Gene Beresin, M.D., co-director of the Center for Mental Health and Media at MassGeneral Hospital for Children, shares advice on how to talk to children and teenagers about the recent shooting at the movie theater in Colorado.



Q: What should I say to my child if he/she is afraid or seems reluctant to go to the movie theater?

A: Before addressing the issue of going to the movie theater, all children and teens need to have answers to three fundamental questions:

• Am I safe?
• Are you, the people who take care of me, safe?
• How will these events affect my daily life?

It’s important to provide answers to these questions, even if your children don’t put them into words. You should expect to answer these questions several times over the next few weeks.

Parents and caregivers should to try to address what their child is experiencing by asking "What are your questions, concerns, and what are you worried about?" Kids have different fears. Many will worry about the movies but others will worry about such events spilling over to other areas, such as the mall, school, and their neighborhood. For kids of all ages, it is really important to let them know that these kinds of events are incredibly rare. Movie theaters are a very safe place. Ask them to think of all the movies they, mom and dad and everyone have gone to. Things like this really do not happen much at all.

Q: Should my response vary depending on the age of the child?

A: The reactions to kids need to be tailored to their developmental level. School-age kids and teenagers tend to go to movies more often. Very young children may be more disturbed by their parents' and caregivers' distress. That’s why they’re comforted more by your actions than your words. Remember that school-age children often work through emotional issues with play instead of words. Don’t be surprised if your children use toys to replay the images of destruction that they’ve seen or imagined. This is healthy. It can also give you insights into their fears and misunderstandings.

Parents and caregivers also need to “take their own pulse.” If a parent is anxious about having a child go to the movies, the child is likely picking up on this, and may be sensitized to their parent's fear. It is always wise to reflect on one's own emotional reactions and, particularly with teenagers, voice them. “I know you can sense that I am anxious about movies, but this is a normal reaction. I also have to remind myself that movies and other public places are very safe.”

The conversation with teens may open new doors. For example, I would ask if they every heard of a movie shooting? Then I would wonder with them what is more dangerous, going to a movie, to school, or driving with a friend who has had a few beers? Schools are very safe and while there have been some shootings in the past, they are very rare indeed. However, kids die all the time from wreckless driving, drugs and other risky behavior. 

The most important thing is to keep conversations about worries and concerns open.

Q: Does my child’s personality factor into how I should respond to their concerns?

A: It is important to understand and know your kids. Anxious, shy, inhibited kids may need to stay back from visiting a movie theater for a few days or weeks. Others may want to go to the movies and feel better by having friends and family with them. Teens, may want to hold off or go with others. I would tend to base the decision on going to the movie theater on how anxious, worried and upset you’re the child is. Frankly, if you keep them away for too long, they may develop a phobia of movies. While we don't want to push them, we do not want to give them the message that movies are dangerous places. They are not! What may happen is that movie companies themselves may hire security guards, or close (as we have seen in some news reports) and this, in my view is potentially bad practice. It gives the wrong message.

Q: Should I limit my child’s viewing of news reports about the shooting to protect them from becoming traumatized by it?

A: Preschool kids should certainly not be allowed to watch TV or view the scene on computers. School-age kids should also be shielded as much as possible. The younger ones who see the scene repeated over and over from different angles may think it is still happening. Some do not know how far Colorado is from their home. School-age kids, if they do see something on TV, should be encouraged to talk about it and ask questions.

Teenagers, on the other hand, have tremendous access to TV, computers, smart phones, etc. I would urge parents to watch TV with them, discuss how they feel about what they are seeing, and open a dialogue with them. Let them wonder with you why such things happen, how often they happen, what any motives of the suspect may be. These situations can open a dialogue about violence. You might ask, “What can we all do to prevent violence?” It may be that we cannot stop a very small number of individuals who are way out of line, such as Charles Manson or the Unabomber. But we may use this time to discuss the risks of available assault weapons, how to prevent or stop bullying, or how to manage conflicts between individuals without resorting to aggressive behavior.

Media portrayals of shootings and mass deaths have been shown to cause Post-Traumatic Stress Disorder (PTSD) remotely. This has been studied from the Oklahoma City bombing, the Challenger disaster, the scud missile attacks on Israel, and the 9/11 attack. The same principles as above should be maintained in terms of media access to these events, but parents should know that remote causes of PTSD have been documented in research. 

Q: How can I tell if my child has been traumatized by reports of the events? 

A: There are a number of things to look for in many kids, remembering that age makes a difference:

• Changes in your child's eating and sleeping habits, energy level, and mood
• Refusal to attend school or go outside and play
• Your child seems socially withdrawn: refusing to play with friends and engage with family or siblings
• Your child begins compulsively re-experiencing the traumatic event and is plagued by intrusive thoughts and nightmares. However, school-age kids may play out the tragedy with toy dolls or figures, and this is quite normal and actually does help them "work it out."
• Heightened states of arousal: they become jumpy, irritable, emotionally unstable, or over-reactive emotionally.

Concerned parents should contact their pediatrician or a child and adolescent psychiatrist for an evaluation.