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. b. c. d. A change in the child’s manner: Suddenly fearful without anything frightening happening in the classroom. Angry/Aggressive with little or no apparent provocation. Suddenly excessively sleepy. 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 keychain, 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 timeout 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-supportteam, 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, childprotective-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.