included some questions in the concluding part of this booklet which are most frequently asked to our "Telefono Azzurro" experts by parents and teachers, but also by children and young people: we have found and suggested a short answer for each of these questions, and also pointed out some professionals who may be contacted in case of doubt, or when a child's fear (or a student's fear) is so intense or lasting that it causes worry.
Prof. Ernesto Caffo
President of "Telefono Azzurro"
1. FEAR DURING CHILDHOOD AND ADOLESCENCE
Various researches has highlighted that some particular fears are present in certain age groups.
In the first years of life it can be difficult to recognise the basic representation of fear: In fact, children as young as two or three years of age start to communicate content more frequently. In this phase of development fears mostly correspond to the perceptions of sudden changes in the surroundings that children find themselves in: in cases of noise, sudden movement, intense light or a quickly approaching object. Fearful reactions of this type lessen gradually over the years, and have almost completely disappeared by around three years of age. Around eight months, the distinction between the familiar and nonfamiliar can cause fear of strangers and strange objects, unknown places and unusual circumstances. Laura, a two year old child, was frightened by a bad thunderstorm. She is still very nervous, doesn't want to go outside, doesn't want to get in the car, doesn't want to stay in crowded areas and she has lost her appetite. Her parents have asked for help because they are unsure what to do and how to react to this. Do they force her or leave her be, speak to her or avoid speaking to her in the hope that it sorts itself out.
At preschool age, from three years old, children often show fear when separated from parents (see: study on separation anxiety disorder). At this age, fear may be caused by certain scolds, for example "if you aren't good the boogie man will take you away". Children can even believe in tales/stories, encouraging the characterisations of people, animals or people known to them: fear of the wolf can start (because it eats children), the ogre (who cooks children), a woman with long, black hair (because she looks like a witch in a book) and so on.
Fears are often irrational in small children, and the child may not be able to describe it to us. Marco is a four and a half year old child, and for some time now has started repeatedly waking up crying and screaming during the night. He has difficulty going to sleep because he says he is afraid to close his eyes: when he does so, he says he sees "bad things", but he is unable to describe them.
At preschool age, fear remains to be from ghosts, monsters and ferocious beasts that can attack or harm. These fears can be accompanied by others which are linked to real experiences: the cat (that scratched the child), the bee (that stung the child), etc. In particular, around eight years of age, following the completion of the perceptive and relational processes fear of death can arise, which is at times accompanied by fear of illnesses and accidents. Instead, around nine years of age, fears can arise which are linked to the child's social role and to circumstances in which the child is evaluated.
Stefano is ten years old. For some time now, he repeatedly asks his mother to stay close to him because he is afraid of death. The fear of mum and dad leaving him: for this reason, he tells them to always be aware and he becomes very worried when he is sick, even due to a cold. In the last few days, he doesn't want to leave the house, saying that he dreads something happening on the route from his house to school.
These fears generally intensify during adolescent years: with the basic appearance of the fear of an unsuccessful personal and/or scholastic life, fear of being mocked or rejected by peers and fear of feeling embarrassed in relation to first experiences of sentiments/friendship.
Development not only brings modification of the content of fears, but also the method of confronting them: if children initially require the support of an adult and show need of reassurance, by growing, they develop the ability to perceive, allowing them to manage and dominate fear in an autonomous way.
To make this possible, it is necessary or at least desirable, that an important adult places himself before the child as a source of emotional and perceptive support: parents and teachers can not only help the child to perceptively evaluate the danger and their appropriate reaction, but also teach the child how to confront these circumstances that generate anxiety. A lack of support by adults can have long term consequences on the child's development: fears - in the eyes of those
without instruments to confront them - can become more and more intense, and in some cases out of control in respect to the real circumstances from which they originated.
It is therefore necessary that adults are aware of the rise of signals that can accompany the emergence of a particular fear: we are dealing with more intense, prolonged crying, nightmares or the child distancing himself from playing and social processes.
2. MOST FREQUENT FEARS
The fear of the dark is certainly among the most frequent fears in childhood and can manifest itself in connection with the fear of going to sleep, or appear in an independent manner. The child can start to cry when the light is turned off, asking for parents to leave the light on to encourage sleep. When the child is big enough to go around the house alone, he should avoid going into dark rooms or turning on lights; in other cases, fear of the dark seems to localise itself in a particular part of the house, in a poorly light corridor or in a bedroom with a dark corner. It may also happen that the child develops "the fear of being afraid", by expecting these elements which, in conditions of poor lighting, may frighten him: clothes on a chair may evoke the image of a person, folds in the curtain etc.
Another frequent fear in childhood is the fear of animals (snakes, spiders, birds, mice, cats and dogs, etc.), experienced with a sense of shame and can disappear/fade away when the animal is far away or disappears from sight. Fear of big animals (dogs, horses) are frequent from 3 to 5 years. The child imagines being followed or harmed, contents which fill childhood nightmares and fantasies: he can awaken in terror and needs reassurance from a parent before falling back to sleep. Fear of small animals is typical around 4 years of age (toads, beetles, mice), seen to be disgusting and repulsive.
Other childhood fears relate to the environment (lightening, thunder, wind and darkness) and people: fear of strangers is one of the first to appear around eight months old.
Around eight years old, often following a family bereavement or the death of a family pet, the child can develop a fear of death. Children under five years of age see this event as a temporary separation from a loved one. Afterwards, however, the concept of death becomes more personal and can cause a feeling of strong vulnerability in the child, from which intense fear derives.
Another fairly frequent fear is a fear of illnesses, which can be accompanied by fear of doctors. The latter may be more easily understood and explained if we think of a medical visit which may involve the separation of the child from it's parents and reawaken - above all in small children - the fear of being abandoned. In many cases, the doctor- adult who is often a stranger for the child - becomes associated with an experience of physical pain: it's the case of invasive medical examinations, but also the more common "fear of injections".
With evolutionary age groups, fear of school is also widely diffused.
Many children, above all those starting scholastic life, can cry down the road or grab on to parents when it's time to go into school (see following study). Some, having entered the classroom appear inconsolable, crying for long periods and refusing to actively participate in playful/scholastic activities. Fear of going to school is associated with real physical disorders (headache, stomachache etc.), which spontaneously disappear, in the majority of cases, during the course of the morning.
ANXIETY SEPARATION DISORDER
As the name implies, anxiety separation disorder is diagnosed when children develop extreme anxiety if separated from a parent or loved one. It can suddenly appear and the anxiety can be so intense that it interferes with the child's daily life: the child may refuse to leave the house, go visit a friend, go camping; at home, the child can become attached to a parent or follow the parent like a shadow.
A child suffering from anxiety separation disorder can complain of a stomachache, headache, nausea or vomiting; the child can have palpitations, feel weak or suffer from head spin. Many children with this difficulty have problems going to sleep and want to sleep in their parents' bed. When separated from their parents, the can dread "something bad" happening to their parents, or that they may never come back.
This anxiety separation disorder may also develop into what has become known as "scholastic phobia". Generally, children refuse to go to school because it means separating from parents, and not because they are afraid of the school surroundings.
Children with an intense fear of going to school can feel in danger if they are alone in a room, show an extreme attachment to a parent, have sleeping disorders or have nightmares and show an extreme, unrealistic fear of animals and monsters.
In the majority of cases, the fear regresses rapidly, but, if not voiced by the child and not taken care of by an adult, this fear can carry on, or come back in the years of scholastic life which follow. To conclude, we would like to refer to all fears that develop following specific traumatic events in which children or teenagers are direct or indirect - often through mass media - spectators.
These unusual events, which are sudden and extremely stressful, can be represented by episodes of violence when the child witnesses natural disasters, terrorist attacks or war. Fear that strikes the youngest children in these circumstances can be accompanied by a state of confusion, bewilderment and helplessness. We would like to remind you, on this subject, that fear is a normal reaction to a traumatic event, but it can persist over time as a symptom - particularly common in children - of a Post Traumatic Stress Disorder (see study on PTSD).
Therefore, whatever fear arises from a given event, and is persistent, it is advisable to refer the child to an expert in child problems.
THE FEAR OF WAR
A worried mother recalls the previous day, when her ten year old son Paolo, on seeing some images of the war in Iraq, got up and while starting to cry, turned off the TV. From that moment onwards Paolo has not wanted the TV on, if he is not absolutely sure a cartoon is being broadcast.
His mother also recalls that each time he hears the noise of an airplane, he hides himself under the bed, in case the house is "bombed"...
In extremely complex, unstable times, a time that characterises current society at war or at risk of terrorist attacks, it appears more urgent than ever before to create a peaceful, stabile family and scholastic environment around children and teenagers, which is capable of supporting their perceptions, emotions and state of mind. The risk of children and adolescents living these circumstances in a confused way, developing fears or forming inappropriate judgements or stereotypes, can not only be confronted by giving them the support and most suitable instruments to manage the threat of a tragic event, but by also trying to run back over these particular moments of world emergency as points of reflection by providing children and adolescents with the necessary instruments to understand and manage their emotions.
The mass media can increase a child's awareness of violence, attacks and the speculation of conflict: for this reason, it is fundamentally important that influential adults help children to unscramble these messages and images, such as those broadcast on television, from newspapers and Internet.
We must not forget that "visual education", and all it involves, must not be left to improvisation, dictated by a moment of emergency such as this. A child's defense against aggressive/violent images and the contents which drive them, must further represent a daily value to be pursued.
"Contact", in this sense, can become a key element; in particular educational contact represents the most significant reaction in contrast to the power of codes and languages that television proposes, by simplifying reality and by imposing a level of interpretation which often confines thoughts and emotions, not allowing the development of autonomous, critical reflection.
In relation to current circumstances of political and social emergencies, helping children and adolescents unscramble the images, with messages becoming more decisive to help them understand and manage their emotions and worries. We are dealing with moments and occasions capable of strengthening the relationship between parents and children and teachers and students. Children, in general, ask many questions and are very curious during the various evolutive phases, and adults can, and must provide answers: without doubt, the most difficult questions relate to war, terrorism and the fears they create.
When news starts to circulate and is divulged by the media, parents and teachers (the influential adults for children) can ask themselves how appropriate is it to protect children for reality - try to hide it - rather than helping them to confront it, listen to questions, doubts, opinions, feelings and fears.
It may be difficult to decide what is better to confront, in a way, what contents to omit, what information to provide to the child and what is the best way to deal with, and support the child, above all, at times of greater confusion and anxiety even in the adult world.
It is useful to remember that the suitability of a determined explanation or an attitude depend on different factors such as the age of the child, personality, type of exposure to the event, personal and social experiences and other factors relating to circumstance.
Regarding age, preschool children can be the most disturbed and influenced by what they see, hear and perceive from the outside world. Not yet having the capability to distinguish reality from fantasy can cause even greater difficulties in managing fear and the anxiety generated by news heard. They can be as deeply struck by tragic news, as they can confuse a film clip of war with real news which is broadcast by the news channel and believe that the reported elements in the news are worse than they are in reality. They may not be capable of appropriately evaluating the personal degree of risk or involvement, believing that events which are far from them can touch their lives in the immediate future. The confusion between reality and fantasy that TV images determine, as well as repeating the news over several broadcasts, can persuade children that an episode of violence or an earthquake "really" happened several times, increasing their state of anxiety and fear.
Children of school going age, on reaching the capacity of separating reality from fantasy, can have difficulty doing so in highly stressful circumstances. Not yet being capable of autonomously processing events which happen around them, children can be strongly influenced by the emotional reaction of adults around them: parents who are anxious about war, will inevitably transmit their anxiety to their child.
On this subject, it is worth remembering that parents and teachers are the main reference models for children who observe them and study their reactions, to help them to try and understand what to think, how to behave and react to unexpected, upsetting events (such as war). Since children are unable to understand the significance of an attack or war, it can happen that children concentrate exclusively on the "technical" aspects of the circumstance, asking continuous explanations for events and wanting to speak about them, therefore hiding their fears.
Adolescents, have perceptive and emotional capabilities used to confront tragic or violent events and living through a phase of strong identification they can feel involved in the human and political events relevant to war: this could intensify their desire to become concerned, to discuss it with peers, teachers and instructors, etc. During this evolutive phase there is a continued necessity to challenge, even on these occasions, the opinions of adults and their world vision, generally trying to find extreme solutions (if not simplified and ideological at times) in their thoughts, feelings and actions. They can adhere to strong ideologies and struggle to propose their own reasons, with the risk of anger turning into hatred and sadness turning into depression. We have seen that children who have not yet developed an autonomous capability to manage fear, confusion and conflict almost totally depend on influential adults. However, their reactions also depend on their personality, character, temperament and the circumstances they find themselves in. Some children seem more inclined to experience persistent emotions of fear and anxiousness. This inclination, naturally, can be stimulated by news of war, by increasing their worries of a missile attack, a bomb, a terrorist attack, even in their own town, striking their own house and family: we must remember that children and adolescents tend to personalise the news they hear, associating it with their own private and social lives.
Others, who have strong personality structures can confront discomfort and fear caused by news of war, with contents of anxiety and emotional difficulty.
Some children seem "immune" to suffering and anxiety deriving from dramatic news relating to a terrorist attack, a catastrophe or war.
These can cause apparent "indifference" or "insensitivity" and the continued enjoyment of news. This type of circumstance requires particular attention: a lack of emotion can signal the refusal to accept something that is perceived as extremely worrying and distressing. Psychological literature and studies on attitude report some interesting results, such as: "strong" and particularly disturbing images, such as persuasive messages that use "fear, are often perceived thanks to an information selection mechanism. We are obviously dealing with a normal defensive process that releases profound worry and anxiety that children don't want to take charge of. This means that adults who are capable of reading emotions that can undergo refusal could do it, even among the most unaware.
In light of what has been mentioned on the loss of correct time and space perception, this analysis must also consider another phenomenon which is closely linked to the dimension of fear and war. We are dealing with a near virtual phenomenon like the continuous use of video games, watching films and/or particularly violent cartoons in which death is repeatedly shown, and it therefore becomes a normal event for children, which is irreversible. In these cases, the child risks not possessing appropriate instruments to understand the seriousness of the event and the real human cost.
It is also useful to remember that children perceive and understand emotions of fear, anxiousness and distress experienced by adults; it is therefore fundamental that parents and teachers establish a suitable balance and genuine respect with children/students for current events, by learning to confront their fears linked to war, terrorist attacks and catastrophes in general. At a time of profound unease and real stress caused by events, parents and teachers, when possible, should try and deal with children's concerns in the most calmest way possible: it is necessary for adults to help children and make them feel safe and "rescued", even more so at times in which the world seems to have lost its stability and safety.
Contrary to what is thought, dealing with discussions on war with an adult can help a child/adolescent to better understand and evaluate events and news. On this subject, children (and also teenagers) need to be informed in an appropriate, genuine manner. Firstly, it would be advised to try and understand the type of information the child has available to them by evaluating the elements and information they know. Starting from the child's stories - relevant to his fears and the events that frighten him - and from his questions, it can be possible to choose what to speak about and in what manner. Naturally, it is important to adapt this information (how much detail, the type of words and the tone to use) since the child, according to his age and his capabilities is able to understand, and at the same time try to establish a sense of trust in the people around him: his parents, teachers, figures representing civil protection (Firemen, Law Enforcement Officers, etc.).
Children need to know that it is important and right to continue enjoying themselves and to carry out normal daily activities, without continuously thinking about imminent danger. Adolescents, particularly, also need reassurance about measures taken to maximise and ensure their own safety; as well as having appropriate, firm emotions in respect to possible aggressive/self-destructive behaviour.
It is useful to remember that children/adolescents have difficulty verbally confronting fears and doubts. It is necessary for parents, (or influential adults such as teachers and instructors), to remain aware of their state of discomfort, evaluating themselves based on some behavioural and emotional indicators.
It is normal for a child to start "playing war", , using real war in a imaginative way, with young children going back to behaving as in a previous evolutive phase (wanting hugs, wanting the light on at night, showing anxiety when separated from parents, etc.). It is fundamental, in these circumstances, that the child's requests are not trivialised or mocked: we are dealing, in fact, with a real experience of discomfort and anxiety where the child needs to be comforted.
Many children can have problems sleeping (such as insomnia, nightmares, etc,), enuresis, fear of separation from parents when brought to school, problems concentrating, irritability, nervousness, aggressive behaviour both at school and at home, physical unease (headache, stomachache, etc.) as well as feelings of sadness, apathy, clear loss of interest and poor participation in daily life, fear related to war, in general and through the anxiety shown for their own safety and the safety of others.
The answers to these circumstances can vary depending on the child: in general, however, it is possible to identify typical reactions in children when they confront a circumstance of war, or the threat of war. Fear is the main reaction in these cases, and it is mainly fear for their own safety: for example, it is typical for a child to imagine an air attack that destroy his home.
Military actions are events that children (and even adults) have no control over: this causes an increasing sense of bewilderment and confusion.
As well as fear, another frequent emotion is anger which is often released on the person closest to the child: children can suddenly be aggressive to classmates or family members.
It appears evident that this circumstance can interfere in the child's daily life and normal participation in activities, threatening the child's sense of stability. To prevent the treat of war and the fears that can derive from it having long term consequences on the child's development, it is necessary for adults to know how to recognise signs of discomfort, by evaluating their intensity and persistence. When they are particularly disturbing and long lasting, it is advisable for parents, teachers or other influential figures to request help from a child expert.
3. SUGGESTIONS FOR PARENTS AND TEACHERS
The general concept developed in the following pages deals with educational methods and strategies that can be used by parents and teachers to confront different fears shown by children and adolescents.
AT HOME
An appropriate family, relational and loving environment, which guarantees respect for the child in every aspect of his behaviour during his development. Parents, in any case, are the most appropriate people to listen to children's fears, helping them to overcome them; it is worth finding the time and the calmness necessary to respect their emotions. "To listen" to a child's emotions is without doubt difficult and it requires multiple channels of communication; these emotions represent one of the most significant methods of communication.
Trying to convey emotions is one of the methods used by the child to express his entire world, and come in contact with others. Childish language, in particular in the first years of life, is above all the language of emotions, and for this reason it is important to approach this theme always respecting different child realities, that is, based on the knowledge that the psycho-physical and intellect immaturity is part, as mentioned, of the natural structure of the child. It is also important to point out that adults must accept the biological rhythms of their children: there are those who grow up quickly and there are those who are late developers, and the anxiety of wanting a "mature" child at all costs causes parents to lose sight of his development, therefore suppressing his potential.
It is fundamental in this sense, to listen, listen "actively", that is, noticing verbal messages during the different phases of growth.
Another element to always be considered by parents is that the attitude of the parents can influence the child's fears in both a positive and negative manner, such as when it is necessary to teach the child the dangerous consequences of some of the things he tries to do. And to the same extent, it is important not to frighten him beyond measure: his fears, as we have already seen are natural and they are not to be associated with adult worries and fears.
Appropriate parental support can be demonstrated by behaving in the
following manner:
- Pay particular attention to children during moments
of crisis or transition (the birth of a brother/sister, going to a new
school, moving house, mourning etc.).
- Always try to find the time necessary to stay with
children, trying to calm them.
- Take children's fears seriously and speak with them
using suitable language for their age group.
- Listen to the children's stories, without degrading
them. It is important that the child learns to speak about his fears
and to ask for help.
- Strengthen the child's trust in you by being emotionally
close to him, and reassuring him.
- Help children to name their feelings and their emotions,
and respect them.
- Do this in such a way that children feel free to
show their fears; this will help them to realise that everyone has fears,
including adults, and it is necessary to encourage and make them determined
to overcome them.
- Encourage expressions of emotion or fear through
drawings, a game or a little drama act.
- Carefully choose specific literature (to confront
fears alone or with the parent's help), and thanks to which children
can understand and overcome their fears.
- Always pay attention and show interest in their relations
with others, confronting fears with teachers and instructors.
- Be decisive and firm in educating the child, and
in the fundamental rules he must follow; a lack of these rules and incoherency
can, in fact, provoke fear and insecurity in a child's surroundings.
- Avoid subjecting children and adolescents to excessive
requests: this can create feelings of inadequacy and incapability, which
can bring about fears and states of anxiety.
- Avoid using expressions such as: "...now you're a big boy..." or "...be a good little boy...". Certain statements, in fact, can result in the risk of the child feeling inadequate.
- "Accustom" your children to their fears in a gradual manner and without force. Some need more time compared to others to learn to confront and manage new circumstances.
- Openly communicate with the child that some fears
are appropriate to protect oneself from dangers in our surroundings (e.g.
touching hot objects, playing on the street, hanging out in particular
areas of the city, etc.).
- Do this in such a way that your children feel justified
in having these fears.
- These fears lesson when we feel in control of them.
Remember that children can, for example, close their eyes or turn off
the television if an image is too strong for them, and when the image
is also a source of anxiety.
- Avoid leaving children alone in front of the news
or a film with strong imagery: in any case, try and explain to children
in an understandable, realistic manner what is happening, and distinguish
this from what happens in the movies.
- Pay particular attention to their reactions; children
and adolescents are influenced by our behaviour, and remember that fear
is quite contagious.
- Pay attention to the content, and the method of verbal
exchange within the family or with friends; we often don't realise that
our banal comments can influence the thoughts of children or adolescents
(e.g. "you're not even safe in your own home...." etc.).
When fears are linked to particular traumatic events
- such as war - it is important:
- to dedicate more attention to children; remain physically
close to them, avoiding long periods of absence, if not absolutely necessary;
- help children to understand what is happening, by
explaining circumstances in simple words and by telling the truth: even
though parents are tempted to hide dramatic events from their children,
we would not advise it, since providing false information or avoiding
to discuss events with children serve no purpose;
- when speaking about war, it is important to use a
language, and to discuss concepts, which are appropriate for the child's
age group and the interests of the child: real examples can be used with
very young children and more complex themes confronted with adolescents;
- open conversations with what they have heard, or
what they think of war, and try to understand the possible incorrect
opinions they have developed (due to the confusion between reality and
imagination); remember, however, to respect a child's desire not to speak
on these themes;
- also pay great attention to nonverbal behaviour,
such as facial expressions, posture and games;
- answer questions, even if the child repeatedly asks
them or is insistent;
- help the child to express what he is trying to say,
but respect his feelings;
- help the child to understand that fear is normal,
as are feelings of sadness or anger;
- help the child to confront fears and anxiety, by
discussing them with the child and try to overcome these fears together;
- do some relaxing, pleasurable activities with the
child, helping him to carry out normal daily activities;
- provide the child with a sense of safety, telling
him that he will be protected in every way and that mammy and daddy will
always be there for him (e.g. even using a mobile);
- protect him from repeated exposure to traumatic images
(e.g. on TV) and take time out to watch TV with him, which may even encourage
the child to talk.
AT SCHOOL
Even school has a fundamental role in this environment from the moment it becomes the place where children and adolescents pass a lot of their time, and where much of their experiences occur, including those linked to different fears.
School can also be the place where some fears establish themselves, and continue to grow: it's the case of fears linked to entering a classroom for the first time, the apprehensions linked to how you perform, the difficulty in managing relations, both with classmates as with influential adults. It is worth remembering that it is in fact, within the scholastic environment that teenagers experience their first difficulties linked to their sudden psycho-physical and sexual development.
New fears can arise in this evolutive phase, fears that are almost untold and often go unnoticed by the family for some time, in which the young woman/man tries to distance themselves, while continually trying to find a new reference point. It is indisputable that a tutor represents a main reference point for many students, where students can ask, even implicitly, for support and help.
This proves to be indispensable, also on their part, putting particular attention on the student and showing a genuine interest in what the student "says" and "doesn't say". It is necessary to help students express their feelings, emotions and fears through the use of different methods. On this subject, where possible, it may be useful to provide time for debate, discussion and games by choosing different methods which are suitable for the student age group.
Teachers must be aware of the importance of their role in managing the fears experienced by students.
- Create a warm, trusting atmosphere that encourages the expression of positive and negative emotions, even in school.
- Remember that small children, in particular those at preschool age, find fear to be incomprehensible; the risk is, since the child does not know how to define fear, he can become isolated and close himself into a world of solitude.
- Do not expect too much from children and adolescents, and respect their time and individual growth.
- Suggest work groups or workshops centred on emotions that various fears can cause, therefore their anxieties can be worked on and not kept silent.
- Encourage, the expression of emotion, and not just verbal discussion, by using expressive methods such as drawings, games, music and theatre. The best instruments to use with preschool children are drawings, fairy tales, nursery rhymes, little dramas with toys or puppets; this dramatisation, and consequent identification, allows the child to easily express his feelings and fears, which a child at this age would have problems communicating, and perhaps may not tell to others for fear of being called a "coward".
- This is even possible with teenagers to get them express themselves by using tales or narration or games, which naturally need to be more structured. All these instruments can encourage the expression of stress and anxiety.
- Pay particular attention to those who tend to isolate themselves from their peer group.
- Always use a language that adheres, as much as possible, to reality, even when the fears in question are those of death and war, naturally considering the age and the perceptive abilities of the child.
- Plan time dedicated to fixed topics which are relevant to that period (e.g. war), to allow students to freely express their thoughts and feelings.
- With such themes, students can have a misrepresented view of these events and the causal links, therefore it is necessary to help them have a more realistic idea of the circumstance.
4. CHILDREN'S QUESTIONS, ADULT ANSWERS.
ADULT'S QUESTIONS, EXPERT ANSWERS
As seen in previous paragraphs, during the evolutive phase fears can vary not only in type or intensity, but also in the manner in which they are confronted. In many cases, fear is not determined by the specifically dangerous circumstance in which the child finds himself, but by the feeling of having to confront it alone: the problem is centered on the quality of relations between the child and adult.
As we have already seen, the attitude of parents is of fundamental importance when their children demonstrate fear to, what is for him, his figure of reassurance and trustworthiness. An appropriate explanation, which is both logical and rational in circumstances of fear, accompanied by someone who is reassuring, caring, understanding, patient and respectful towards the child's time and feelings, can instill the formation of new safety and emotional stability in the child. It is important that the adult, who the child expresses his fears to, does not decide to ignore him, by mistakenly thinking that the fears might resolve themselves: in fact, fears that go unheard can become even bigger and more unmanageable, and can carry on over time until they heavily limit and threaten involvement in normal daily activities.
In these cases, from natural experience, fear is used to defend and guarantee the individual's survival, but it can become an obstacle for his tranquil growth.
The vast experience of "Telefono Azzurro" points out that active interest and attention from parents and teachers, those important influential adult figures for children, can help confront signs of stress in the most appropriate manner, expressed not only by young children, but also by adolescents. The intention of this section is to shed light on the most asked questions by children and adults in relation to feelings of fear caused by circumstances or events that take place, in the real and imaginary world and in the child's world of experience and emotions, during their evolutive phases. Childhood suffering should be received, supported and confronted by those adults who, by placing themselves in a bonding relationship with the child, can notice the signals of stress and make themselves responsible to answer the child's questions in an adequate, positive manner.
Being educated on fear allows the adult to have the capacity to encourage the child to freely express his fears, together with a direct aptitude to ask for help to those adults who the child trusts, and who are capable of protecting and helping him.
1) How do children show their fears?
A child's attitude can vary when confronted with fears
and phobias: some speak openly and can easily show their feelings, at times
even quite forcefully; others try to disguise their fear, ashamed of what
it might prove. In the first case, they take immediate consolation and
support from parents just by being there, the effect of their hugs and
kisses and their reassuring words. Fears can lessen more rapidly than a
child shows and the consequences of which include feelings and attitudes
of affection and closeness. In the second case, when parents recognise
their child is hiding his fear, it is a good idea to listen adequately,
avoiding as much as possible to force the child to describe his worries.
2) How can I reassure my child?
Children's fears should not be underestimated. Children
can feel embarrassed or negatively judged by others when
their fears are minimised. By analysing the reasons for the child's fear
with him, and
finding a positive way of overcoming these fears, the
child is helped to control his fears and anxieties. Parents and professionals
can reassure
children and therefore encourage the development of a
healthy sense of safety. It is advisable to remind the child of the importance
of speaking
about anything that can make him feel uncomfortable with
an adult he trusts. The greatest form of safety for a young person is developed
within a peaceful
family environment, guaranteeing firm regularity which
is reassuring for him, both for the level of information that is available
to him, as for
the level of closeness it guarantees.
3) How is it possible to help children defend themselves from real dangers, but avoid causing fear?
Adults are obliged to teach young people some safety
measures which they need to know for everyday circumstances.
For example, it is important that they teach children
the rules of the road when using
a bicycle, the actions to take in case of a fire or accident,
the general rules of the road, etc. These topics can
be dealt with in class, but they
need to be taken up and enforced by parents at home.
However adults should take care not to cause mindless
fear, avoiding to convey their own fears
to children/students in relation to particular dangers.
Also in this case, the child's age must be considered
to avoid saying more than the child
needs to know.
4) When a child is afraid to go far from his mother, does this mean he is over-protected?
Even though the anxiety of separation is established
and developed within the family, it is not necessarily
caused by over-protection or inadequate parenting. During
the first year of life, a baby is vulnerable
and needs to feel safe and confident in himself which
is achieved by means of adequate psycho-physical development
encouraged by the relationship
with his mother. He strongly depends on his mother's
influence and the lack of a family environment can create
uncertainty and mistrust in him.
Around one year of age, the baby is ready to become "independent" from his mother. If a child seems to be particularly anxious, the parent needs to protect and reassure him and his independence can be delayed or slow as a result of his anxiousness. The problem, however, is not necessarily caused by the parents' tendency to worry: parents in these circumstances, in fact, cannot respond to the child's need for more attention or protection. Therefore, it is important that parents respond to the child's requests, while respecting his time; in the meanwhile however, the parent must try and encourage the child's autonomous capability to manage anxiety.
5) Many children are mocked and called "crybabies" by their peers when they openly express their fears. This only causes isolation and tears. How should adults react?
Mocking these children certainly does not help them.
In fact, this attitude contributes to the development
of profound feelings of incompetency which often form
the basis for fear. In fact, it can happen
that a child learns to avoid his fears, rather than confronting
them. A functional strategy is that of explaining the
circumstance to classmates/playmates, while guaranteeing
the child can slowly bring himself
closer to this stressing
circumstance, with the support and reassurance of adults.
6) What are children that won't even leave the house to go to a party hiding?
When a child shows such an excessive fear, which is exaggerated
when faced with a particular object or circumstance,
he may have developed a phobia. Phobias are characterised
by a fear or repulsion, which is directed
at a particular object or a specific circumstance, causing
an unjustified reaction. A phobia can seriously limit
a child's normal activities: a young
person can show a phobia to dogs, for example, at first
avoiding dogs, then avoiding all circumstances outside
his home environment where he may
come in contact with a dog. The most common phobias are
to blood, the dark, fire, altitude, insects, enclosed
spaces or small areas, snakes, spiders,
thunder, etc.. Demonstrating such phobias every now and
then is a normal, passing phase in the transitional development
of a child. While at other
times they can be of a pathological nature, when, due
to their seriousness, intensity and persistence they
become uncontrollable, to the point where
they interfere in the child's daily life. We are not
dealing with a whim in these cases, but a symptom that
requires necessary treatment at psychological
level, in close collaboration with a psychologist, pediatrician,
the family and their child. It is important to remember
at educational level that
a forceful, authoritarian or threatening attitude can
contribute to the endurance of a child's fear.
7) Can the media stimulate children's fears?
It is possible that television programs can bring about
fear in children and adolescents. It is advisable for
parents to monitor their children's TV viewing as much
as possible (by watching TV with their
children), or at least filter the programs. When a child
watches the news, a film or a program with uncensored
imagery and words - particularly when
violent images refer to real circumstances of war - it
is advisable for parents to stay close to the child and
speak to him about what he saw.
It is important for adults to act as influential figures
from both a knowledgeable and emotional point of view:
to help children unscramble the images and
their content, to try and understand their emotions,
share their worries with them, representing occasions
to strengthen relations between parents
and children, teachers and students. Protection from
violent images and their contents must represent a value
to be pursued daily, while looking
for and promoting real solutions. The most recent reports
of war may be a good occasion to reaffirm the importance
of protecting children from
violence shown on TV.
8) How can I explain war?
It is better to use direct, precise terms to describe
what is happening, rather than "sweetening the bitter pill" with words and expressions that would inevitably be misleading. Naturally, it is important to use language that is appropriate for the speaker, considering all the information and messages that adults want to communicate have to be truthful. That is, until the child and adolescents can have a realistic outlook on the circumstance, and not a misrepresented version of events. To help children "distance themselves from fear", which can be particularly frightening for small children, it may be useful to show a map of the location of the countries at war, therefore reassuring children that the war is in a country far away.
9) How do you answer a child who, on hearing about war, asks: "Will the children be killed too"?
This question requires an answer which is appropriate
to the age of the child that asks it. Unfortunately,
it can happen that a child is the victim of a terrorist
or military attack during war: for
this reason, it is important that a resolution to the
international conflicts is found and that these solutions,
apart from war, are promoted. In general,
we believe reassurance is useful in every way, not
only through physical closeness, but also by telling the child
that the people who love him will
protect him from danger in every way possible.
10) Does my son need professional help?
The majority of childhood fears are not pathologic,
but form part of the natural growth process. This
does not mean that they don't need to be confronted and overcome:
understanding and working on a fear,
on the child's part, requires great trust and assurance
in his own capabilities, which strengthens his self-esteem.
Fear is worrying only when it is intense,
uncontrollable, persistent and when it limits someone's
normal daily activities: the frightened child won't
leave the house, can't sleep calmly, isolates
himself from his peers and cries continuously. In
these cases, it is necessary and important to see a specialist
for an appropriate evaluation. It is
possible to go to different specialists, such as
psychologists, pediatricians, child neuropsychiatrists and experts
in family advisory centres or youth
advisory centres.
This does not mean that your child or student suffers
from a mental disorder or, as influential adults,
you have not been able to offer him the support he needs.
It may be useful to visit a specialist,
who deals with child and adolescent problems, by
yourself if you have doubts or questions in relation to fears
your child/student may have.
POST TRAUMATIC STRESS DISORDER (PTSD) IN CHILDREN AND ADOLESCENTS
PTSD was identified as a psychiatric diagnosis by the American Psychiatric Association in 1980 (DSM III). Little or nothing was known at the time about its appearance in nonadult age groups. today, we know that even children and adolescents are susceptible to PTSD and that it has age-specific characteristics.
To be diagnosed with post-traumatic disorder, an individual must be proven to be a threat to life and physical integrity (one's own or others), and which the person responds with intense fear, making the individual helpless and horrified.
A certain number of traumatic events have shown to cause this disorder in children and adolescents: natural disasters or those provoked by man, violent criminals, car or plane crashes, serious scalding, violent events in the community, war, suicides, sexual or physical abuse.
The reactions to trauma can appear immediately after an event, but also days or sometimes, weeks later. The can further vary, based on the history and resources of the individual: the same event can cause trauma for some, while others are indifferent to it.
According to recent research, three factors are particularly linked to the risk of developing PTSD: the seriousness of the stressful event, the parental reaction and the temporal closeness. It seems "interpersonal" traumas - such as kidnapping or aggression - are more likely to cause PTSD, than other types of traumas. A further connection exists between the overall number of traumas, suffered in the past, and post-traumatic pathology: a stressful event can have a greater impact on child and adolescent victims of previous traumas (e.g. physical abuse, emotional abuse, sexual abuse, maltreatment, etc.) or with relational issues. Regarding gender, different studies have shown that females are more likely to suffer PTSD than males.
If it is true that the more exposed you are to a traumatic event, the greater the risk of emotion damage, recent research has shown that indirect exposure can also cause long-lasting effects: e.g. witnessing an murder, the suicide of a peer, sexual abuse or violent abuse of some kind, intra or extra-family violence; having been threatened with a weapon, exposure to natural or man-made disasters, even without suffering physical harm and violent images on TV or relating to a catastrophe.
Therefore, it is worth paying particular attention to children and teenagers who are directly, or indirectly exposed to serious events: in this way, it is possible to quickly identify eventual signals of discomfort.
Symptoms and signs of PTSD
The reactions of children and adolescents to traumatic
events can vary according to age, personality and according to how they
perceive the event. They can also be very different from adult reactions:
for this reason, the criteria for PTSD diagnosis have been revised and
a list of age-specific symptoms have been introduced.
Very young children can appear to have a small number
of typical PTSD symptoms: it possibly occurs because at least eight elements,
which are included in this pathology, require a verbal account of sensations
and experiences.
On the other hand, young children report general fears
such as separation anxiety, fear of stranger, outcomes of circumstances
that are more of less linked to a trauma, sleeping disorders. They can
also repeat the themes of experiences in post-traumatic games or lose the
evolutive capabilities they had previously developed. Regressive behaviour
is more evident in this age group (such as thumb sucking, bed wetting,
fear of the dark), as well as anti-social, aggressive and destructive behaviour.
Furthermore, children are more sensitive to the emotional states and reactions
of parents, than the event itself: the family is capable to direct the
child towards a positive reaction; for the same reasons, a child that lacks
family support risks having a lesser possibility to recover.
Clinical trials suggest that children of school-going
age can experience "temporal confusion" and "premonition" symptoms, which are not found in adults.
| EXPOSURE TO TRAUMA | INDIVIDUAL | FAMILY | SOCIAL FACTORS |
|---|---|---|---|
| Physical closeness to the trauma | Age | Family history | Social support |
| Seriousness of the trauma | Gender | Reaction of parents to trauma | Absence of immediate treatment |
| Duration of trauma | Evolutive phase of development | Family support | |
| Emotional involvement | Personality | ||
| Personal history | |||
| Level of perceptive development | |||
| Physical health |
"Temporal confusion" is defined as a phenomenon in which a person fails to recall a sequence of events; "premonition" is
intended as the belief that alarm signals exist that can predict a trauma is
about to happen. As a result of this, children can convince themselves, if they
are aware, that they can recognise these premonitory signals, avoiding similar
future experiences. Furthermore, they tend to represent these traumas in their
games, drawings and in what they say.
In adolescents, PTSD is more similar to that of adults, with only a few differences. It can be associated with personality disorders, depression, substance abuse, anxiety, eating disorders (anorexia/bulimia), problems relating to sexuality. Adolescents often exhibit impulsive or aggressive behaviour.
The difference in reactions caused by stressful events is determined by a serious of pre and post-traumatic factors: characteristics of the individual, the nature of the trauma and family and social support received. The following table shows the factors which can contribute to the formation of PTSD.
Diagnostic criteria of PTSD
The criteria of PTSD are:
- exposure to a traumatic event which causes feelings of fear, helplessness, horror;
- the incapacity to detach from the traumatic event, continually reliving it through memories, repetitive and intrusive dreams, thoughts and flashback;
- avoidance of stimuli associated with the trauma (places, people, activities, etc.);
- difficulty in the completely recalling the trauma or symptoms of hyper-activation (e.g. sleeping disorders, irritability, anger, hyper-vigilance. loss of concentration, overreaction to alarms);
- symptoms that generally develop within 3-6 months of the event and persist for more than a month;
- possible depression co-presence.
During appropriate intervention, is important that the clinical evaluation includes an interview with parents, as well as the interview with the child or adolescent. The interview should explore family history, the child's development process before the trauma, and the parents perceptions of how their child has changed following the traumatic event.
To give a correct diagnosis and perform an effective interview, the specialist can use instruments available to him (semistructured interviews, directed at parents and children) that follow specific criteria and refer to a precise system of classification for mental disorders (DSM IV from the American Psychiatric Association).
The course of PTSD
Children and adolescents, who are exposed to an event,
at first suffer an intensive emotional reaction; it is only afterwards
that they start to work out the event and seemingly recover from it quite
quickly, re-establishing their normal daily activities
In some cases, the personal resources of the child and
his family environment can encourage the child to share his experience
and emotions in relation to the event, allowing the child to recover quickly
from the disorder.
The co-presence of some factors - direct exposure to a particularly dramatic event, a weak personality, difficulty sharing emotions within the family and a lack of support from external surroundings - can, instead, cause the disorder to persist.
The course of recovery from PTSD is not easy and can
be characterised by long-lasting symptoms. Furthermore, adolescent PTSD
can be associated with other disorders which are characteristic of this
evolutive phase: personality disorders, depression, substance abuse, general
anxiety, eating disorders (anorexia/bulimia), problems relating to sexuality.
These considerations highlight at least three fundamental
aspects in the clinical approach to PTSD in the evolutive age group:
- the importance of early diagnosis of the disorder, through an attentive survey of the signs and symptoms;
- specific therapeutic treatment that considers the factors of the syndrome, but also those of the intra and inter-subjective recovery period;
- the necessity to prevent indirect trauma, when linked to mistaken or avoidable behaviour (e.g. letting a child watch potentially traumatic images on his own).
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"Telefono Azzurro"
S.O.S. Organisation "Telefono Azzurro" is a nonprofit organisation that operates on the principle of preventing and assisting young people who have been subjected to abuse or violence. "Telefono Azzurro" have been the reference point, for more than 16 years, for children and adolescents with difficulties and it is committed to defending children's rights, and the diffusion of a culture that respects and values their existence.
THE NATIONAL ADVICE CENTRE
The National Advice Call Center is the heart of "Telefono Azzurro", with the head office in Milan, which takes thousands of calls a day from all over Italy.
The Organisation is involved in continuous operative, theoretic, and methodological collaboration on an international level with English, French, Spanish and Austrian Helplines to identify and adopt common guidelines in managing consultancy, information and the development of the operator's capabilities. The Call Center divides the 19696 free phone line, which is active 24 hours a day, 365 days of the year and is available to all children and adolescents up to 14 years of age who want to report maltreatment or abuse, or who wish to speak to an operator about particular problems or difficulties, and the "Linea Istituzionale" 199.15.15.15, for adolescents over 14 years of age or adults, teachers, professionals who want to discuss cases involving minors, or ask advice on how to manage cases.
Through the consultancy offered, the National Advice Center processes the data gathered, with the Organisation representing a privileged observatory for children who live in abusive circumstances or who request help due to their circumstances of maltreatment or discomfort.
REGIONAL CENTERS
Supporting the National Advice Center, "Telefono Azzurro" has maximised its nationwide capabilities with the presence of Regional Centers in local areas. With the foundation of these Centers, "Telefono Azzurro" will start to make its presence felt, using a more structured method to pass on its experience to local organisations: from one of the Organisation's intentions such a service to protect children to the direct activation in place, not only in the management of cases reported to the National Advice Center, but also the development of suitable projects to educate, research and sensitise. Centers have already opened in Bologna, Palermo, Rome and Treviso
DEVELOPMENT OF INNOVATIVE PROJECTS:
"Tetto Azzurro" AND THE EMERGENCY TEAM
The path to developing "Telefono Azzurro" has brought the testing of new intervention projects, strengthened by the foundation of the Treviso Emergency Team and "Tetto Azzurro" in Rome.
The Treviso team is distinguished for implementing an intervention model for emergency circumstances, by interacting within the internal inter-institutional network which is composed of different regional agencies, e.g. Law Enforcement, the Public Prosecution Office, the Social Sanitary Services, Schools, etc.
The project was founded on collaboration with the Child Study Center in Yale University (U.S.A.) and continuous work with "Telefono Azzurro". The task of the emergency structure is to intervene in circumstances of violence or intra-family discomfort, under-age prostitution, irregular treatment of minors, run-a-ways, self-destructive behaviour and mental disorders in evolutive age groups. The team is structured in four areas: the clinical area, management area, study/research area and the training area. Furthermore, from May 2001 the Treviso Team offers a refuge where child and adolescent victims can air their traumas, or if they are living in emergency circumstances, for 48 hours after the event. "Tetto Azzurro" in Rome is different, in that it was founded as a multifunctional center to host, diagnose and treat abused or maltreated children which the Province of Rome had entrusted to "Telefono Azzurro" due to its experience of stressful childhood problems and its organisational capabilities. The Center has activated multiple services that are identified and directed at different objectives, among which diagnostic and treatments services for individuals and families in circumstances of abuse or maltreatment of the evolutive age group, a Residential Host Center and a legal consultancy service for the operators of regional services.
"Tetto Azzurro" and the Emergency Team even offers the regions a privileged place for clinical intervention for sexually abused, maltreated or psychological abused children. These two structures are intended as a refuge, guaranteed to listen to minors for judiciary purposes and as a "neutral space" to encourage parental continuity.
THE TRAINING SECTOR
The Training Sector of "Telefono Azzurro", through the use of appropriate training schemes, aims to promote and diffuse the knowledge and capabilities they have built up over a 16 year period in operation, along with people in charge of the management of minors and their problems: social sanitary and school workers, law enforcement officers and independent professionals, as well as groups interested in training and the sensitisation of this theme such as parents, students and other agents.
THE STUDY CENTER
The purpose of the Study Center is to gather documentation and materials at national and international level, process the data from the National Advice Center, carry out research and studies and promote a permanent observatory for children and adolescents.
Faced with an ever increasing articulate, complex society, in which terms of analysis and traditional references lose importance and credibility, a scientific, statistical type approach may provide useful elements for theoretic processes and practical applications that want to be effective in understanding and helping children. An initiative linked to "Telefono Azzurro" and "Eurispes" was established on this knowledge, which in 2000 led to the "First national report on childhood and adolescent conditions" and included the presence of the President of the Italian Republic and is in its third year. The Study Center also produces information material for parents and teachers, e.g. "The guide to depression in children and adolescents", Silent victims. Children and adolescents confronting war, terrorism and other traumatic events", "Listening to adolescent discomforts", "Guide for parents in the prevention of sexual abuse and its effects".
INTERNATIONAL EXPERIENCE AND COLLABORATION
International comparisons with other organisations, institutions and services in the prevention of circumstances of abuse or the struggle against pedophiles represents another important element of "Telefono Azzurro's" work over the years. There are multiple objectives that form part of this international strategy, among which the need for public comparison on the best practices present in Europe with the purpose of promoting their implementation at national level, the establishment of a network to offer public services to help effectiveness and quality, while at the same time promoting a childhood culture which is more attentive to childhood rights and communal programs, not only aimed at preventing circumstances of discomfort for children and adolescents, but above all the promotion of children's well-being. It is often assisted by the creation of interesting social and economic intervention programs, but they are not attentive to the direct and indirect effects on the child's quality of life.
"Telefono Azzurro", in collaboration with others (both Helplines and Organisations), other than realising specific projects for the diffusion of quality intervention programs, is also involved in the promotion of awareness debates on the instruments and strategies to make the rights of children a common basis for social, economic and cultural programs in Europe.
Here, the international comparison, to which we refer, includes a greater commitment to participating in a sole system of monitoring and comparison. As already mentioned with national circumstances, they can only expand on an international level.
In this case, the comparison between different methodologies, between data and the specific phenomenon of different contexts, between juridical specifications demonstrated at national level, between realisation methods for invention programs against pedophiles, representing further elements to be considered.
Among the main "Telefono Azzurro" projects worked on there is: the Daphne Program aimed at comparing operative methods in the main European Helplines to promote an advice service with the same principles of quality and effectiveness; the Ombudsperson Project to promote the image of the European Guarantor of children's rights and the identification of minimum quality criteria for the functioning of children's services while fully complying with the International Convention for Children's Rights; the Hippocrates Program to promote a method of quality in the treatment of minors who have committed a crime; the Safeborders Program to create a European network to create a transnational campaign to sensitive people to the safe use of Internet by children. The e-Safe program to prevent the diffusion of illegal sites and the promotion of innovative listening methods such as simultaneous or asynchronous network methodologies (chat, e-mail etc.).
1 M. Mayer, "Brutti sogni in ripostiglio " in "Storie di paura", Einaudi Ragazzi , Turin, 1997.
2 (cit. in "Bambini" ed. Junior, no. 12, year 1998; pages 24-29)