Childhood Dissociation Website

Questions Frequently Asked by Teachers

Prepared by ISSTD’s Child Adolescent Taskforce

Note: These questions and answers are designed to assist teachers in

understanding and managing dissociation in the classroom. The
recommendations below are not a substitute for professional consultation with a
psychologist, psychiatrist, therapist, doctor specializing in the area of
dissociationwhere a careful, accurate handling of possible dissociative behaviors
in school children can be collaborated.

1) What do dissociative children in the classroom look like?

Dissociation can take many forms and can mimic other common problems. In
fact, many of the symptoms below can reflect situations and issues other than
dissociation. It is the combination of numerous symptoms and often an abrupt
shift into behaviors described below that most suggests dissociation.

In general, dissociative responses in children can be divided into two major

behavior groups (though some children present with behaviors mostly from one
of the ‘groups’; others oscillate between the two, with behaviors that can shift
dramatically).

• Overt responses: (dissociative behaviors in this group are usually

difficult to ignore in the classroom because they are often disruptive)
a. Behavior issues: unusual non-compliance, and/or shifts in maturity
levels from age-appropriate to babyish and immature; refusal to
answer to his/her name and demand that child be addressed by a
name other than his or her own; denial of misconduct even when
there’s clear evidence that the child is at fault (child seems be brazenly
lying).
b. Acting out: abrupt onset of aggressiveness toward peers and/or
teacher, sudden use of foul language; rapid and intense emotional
shifts (child is calm one moment and the next is raging or weepy or
appears terrified).
c. Hyper-activity: especially shifts in activity levels from day to day or
situation to situation (dissociative children are often misdiagnosed as
having ADHD).
d. Learning disorders: dissociative children often have difficulty attending
to learning tasks, and as a result can exhibit learning delays and what
can seem like learning disorders. A child may be resistant to learning
or doing work in the classroom or at home. Dissociative responses are
especially suspected when levels of academic abilities from one day to
the next vary considerably.
 • Covert responses: (dissociative behaviors in this group are at times
easier to miss because they aren’t usually disruptive to the class)
e. Passivity/Apathy: unusual passive behavior and lack of initiative, the
child doesn’t seem to care whether she takes part in activities or not,
whether she does well or not; child’s emotional presentation may seem
‘flat’; lack of motivation.
f. Spacing-out/Inattentiveness: the child day-dreams a lot, stares into
space, seems to be ‘someplace else’, and is not paying attention to
what is going on in the class; may need to be called several times
before responding; may seem disoriented or confused about what is
asked of him; may seem as if he just ‘woke up’ even though he wasn’t
sleeping; may answer completely out of context (as if still replying to a
question that was asked a while ago, unaware that the class moved on
since); may be very forgetful and need to be told things again and
again.
g. Extreme compliance: the child is uncommonly eager to please; she
seeks perfection in everything she does; may do things for and bring
presents to the teacher more frequently than other students; may be
seen as ‘teacher’s pet’; may seem anxiously in need of praise; may be
clingy.

Signs of dissociation in the classroom can often be viewed through a lens of

CHANGE or SHIFT:
• A change in the child’s behavior:
a. Increased activity/reactivity
b. Decreased activity/reactivity
c. Spacing out/glazed eyes/child suddenly ‘not there’

• A change in the child’s manner:

a. Suddenly fearful without anything frightening happening in the classroom.
b. Angry/Aggressive with little or no apparent provocation.
c. Suddenly excessively sleepy.
d. Unexplainably sad/teary/whiney/babyish

• Predictable shifts in behavior:

When you realize that the child’s behavior seems to be tied to certain
classroom activities or specific outside stimuli. For example, if the child seems
okay while in the classroom but every time the students are to leave the room
for the cafeteria or to go outdoors she gets clingy and weepy. Or if for
example, every time there’s a siren outside the window, the child freezes and
spaces out.

2. Why do children dissociate? (also see item #2 in the Q&A for

parents—link to page)
Dissociation is a creative and effective coping response to overwhelming
event/s. In order to survive the overwhelming situation, the child may block
 out aspects of the event, feelings, sensations, even knowledge that it
happened from awareness. While helpful during the event, dissociation can
become a pattern of responding, where even minor reminders—whether the
child knows or doesn’t know what they remind her of—cause the child to
dissociate, resulting in disruptions to the child’s normal abilities. These
disruptions can result in difficulties in many every-day situations, including the
classroom and other school-hours interactions.

Dissociation has been documented to follow a variety of childhood traumas.

• Interpersonal Trauma:
a. Abuse: physical, sexual, emotional
b. Neglect
• Medical trauma:
Repeated painful medical procedures due to: cancer, burns, accidents,
congenital malformations (e.g. cleft-palate, cerebral-palsy), etc.
• Environmental trauma:
a. Domestic violence
b. Gang violence on streets and in housing complexes
c. Poverty
d. Immigration (especially when child’s family are refugees who were
exposed to trauma in native country)
e. Natural disaster (especially being in or witnessing)
• Separation, loss, and attachment trauma:
a. Parental mental illness: mentally ill parents may be less able to care for
the child, and their responses may be chaotic or frightening; the child
may end up in a care-taking position and have no one to go to for
managing her own overwhelm.
b. Foster placements (especially multiple placements, where the child is
repeatedly experiencing loss and unknown future).
c. Family chaos: multiple family configurations that keep shifting,
homelessness, frequent moving from one house to the next (which
means the child needs to keep adjusting to new surroundings as well
as at times new schools).

3. What can make dissociation in the classroom worse?

When a child’s behavior (or what may seem like misbehavior) in the classroom
stems from a dissociative response, confronting the child while she is
experiencing dissociation is usually counterproductive and can lead to further
increase in dissociation. For example, if a child dissociated because a loud
voice scared her, raising a voice at her to try and ‘get through’ can serve to
scare her even more.
Restraining or grabbing the child can similarly exacerbate the child’s need to
dissociate and in some may result in acute escalation of aggression or
withdrawal.
Similarly, judging the child as a whole (rather than a particular behavior) as
“bad”, “lazy”, “manipulative”, “mean” and so forth, only serves to deepen the
 child’s sense of inherent badness and see the world as a frightening place
where he can do nothing right and expect no support from others. This is
especially true if the child doesn’t remember what happened while she was
dissociated and therefore what she is confronted about; thus internalizing that
she must be simply bad...

4. What can make dissociation in the classroom better (i.e. less

dissociation)?
Though it may be interpreted as ‘coddling’ and ‘rewarding bad behavior’,
refraining from confrontation and treating the dissociative episode empathically
as responses to trauma reminder usually helps the child regain hold in the
present (more of how to do so in item #5).
Learning to recognize the child’s ‘triggers’ for dissociative responses can help
you prevent some occurrence of triggers (e.g. if sitting with the back to the door
causes the child to startle and become aggressive every time someone enters
the classroom, maybe having the child sit with view of the door can help) or
minimize their impact (e.g. if leaving the classroom makes the child anxious
and results in spacing out or immature behavior, it may help to prepare her by
letting her know that soon all will be leaving for lunch, and by reassuring her
she’ll be safe, maybe even have her walk next to you or with a child she feels
safe with).

General preventative measures to help the child remain relatively calm

included:
• Limiting surprises;
• Fostering a supportive, caring classroom;
• Considering a dissociative as the FIRST possible explanation for a
behavioral issue;
• Letting the child know that all his feelings are acceptable for you (even if
you don’t understand why the child is responding the way he is at a given
situation);
• Allowing the child to go to a safe space within the classroom (maybe a
reading corner or a spare table) or reach into his bag for a safe-object for
a few moments to get himself together if he is feeling overwhelmed.
Sometimes just knowing that the option is available helps the child feel
safer, and feeling safer means less need to dissociate…;
• Accepting all aspects of the child (i.e. however tempting it may be, not
stating that you only like the child when she is on her ‘good side’
behavior…) encouraging the child to use more appropriate ways to
express difficult feelings;
• Minimizing confrontation and presenting consequences for undesirable
behavior only when the child has calmed (more about that in item #5)

Even with all the best and most compassionate safe-guards, triggers will
happen and the child may dissociate. An empathetic and reassuring response
 can help minimize the extent of the reaction, calm the child and shorten the
duration of the dissociative episode and help the child reorient ‘back to the
present.’

If a child is already receiving trauma-counseling, collaborating with the therapist

can help you utilize grounding cues—such as subtle hand gestures between
you and the child—and other techniques that the therapist is reinforcing in
therapy and thinks can carryover to the classroom. Please see the next as well
as item #7 for more information about supporting the child and support for you,
the teacher, respectively.

5. What can I do if a child is dissociating?

There are many things that you CAN do to help the child within the classroom
and with relatively little interruption to the classroom routine. In fact, often the
simple interventions listed below are far less disruptive to the classroom than
punitive or confrontational methods. Utilizing these tools often translates into
fewer dissociative episodes, improved classroom management, and increased
trust and connection between you and the child as well as between the child and
peers.
Classroom intervention cannot and should not take the place of specialized
trauma treatment, where the child can be helped to work through the trauma and
deal with the issues that underlie the dissociation. Nonetheless, the tools below
can assist both you and the child in feeling more in control, and can help make
school experience a safer one for the child.

The ‘Teacher’s toolkit’:

a. Grounding
As soon as you notice a dissociative episode, let the child know where she
is and remind her who you are—don’t assume she knows. Tell her the day,
the time, and her location. For example, you can say: “This is Mr. B and
you are in the classroom with your classmates, and it is Tuesday, and we
just came back upstairs from having lunch.”
b. Reassuring
Let the child know she is safe. She may not be aware that she is. Let her
know that she is no one is being hurt, that she is not being hurt, that
nothing bad is happening right now, that she is okay. Let her know that
she is safe
c. Checking in
Once the child seems more present, ask her if she is okay. Does she
know where she is? Who you are? If you know of something she has at
school that brings her comfort—it could be a stuffed animal, a special key-
chain, a squeeze-ball, a journal—offer it to her. Ask if she wants a drink of
water or to wash her face.
d. Narrating/describing/putting in context
 Rather than ask the child what SHE thinks happened, tell her. Dissociation
causes a rupture in awareness and the child may not remember what
happened, or have a hard time putting it into words.
Narrate what is going on. Depending on the child’s age you might say, for
example: “An ambulance passed outside” or to a younger child, “An
ambulance passed outside and the siren was loud but it is gone now to
help people and everything is okay here.” If something happened within
the school, describe it simply: “There’s a child crying in the hallway, but
she is okay” or “So and so bumped into you and maybe that startled you
and you got upset.”
e. Deferring blame/investigation until the child is grounded
Refrain from using interrogative questions such as: “Why did you do that?”
or “What got into you?” The child may well now know why she did what
she did, or what got into her… Dissociation disrupts exactly such
continuities of awareness.
Even after the child is completely present and calm, reiterate what took
place. What you said a little while earlier while the child was still
struggling to reorient may not have ‘stuck’ in her memory. Stating it again
can be very helpful.
If misbehavior occurred that requires consequences, wait until the child is
grounded and calmly explain the cause and effect. For example, you
might say: “You pushed so and so, and when someone in our classroom
pushes they get a ten-minute time out. So you need to go sit in the time-
out chair now.”

While these steps may seem time consuming, in effect they need not take much
time, and even less time as the ‘routine’ becomes more familiar (to both of you)
and the child learns to associate your voice and words with reorienting.

You may worry that such ‘coddling’ may make it ‘worth it’ for the child to act-out in
order to get that special attention. However, most likely it will only serve to
reassure him that you care and that he is safe with you and can trust you to help
him when he’s swept into overwhelm. You may worry that other children in the
class will resent the ‘special treatment’ that the child will be getting. However, if
the child is aggressive or explosive they may well welcome less drama…and a
quieter classroom. It is not unusual for classmates to mimic the teachers’ calming
demeanor if the child gets ‘upset’.

Dissociative and post-traumatic behaviors stem from fear, rage, shame,

helplessness, loss, confusion, and other difficult feelings.

Accepting a reality where children can and do experience so much pain and
overwhelm that their only way to cope is to remove themselves mentally from
situations is heart-breaking. Managing highly-reactive children (see #1), is
challenging and can be frustrating. Realizing that there’s a link between a child’s
trauma, and his ‘acting out’ can help soften that frustration into compassion
toward devastating experiences that taught the child to manage his feelings in
that way. Children in distress aren’t available for learning. Empathy and
compassion can go a long way to help break the cycle of stress/distress. They
can foster a caring, secure school environment for the child, which will in turn
make it more conducive to learning.

6. Who can help the child? What about the child’s family?
Dissociation responds WELL to specialized treatment. Teachers aren’t expected
—and in fact, shouldn’t—treat dissociation (though they can help support the
child in the classroom by maximizing safety and thus availability for learning).
Treatment is most successful if there is early diagnosis and intervention, and the
child is in a safe environment.
If you suspect a child is currently maltreated, as a mandated reporter you must
report your suspicions to Child Protective Services or relevant authority in your
country.

You may have no reason to suspect that the child is currently maltreated.
Dissociation in of itself is no indication that a child is being harmed at present,
because it can and often does continue long after a child has been in a safe
environment. In fact, dissociation often persists until the child receives
appropriate therapy. So if you do suspect dissociative behaviors in a child, let
someone know: the school counselor, the principal, the school-based-support-
team, the district office, the parent/guardian of the child. Describe what you see
and recommend that the child is referred for an evaluation by a therapist
specializing in dissociation.

It is not your responsibility to diagnose the child, but your vigilance in referring
her for appropriate help can be truly life-saving by saving prolonged agony and
misdiagnoses.

(For understanding why some children are misdiagnosed and why some people
—even mental-health professionals—you talk to about dissociation may not be
familiar with it, see item #5 in the “Questions Frequently asked by Parents”—
provide link).

If you work with disadvantaged populations, you may feel that recommending a
referral is futile: that there is no budget, that no one who’d take the child to
therapy, that there are no resources, that no one in the area is competent in the
area of dissociation. This may all be true, but it is still important to recommend
the child be referred so that at the very least there is awareness of the difficulties
the child may be facing and a paper-trail of his needs becomes a reality. And
therapy may well be a reality. Several hospital clinics that cater to underprivileged
populations have clinicians who are skilled with dissociation.
More and more mental health professionals are becoming familiar with trauma
treatment, and awareness of dissociation is increasing every year as they
complete trainings, attend workshops, and read about dissociation in
professional publications. Inroads are being made with pediatricians, child-
protective-services, speech-language-pathologists, nurses, and educators.
By reading the information on this web-site, you yourself are one of those
spearheading educators!

If you want to make a referral and aren’t sure what to do or what may be
available in your area, you may choose to consult the membership list of the
International Society for the Study of Trauma and Dissociation. The ISSTD is a
professional association, not a registered body, and thus does not denote
competence or registration. However, you may find someone in your area who
you can at least contact for information and possible local or regional resources.

Once a child is receiving appropriate therapy, the therapist will work with the
parents/guardians to help them deal with dissociation at home and foster
reparative experiences there. The child’s parents may well welcome your
involvement in assuring that the child’s experience at school is positive and
supports her healing.

7. Who can help me, the teacher?

Having a dissociative child in the classroom can be very taxing—sometimes
having one dissociative child is enough to plunge a whole classroom into chaos
and make you feel as if you have to constantly be walking on egg shells.
You may feel that it is best to say nothing lest the frequent chaos in your ‘domain’
will be seen as failure on your part in class management. You may feel that you
are expected to ‘take care of it on your own.’ You may even believe that you can
manage it all alone, and maybe you can.
However, this may be shortchanging you.
Collaboration with other professionals at the schools can be extremely helpful.
Dissociative children often already have other schools professionals on their
team. If they don’t—it may be a time to refer… Many dissociative children have
learning disabilities (if only because they spend so long ‘spaced out’ that they
miss out on a lot of information) and may be receiving remedial learning and
speech-language-therapy. If they exhibit social difficulties, they may be getting
counseling (school-counseling rarely can replace trauma-counseling, but it can
be a resource to help the child manage behaviors in the classroom). They may
be under the care of the nurse for medical or pharmacological issues.

Comparing notes with the other professionals who work with the child can
provide priceless insight into what they’d seen works (and what doesn’t) in
helping the child manage academic as well as social school tasks. It may help
you identify and validate your own observations about the child’s triggers and
provide brainstorming opportunities about how to best navigate those.
Collaboration with the child’s academic team can target times when the child is
especially vulnerable and plans for their optimal management. For example, if
lunch is especially taxing for the child and you find that eating in a quiet space
helps; one of the other professionals may be available during those times to
provide her office space for the child to come into, or maybe shift schedules to
work with the child over lunch.

Collaboration may also help you plan for times of crisis, when you’d simply need
the child out of the classroom for a while but without making it a punishment.
Maybe the child is having a really bad day…or you are…or another child in the
classroom is and you just know your resources are spread too thin. By
discussing such eventualities and learning of the others’ availability and
willingness, you may be able to pre-arrange for the child to go (or be escorted) in
such times to another professional’s office where she can be safe and in a
familiar, non-punitive place.

Sharing your experiences with other professionals on the educational team (and
with the child’s therapist, if such contact is available to you) can be a way to air
out some of your feelings and frustrations and be supported. Having a
dissociative child in your classroom is challenging. It is not the child’s fault that he
is dissociative. Neither is it yours… By taking care of yourself and making sure
you, too, receive support, you can be a better support for the child, as well as to
the rest of the students in your class.