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TALKING TO CHILDREN AND TEENS Developmental Considerations, Language Skills and Communication Strategies Donna A.

Gaffney, DNSc, PMHCNS-BC, FAAN INTRODUCTION Talking to children is both a rewarding and challenging experience. While there isn't a right or wrong way to talk to children and adolescents, there are techniques and skills that facilitate communication and allow us to better understand and protect them. Communicating with young people is an art that takes practice and patience! At different stages of development, consider the way children and teens: Understand the world: Cognitive Development o Piaget's stages of cognitive development provide a framework that allows the clinician to determine the child's capacity to understand questions as well as their perceptions of the world. o Children do not move from one stage to the next, but gradually transition to higher-level cognitive abilities. Communicate: Language Capabilities o Remember that language does not accurately predict a child's ability to understand the world. Sophisticated language and adult word usage indicate a child has successfully learned how to use the words in a sentence not the meaning of the sentence. Show Emotions Confront the circumstances and context of the your session. VERY YOUNG CHILDREN: Toddlers And Pre-Schoolers Cognitive Development : Piagets Sensori-motor stage (2 yrs) to Pre-Operational stage (2-5 yrs) Primitive description and adequate sharing observations The toddler and preschooler exhibit: o Egocentrism- the causes of most events, everyday and otherwise, attributed to himself. No matter how many times a young child hears any other explanation. o Illogical thought and magical thinking- thoughts may seem bizarre and humorous to adults, but to the young child, these explanations are perfectly justified and logical. o Animism -attributing life to inanimate objects, often incorporated into magical thinking. o Centration inability to pay attention to more than one characteristic of a particular person, place or thing, eliminating all but the central focal point for young children. Even if a child is told that something is both big and round, he is unable to understand both qualities, it can only be big or round. 1

Comprehension of time not the same as older children and adults. o The digital clock does not accelerate the comprehension of time for young children; it merely helps them say the numbers on the clock when they see them. o The concepts of hours, days and weeks are elusive. In the car trip, Are we there yet? To help young children understand the passage of time use familiar points of reference; mealtimes, after school, waking, bedtime etc.

Language Meanings of words are subject to childs private interpretations. As verbal skills improve, so too does child's ability to accurately relay events in his life. Limited linguistic skills do not allow detailed descriptions of events in the outside world. Sentences develop from 2-3 words at three years to longer sentences at five years. Emotional Development and Behavior Separation from parents can be a major concern. A time of curiosity, may be more interest in the clinician than the topic of discussion. Abundance of energy, they may have a difficult time sitting still to answer questions. Goals at this young age might be best realized through observation or watching motherchild interaction. Reliability of Young Children Children are often described as unreliable historians and vulnerable to suggestibility. The issue of suggestibility is the subject of controversy in a number of research studies, especially those concerning forensic interviewing. There are four critical factors in determining a child's suggestibility: 1. The younger a child's age the more suggestible he is; 2. Children may not tell the truth if they are motivated to do so; 3. Younger children can not recall the same volume of information as older children; and 4. The context of previous encounters with people may distort the child's perceptions. (Ceci & Bruck, 1993) THE SCHOOL AGED YEARS: Children From Six To Twelve Cognitive Development: The period of Concrete Operations (Piaget, 1963). Use of logical thought and relies less on primitive intuition and rarely retreats to magical thinking. The child is able to see the point of view of another (centration and egocentrism have disappeared). Children eager to learn the causes for every action or event. o Yet the school-ager's skills of reasoning are focused in the concrete arena, abstract thought does not appear until adolescence. School-age child can: o Focus on important factors and eliminate the irrelevant ones. 2

o Reverse thought (subtraction) and demonstrate increased flexibility of thinking. o Attend to more than one aspect of an event simultaneously allowing them to classify objects along a number of characteristics. o Use mental images of spatial relationships, give and follow directions and use maps. At 10-12 years can estimate distance, and identify landmarks. School-agers have a more complete understanding of distance, judgment of distance is influenced by attractiveness of the path, motivation of the child and different starting or ending points. o Tell a story, starting at point A and understand all the sequential steps that bring him to point B (transivity). o Retrace the steps from point B back to point A. (reversibility). The school-aged child has a more sophisticated concept of time, not only hours of the day but weeks, months and seasons. Concepts of historical time are not well developed.

Language Children from 6 to 12: Introduce social amenities in speech in appropriate situations Can carry on conversation at rather adult level Follow fairly complex directions with little repetition Are able to tell a connected story about a picture, seeing relationships between objects and happenings at 6 years and at 12 years relate rather involved accounts of events, many of which occurred at some time in the past Should be few lapses in grammatical constrictions-tense, pronouns, plurals Emotional Development and Behavior Children from 6 to 12 years: Apply themselves to tasks- school, organized activities, sports Work and play with others (friends are important) May look to others(friends, teachers, parents) for answers to questions. Have specific fears: darkness, large animals, fire, kidnappers, burglars, war ADOLESCENCE Cognitive Development: The stage of Formal Operational thinking (Piaget, 1963) A time of increasingly complex thinking marked by abstract thought, inductive and deductive reasoning. Teens develop the ability to consider multiple viewpoints while weighing various criteria in debate and expression of opinions. Not every teen achieves the same skills at the same age Teens can: o Attend to issues of reality and possibility. o Use abstract reasoning and problem solving skills that are applied in a logical, systematic manner. o Use deductive reasoning and meta-cognition or thinking about thinking.

o Become a novice philosopher, often analyzing the moral consequences of any decision they or others make. o Value their peers' opinions and rely on their age-mates for guidance, advice and confidence. Adolescent Emotions and Behavior The adolescent years are the testing ground for the essential transition from child to adult. The critical task of adolescence is for teens to find out who they are and how they fit into their families, peer group and the global community (Erikson, 1968). Teens will: Question previously held ideas. Explore how they appear in the eyes of others as well as how they see themselves. Have concerns about their goals in life and may even overly identify with those around them. The danger during this time is a crisis of doubt Experience characteristic emotions and behaviors during early, middle, and late adolescence. o These stages classically address issues of independence, relationships, physical appearance, school and work interests and sexuality and romantic attachments. o Moodiness, conflict and distancing regularly occur within the family of the teen, particularly during the middle adolescent years. o At 12 to 14 years old, shows initial movement towards independence with a newly developing sense of identity. They can experience labile moods or mood swings yet have a tendency to return to childlike behaviors. They are just beginning to describe their own emotional state with words, but it may still be more comfortable to express feelings in actions rather than words Close friendships become important may show less respect to their parents. There are subtle signs of disrespect, Their quest for autonomy is revealed through self-involvement, sometimes alternating between unrealistically high expectations and a fragile selfconcept. They may feel periods of sadness as the psychological loss of both parents and home takes place. Examine their inner experiences, often demonstrated through writing or keeping a diary 4

o From 14 to 17 year s, teen s continues moving towards independence.

Often perceiving parents and family to be prying and interfering. Make concerted efforts to establish new friendships. The group identity holds a certain selectivity, superiority and competitiveness among the entire teen population in the school or community. Extremely focused and concerned with physical appearance and with their bodies but there is also a sense of being a stranger in ones own body.

o At 17 to 19 years, the teen is on the brink of adulthood with a more fully developed sense of identity and self-reliance. They are able to make independent decisions. Able to delay gratification and have increased emotional stability. Gain insight into the emotions and behaviors of themselves and others. Show greater concern for others and recognize parents and teachers as resources. Older teens have increasing concern for the future and thoughts about their own role in life Talking to Teens about Difficult Situations: Although teens are able to use abstract thinking and complex reasoning, they may not be able to use these sophisticated skills when they are confronted with difficult situations in their daily lives. o The nature of the subject can influence how effective the adolescent is in making decisions and reasoning about choices. Talking about painful or frightening experiences may remind teens of the emotional pain in their lives and that they are different from their peers. o They may push it out of mind. o Not unusual for an adolescent to admit that talking about their problems makes them feel worse than before. PLANNING, PREPARATION AND STRATEGIES Keep sessions to age-appropriate times*; Under the age of 9: 20 minutes For children between 10-14 years : 30 minutes For adolescents: 45 minutes Try to arrange to talk to the child in comfortable, familiar surroundings with minimal distractions.

Observing Children Before speaking to a child, observe first. Stand at a distance of at least ten feet and observe the child for 5-10 minutes before initiating contact. Noting a child's appearance, mood and mannerisms will be helpful. The questions below can provide a useful framework: Does the child appear healthy? A rosy color to cheeks, or sallow or pale? Does the child appear frail or fragile? Or robust and sturdy? 5

Is the child's hair groomed and clean? what style? (braided, etc.) Is the child's clothing clean? What kind of condition? Style? How well does it fit the child? Are the child's eyes bright and clear, or tired-looking, unfocused or dazed? How alert is the child? Is he/she awake or tired, yawning with half-closed eyes? Also note behaviors and mannerisms: Does the child cling or hide behind an adult/parent? Does the child look to the parent when he/she is asked a question? Is the child shy or nonverbal with strangers? Is the child hyperactive or unable to focus for more than a few minutes at a time? Is the child upset, crying or fearful of things or people? What is the child's mood, sad, happy, angry? Is the child anxious, worried? Fidgeting, wringing hands or rubbing hands together, hyperventilating, sighing, unable to make eye contact, blotching skin, cold hands, dilated pupils, widening or tearful eyes, fretting, twisting or pulling hair, sweating. A change in behavior during the session may signal a reaction to the conversation. Children are often unable to express how they feel about a particular topic but their behaviors often reveal what they cannot express in words. A topic that triggers a behavioral shift is worthy of noting and exploring in a sensitive manner. Introduce Yourself to the Child Identify your organization, who you are and why you want to talk to the child. You may want to hold back on using the words "child" or "children", as some young people may feel insulted when you refer to them as children! Maintain an equal power base by sitting at the same height as the child; your eyes should be at the child's eye level. Try not to bend over and look down at the child or squat to look up into the child's face. Locate stairs, chairs or benches and enlist the help of the child to find a suitable place for talking. Invite the child to join you, " Let's sit here where we can be more comfortable." Keep your eyes aligned with the child's. These strategies promote a sense of respect for the child and what he is about to tell you. It also reinforces a feeling of trust. Assessing the child's age and experience is critical. Don't overestimate his sophistication if you meet a "street smart kid who knows how to use the language or by "little ones" who may understand far more than they appear to. Always let a young person know that he can stop at any time during the session, if he wants to. Children often don't abruptly end a session but it is a safety valve for both parents and children. Finally, it never hurts to remind kids that there are no right or wrong answers; you are only interested in their own experiences and ideas. It is helpful to indicate how many times (or the approximate number of times) you would like to 6

meet and how long each session will last. TECHNIQUES AND STRATEGIES Begin with a brief introduction for your reason for meeting with the child. Although you will most likely have general background information; age, school, grade, interests, etc., you can ask again. When asking about family, phrase questions in a more open-ended manner, "Who lives at home with you?" Asking about specific family members can backfire and limit responses. In addition, the child may be embarrassed to correct you, which can further close down communication. Use words and phrases that facilitate communication. Whenever possible use open-ended questions. Avoid "yes" or "no" questions. These close communication and may frustrate the child or simply result in false agreement. Avoid leading a child; dont make a statement and end with a question asking confirmation of your statement. This is the easiest way for a child to give false information or distortions of his experiences. Instead, use broad openers: "Tell me about," "Describe for me. . . ," "What happened. . ," Avoid using the word "why" or "how come." This will result in an answer that is usually very frustrating for you and the child, "I don't know, shrugging shoulders or silence. Instead ask for the child's opinion as to why something is so, "What do you think the reason is...?" Don't stop with the first response, although it may feel like a dead end. Use words that encourage the child to continue talking: Tell me more about that...., What do you mean by . . . . Give me an example of . . . . Go on.... Tell me again what happened. . And then what happened? Say more. . . Children may give answers because they want to please adults, a behavior learned from classroom situations. They wave their hands and vie to give the right answer to the teacher. Allowing them to tell their story eliminates "pleasing the interviewer" with answers. Be sure the child understands what you are saying, avoid the typical "reward" comments a child may hear in school, i.e., "Yes, that's right," "That's good," "Great job." Choosing the Right Words Children, especially pre-schoolers or young school-agers, are very concrete in their interpretation of words and language. They take words very literally, so you must be sure that words do not have a double meaning. This is especially a problem when talking about topics related to health care or any subject that may have jargon or unfamiliar words. For example, some unfamiliar health-related words and their child-like interpretations are: ICU (I see you?), IV (ivy?), CAT Scan (will there be cats?), shot (with bullets?) If you see the child pause or hesitate when a certain word is used, offer another word or ask if he understands what you have said. Goals 7

Children will give rich descriptions of an event if they first recount what has happened (present or past) without probing. Afterwards you can return to specific points, i.e. "There was a fire in your apartment house, tell me what happened." The child will tell his story and then you can focus in on the details, "Who else was there?" "What did it look like?" What were you doing at the time? "What were other people doing at that time? (you can be specific if you know who was present), "What did you do?" "What were you thinking when you saw the black smoke coming from the window?" Keep in mind that each of these probe statements can generate a long discussion. Shorter phrases can be used to further expand, "Go on," etc. Responses to Events and Situations Childrens reactions or responses to a specific event or situation are generally described along three domains: thoughts, actions and feelings. It is useful to proceed from thoughts to actions then feelings. Focusing first on thoughts and actions allows us to see a more complete picture of the situation before we hear the childs emotional response to it. Expressed thoughts give an indication of the cognitive stage and conceptions held by children. Simply put, you can ask a child what were you thinking when..." Actions are described by the child when you ask, " What did you do?" What did you say when. . . Try to avoid asking multiple-choice questions or "either/or" questions. If children do not remember or state "I don't know" or "Nothing" when first asked about their actions, remind them that it is sometimes hard to remember things that happen but eventually they will and you can talk about it later. Identified feelings indicate the emotional and affective experience of children. For example, you can ask, "What were you feeling when [ xx ] happened?" or "What feelings did you have?" Avoid suggesting a feeling to the child, "Were you scared (angry, sad, etc.)?" or "You must have been scared?" or "I bet you were sad?" Assuming an emotion for the child could cause the child to feel embarrassed or angry. Also try to avoid using the words "How did you feel?" Typically, people respond with the word "Fine." You may have to describe how thoughts, feelings and actions are different from each other. Thoughts are expressed in words about our ideas, opinions, beliefs or remembering a person, place or experience. Actions are behaviors, what we say or do in a situation. Feelings can be expressed in words and describe our emotional state. However, feelings can also be sensed without words, as our internal body state can also tell us what we are feeling: our organs (heart racing, stomach upset), our skin ( cold, sweaty, goose bumps), etc. People of all ages often confuse thoughts and feelings. It is important to remember that talking to children involves not only feelings about a certain situation but the perception and understanding of it as well. Empowering Children After children describe an event or occurrence in their lives, and talk about their reactions, it is sometimes helpful to allow them an opportunity to explore their ideas and solutions, "what would you do if. . ." "What do you think you could do to solve the problem?" "What would you tell 8

other kids to do if they were in the same situation?" Endings Keep in mind the childs needs throughout the time you are talking- food, bathroom breaks, separation from parents. You may have to take a break to accommodate those needs. Remind the child about 5 minutes before you are due to end the session. Thank the child for his time and ask if he has any questions. If you are going to meet the child again, establish the next meeting time. If you have introduced a self-care strategy, this is the time to remind the child to practice it until you meet again. SPECIAL SITUATIONS: CHILDREN WHO ARE TRAUMATIZED The mental health community has only started to change public attitudes towards children and trauma in the past fifty years. In the first half of this century, children were treated as if they were miniature adults, capable of the same thoughts and emotions as adults. Yet their vulnerability is far greater. It wasn't until Margaret Mead wrote her groundbreaking piece for The New York Times Magazine during World War II that attention was focused on the emotional plight of children during the London Blitz. Prior to that time, most adults and professionals, did not believe children could be traumatized from parental separation and witnessing armed combat. It is important to know how children are affected by their traumatic experiences. Lenore Terr's work with the kidnapped children of Chowchilla only confirms this. She is one of the first clinicians to interview children about their life-threatening events. She listened to the experiences of the children first, and later talked to parents and teachers. Terr described the thoughts, emotions and behaviors of the school children with clarity and authenticity, allowing scholars and clinicians to learn from her experience. Recognizing the influence of traumatic events in a child's life is crucial. The closer an event is to the child's family, home and environment, the more traumatic it may be. Children who are witnesses to violent events or tragic occurrences are victims in their own right. They may not be directly involved but as witnesses they are profoundly affected. This is especially true if the child has observed the loss or injury of a parent, sibling or friend. When a child witnesses the death or injury of a parent, it is one of the most horrific tragedies he will experience in his life. Because trauma affects memory, distorts time and fragments the personal narrative, coherently talking about such a debilitating event is very difficult if not impossible. With time, the sensory experience (often recalled first) is integrated with the cognitive experience (the autobiographical memory) and the narrative emerges. The hours and first days following a tragic event may be too soon to talk to a child or family member. Parents are often incapacitated by the same traumatic events that overwhelm their children. Children often regress or avoid talking to anyone, even family members, about their most painful experiences. Proceed slowly and in short segments of time. The child must come to trust you. 9

Remember: There is an interaction between developmental issues and the effects of trauma; children are at greater risk than adults, even traumatized adults. Developmental Issues: 1. Children do not have the life experience or cognitive capacity to CONSENT. 2. Children may not have the capacity to understand your questions: a. They can not distinguish between thought or a feeling b. There is an impaired ability to fully comprehend time and place (developmentally or peri-traumatically) 3. The influence of the parent-child relationship: children are sensitive to parents emotions and follow their responses. 4. Children may try to please adults with the right answer. 5. Children may assume responsibility for that which they have no control (egocentrism) A why? question can lead child to think he was could change the course of events. Traumatized Children: 1. Public recognition and attention often complicates grief and the traumatic response. 2. Memories are fragmented, disoriented, there are time slice errors Narratives are disconnected 3. Children are not usually empowered to take action or ask for an adult to be present, they may express it nonverbally, we must be observant and sensitive to their needs. Classic References Astington, Janet. (1993) The child's discovery of the mind. Cambridge, MA: Harvard University Press. Ceci, S. & Bruck, M. (1993) Suggestibility of the Child witness: A Historical Review and Synthesis. Psychological Bulletin. 113, 403-439. Elkind, D. (1981) Children and Adolescents, Interpretative Essays on Jean Piaget. New York: Oxford University Press. Fine, G. & Sandstrom, K. (1988) Knowing Children, Participant Observation with Minors. Newbury Park, CA: Sage Publications. Garbarino, J.& Stott, F. (1992) What Children Can Tell Us, Eliciting, Interpreting and Evaluating Critical Information From Children. San Francisco: Jossey-Bass. Mead, Margaret (1942) War Need Not Mar Our Children. New York Times Magazine. February 15, 1942. Schuster, C. & Ashburn, S. (1992) The Process of Human Development. New York: J. B. 10

Lippincott & Co. Singer, D.& Revenson, T. (1996) A Piaget Primer, How a Child Thinks. New York: Plume Publications. Terr, Lenore. (1990) Too Scared to Cry, How Trauma Affects Children. New York: Basic Books. Wood, David. (1988) How children think and learn. Cambridge, MA: Blackwell Press.