Why a book about emotional wellbeing and resilience?
A quarter of 14 yr old girls and one in ten boys show signs of depression (Millenium cohort survey), and 50% of adult mental health issues are established before the age 14 (1). Mental health problems have complex causes and there is no single solution. However, psychologists and mental health organisations agree that teaching children to identify and express their emotions is important (e.g. The Mental Health Foundation, Young Minds, Place2be. etc).
Trauma during childhood is one cause of anxiety and depression, especially when the trauma is serious and repetitive (2). Milder or one-off trauma can also lead to the development of Post-Traumatic Stress Disorder (PTSD) and other mental health problems, especially if children feel that their lives are in danger (3), if the event includes separation from the caregiver (4) or if it is followed by negative peer interactions (5).
Trauma is often expressed in young children in different ways to adolescents or adults. The book demonstrates some of the most common reactions children may have, such as fears (Squirrel), separation difficulties (Fox), irritability (Hedgehog), sleep problems and decline of performance at school (Badger).
Trauma during childhood is one cause of anxiety and depression, especially when the trauma is serious and repetitive (2). Milder or one-off trauma can also lead to the development of Post-Traumatic Stress Disorder (PTSD) and other mental health problems, especially if children feel that their lives are in danger (3), if the event includes separation from the caregiver (4) or if it is followed by negative peer interactions (5).
Trauma is often expressed in young children in different ways to adolescents or adults. The book demonstrates some of the most common reactions children may have, such as fears (Squirrel), separation difficulties (Fox), irritability (Hedgehog), sleep problems and decline of performance at school (Badger).
Why is the book about a burglary?
1. Whether it is a minor theft or violent intrusion, being burgled is often a significant shock to children and it can have a large impact on them.
In households that had been burgled, 53% of parents with children aged 0-15 said that their children had an emotional reaction to the crime (such as anger, shock, fear, sleeplessness and tears) (6). In 2014, Victim Support and the security company ADT found that 27% of children had trouble sleeping and more than 10% had trouble at school after a burglary (Victim Support & ADT). Some of these effects can be quite long lasting, as 37% of the adults interviewed by Victim Support and ADT who were burgled as children were still affected in adulthood.
In households that had been burgled, 53% of parents with children aged 0-15 said that their children had an emotional reaction to the crime (such as anger, shock, fear, sleeplessness and tears) (6). In 2014, Victim Support and the security company ADT found that 27% of children had trouble sleeping and more than 10% had trouble at school after a burglary (Victim Support & ADT). Some of these effects can be quite long lasting, as 37% of the adults interviewed by Victim Support and ADT who were burgled as children were still affected in adulthood.
2. Children are likely to already be aware of burglary, so it is an unobtrusive way to introduce shock, emotions and coping strategies – even if the traumatic event they experienced wasn’t burglary.
Burglary is extremely common, with over 700,000 occurring each year in the UK (7). This means that many children will have heard of it, or know someone in their class to whom it has happened. It also features in some famous children’s books, such as Burglar Bill. It is therefore an appropriate way to introduce the concepts of shock reactions and coping strategies – even if the event they have experienced is something other than burglary, e.g. being in an accident, moving home, moving school, medical treatment, parents’ separation, natural disasters, fire, violence, terrorism, bereavement, witnessing domestic violence and abuse.
Burglary is extremely common, with over 700,000 occurring each year in the UK (7). This means that many children will have heard of it, or know someone in their class to whom it has happened. It also features in some famous children’s books, such as Burglar Bill. It is therefore an appropriate way to introduce the concepts of shock reactions and coping strategies – even if the event they have experienced is something other than burglary, e.g. being in an accident, moving home, moving school, medical treatment, parents’ separation, natural disasters, fire, violence, terrorism, bereavement, witnessing domestic violence and abuse.
3. Sadly, those who experience one type of crime are often victims of other types of crime as well.
Children who have experienced burglary may experience other traumatic events in their lives (including more serious ones), and the effects can be cumulative (8). It is therefore important to equip this group with tools for resilience at an early age.
A report by The Children’s Society found that fear of crime was the top concern among teenagers (38%) and that this fear has a big impact on their wellbeing (Children's Society, 2017).
Children who have experienced burglary may experience other traumatic events in their lives (including more serious ones), and the effects can be cumulative (8). It is therefore important to equip this group with tools for resilience at an early age.
A report by The Children’s Society found that fear of crime was the top concern among teenagers (38%) and that this fear has a big impact on their wellbeing (Children's Society, 2017).
How does the book help?
1. It normalises a range of reactions to shock and trauma
NICE, the National Institute for Clinical Excellence in the UK, recommends the use of Trauma-Focused Cognitive Behaviour Therapy when children are experiencing symptoms of PTSD (NICE Guidelines). This is one of the most common therapeutic responses to trauma, and it is also one of the most researched. Lots of studies have found that Trauma Focused Cognitive Behavioural Therapy (TF-CBT) helps children to cope with what has happened to them and reduces symptoms (9).
The first step in TF-CBT is what is called “Psychosocial education” – this means helping children and their parents or guardians to understand the impact of trauma (10). This helps children recognise the ways in which trauma affects their bodies, thoughts, feelings and behaviour. It stops them from worrying about why they are feeling or acting a certain way. It also reduces stigma, as it shows that a range of different responses to trauma are completely normal. This in turn reduces shame, and it means that children are more likely to share how they are feeling with others.
In the book, we see some of the physical effects of shock such as a pounding heart and feeling weak at the knees. We then go on to see a range of emotional reactions to the incident – including anger, generalised fear, fear of separation and sleeplessness. Children who read the book said that they had been worried about their "weird" reactions, but seeing them in a book reassured them that they were normal.
NICE, the National Institute for Clinical Excellence in the UK, recommends the use of Trauma-Focused Cognitive Behaviour Therapy when children are experiencing symptoms of PTSD (NICE Guidelines). This is one of the most common therapeutic responses to trauma, and it is also one of the most researched. Lots of studies have found that Trauma Focused Cognitive Behavioural Therapy (TF-CBT) helps children to cope with what has happened to them and reduces symptoms (9).
The first step in TF-CBT is what is called “Psychosocial education” – this means helping children and their parents or guardians to understand the impact of trauma (10). This helps children recognise the ways in which trauma affects their bodies, thoughts, feelings and behaviour. It stops them from worrying about why they are feeling or acting a certain way. It also reduces stigma, as it shows that a range of different responses to trauma are completely normal. This in turn reduces shame, and it means that children are more likely to share how they are feeling with others.
In the book, we see some of the physical effects of shock such as a pounding heart and feeling weak at the knees. We then go on to see a range of emotional reactions to the incident – including anger, generalised fear, fear of separation and sleeplessness. Children who read the book said that they had been worried about their "weird" reactions, but seeing them in a book reassured them that they were normal.
2. It shows children the importance of building a support network
Some may think it is common sense to ask for help in difficult times, but often people try to deal with things on their own. Children may try to cope alone for all sorts of reasons – not knowing how to articulate the problem, not knowing who to trust, not wanting to be a burden, etc. Trickey et al., (2012) found that after a traumatic event, children are much more likely to develop PTSD if they don’t have social support or if they isolate themselves from others (11). Developing and maintaining a good support network is absolutely essential in children’s recovery after a traumatic incident.
Parents and guardians play a particularly important role as a source of support for children who have experienced trauma. For example, treatment for children is consistently most effective when it included parents or guardians (12).
In the book, the animals help one another develop a plan to cope. Fox learns to talk to the others about how he is feeling, and Badger tells his teacher about the burglary and asks for support at school.
Perhaps more importantly, the book provides a tool for parents who want to talk to their children but don’t know where to start. It prompts children to talk about their feelings without a parent having to ask probing questions – and starts a conversation through the very natural act of reading a story together.
3. It helps children and parents regain a sense of control
People who have experienced a traumatic event often feel that they have lost all sense of control over their lives. Certainly, there are some things that cannot be controlled. However, regaining a sense of control over one’s own wellbeing has been shown to help with recovery (13).
Stevan Hobfall and his colleagues gathered together a panel of experts to make recommendations on dealing with large scale trauma. The panel identified five intervention principles, one of which was the need to regain a sense of self-efficacy and another was the importance of hope (14). TF-CBT recommends that children are given a sense of control over their own state of mind through teaching them a range of relaxation and stress management skills.
In the book, the animals acknowledge that they can’t change what happened, but they also recognise that they do have some control over their own coping strategies. Each one of them creates his or her own plan. The book is careful not to suggest that the plans work instantly or flawlessly, but that they can make a difference over time.
Squirrel, who is the most fearful of the group, learns how to do the Flippety Floppety Rabbit – a variation on a common relaxation exercise, which is widely used with children and adults. The Flippety Floppety Rabbit exercise can be found at the back of the book.
People who have experienced a traumatic event often feel that they have lost all sense of control over their lives. Certainly, there are some things that cannot be controlled. However, regaining a sense of control over one’s own wellbeing has been shown to help with recovery (13).
Stevan Hobfall and his colleagues gathered together a panel of experts to make recommendations on dealing with large scale trauma. The panel identified five intervention principles, one of which was the need to regain a sense of self-efficacy and another was the importance of hope (14). TF-CBT recommends that children are given a sense of control over their own state of mind through teaching them a range of relaxation and stress management skills.
In the book, the animals acknowledge that they can’t change what happened, but they also recognise that they do have some control over their own coping strategies. Each one of them creates his or her own plan. The book is careful not to suggest that the plans work instantly or flawlessly, but that they can make a difference over time.
Squirrel, who is the most fearful of the group, learns how to do the Flippety Floppety Rabbit – a variation on a common relaxation exercise, which is widely used with children and adults. The Flippety Floppety Rabbit exercise can be found at the back of the book.
4. It helps children to express their feelings
One of the most important elements of TF-CBT is enabling children to identify, express and cope with their emotions (15). Children may not be able to identify their own feelings, which can lead to additional worry or shame. But expressing feelings can act as a release – lessening the power of the feelings because they are shared. Children may also believe that their feelings are completely beyond their control, but in TF-CBT they learn that there are ways to manage them.
The animals in the book learn that their feelings can’t be stolen, so they don’t need to keep them locked away and it is better to let them out. We see the feelings in and around the tree at the end of the story, and this page can be used to help children articulate their feelings. If they are struggling to find the words they can point to the green emotion characters instead.
One of the most important elements of TF-CBT is enabling children to identify, express and cope with their emotions (15). Children may not be able to identify their own feelings, which can lead to additional worry or shame. But expressing feelings can act as a release – lessening the power of the feelings because they are shared. Children may also believe that their feelings are completely beyond their control, but in TF-CBT they learn that there are ways to manage them.
The animals in the book learn that their feelings can’t be stolen, so they don’t need to keep them locked away and it is better to let them out. We see the feelings in and around the tree at the end of the story, and this page can be used to help children articulate their feelings. If they are struggling to find the words they can point to the green emotion characters instead.
Thinking about diversity...
Books with human characters are almost inevitably exclusive – focusing on people of one ethnicity or gender, for example. While a book with animal characters is not by definition inclusive, this book strives to present diversity through having four different characters. The four animals are friends, so no assumptions are made about family structure. There are two female and two male characters, and no “main” character. Their reactions to the crime are not stereotypically gendered, so children learn it is normal for girls and boys to feel the full range of feelings – e.g. for a girl to feel angry or a boy to feel scared.
References
1. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593. http://doi.org/10.1001/archpsyc.62.6.593
2. Cohen, J. A., Perel, J. M., Debellis, M. D., Friedman, M. J., & Putnam, F. W. (2002). Treating Traumatized Children. Trauma, Violence, & Abuse, 3(2), 91–108. http://doi.org/10.1177/15248380020032001
3. Trickey, D., Siddaway, A., Meiser-Stedman, R., Serpell, L., & Field, R. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122–38.
4. Osofsky, H. J., Osofsky, J. D., Kronenberg, M., Brennan, A., & Hansel, T. C. (2009). Posttraumatic stress symptoms in children after Hurricane Katrina: Predicting the need for mental health services. American Journal of Orthopsychiatry, 79(2), 212–220. http://doi.org/10.1037/a0016179
5. Terranova, A. M., Boxer, P., & Morris, A. S. (2009). Factors influencing the course of posttraumatic stress following a natural disaster: Children’s reactions to Hurricane Katrina. Journal of Applied Developmental Psychology, 30(3), 344–355. http://doi.org/10.1016/j.appdev.2008.12.017
6. Mawby, R. I., & Walklate, S. (1997). The Impact of Burglary: A Tale of Two Cities. International Review of Victimology, 4(4), 267–295. http://doi.org/10.1177/026975809700400403
7. Office of National Statistics: Crime Survey for England and Wales; Scottish Crime & Justice Survey; Northern Ireland Crime Survey.
8. Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19(3), 339–347. http://doi.org/10.1002/jts.20121
9. CATS Consortium. (2007). Implementing CBT for Traumatized Children and Adolescents After September 11: Lessons Learned from the Child and Adolescent Trauma Treatments and Services (CATS) Project. Journal of Clinical Child & Adolescent Psychology, 36(4), 581–592. http://doi.org/10.1080/15374410701662725
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135–145. http://doi.org/10.1016/j.chiabu.2004.12.005
Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually Abused Children Suffering Posttraumatic Stress Symptoms: Initial Treatment Outcome Findings. Child Maltreatment, 1(4), 310–321. http://doi.org/10.1177/1077559596001004003
10. National Child Traumatic Stress Network, N. C. T. S. (2004). How to implement Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). Durham, NC and Los Angeles, CA: National Center for Child Traumatic Stress. http://doi.org/10.1111/1475-3588.00051
11. See Note no. 3.
12. Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, L., Deppe, J., & Steil, R. (2016). Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children, Adolescents, and Young Adults: A Meta-Analysis. Clinical Child and Family Psychology Review, 19(2), 77–93. http://doi.org/10.1007/s10567-016-0202-5
13. Frazier, P., Berman, M., & Steward, J. (2001). Perceived control and posttraumatic stress: A temporal model. Applied and Preventive Psychology, 10(3), 207–223. http://doi.org/10.1016/S0962-1849(01)80015-9
14. Hobfoll, S. E., Bryant, R., Layne, C. M., Steinberg, A., Watson, P., Bell, C. C., … Gersons, B. P. R. (2007). Five Essential Elements of Immediate and Mid- Term Mass Trauma Intervention : Empirical Evidence Five Essential Elements of Immediate and Mid – Term Mass Trauma Intervention : Empirical Evidence, 70(4), 283–315. http://doi.org/10.1521/psyc.2007.70.4.283
15. See Note no. 10.
2. Cohen, J. A., Perel, J. M., Debellis, M. D., Friedman, M. J., & Putnam, F. W. (2002). Treating Traumatized Children. Trauma, Violence, & Abuse, 3(2), 91–108. http://doi.org/10.1177/15248380020032001
3. Trickey, D., Siddaway, A., Meiser-Stedman, R., Serpell, L., & Field, R. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122–38.
4. Osofsky, H. J., Osofsky, J. D., Kronenberg, M., Brennan, A., & Hansel, T. C. (2009). Posttraumatic stress symptoms in children after Hurricane Katrina: Predicting the need for mental health services. American Journal of Orthopsychiatry, 79(2), 212–220. http://doi.org/10.1037/a0016179
5. Terranova, A. M., Boxer, P., & Morris, A. S. (2009). Factors influencing the course of posttraumatic stress following a natural disaster: Children’s reactions to Hurricane Katrina. Journal of Applied Developmental Psychology, 30(3), 344–355. http://doi.org/10.1016/j.appdev.2008.12.017
6. Mawby, R. I., & Walklate, S. (1997). The Impact of Burglary: A Tale of Two Cities. International Review of Victimology, 4(4), 267–295. http://doi.org/10.1177/026975809700400403
7. Office of National Statistics: Crime Survey for England and Wales; Scottish Crime & Justice Survey; Northern Ireland Crime Survey.
8. Neuner, F., Schauer, E., Catani, C., Ruf, M., & Elbert, T. (2006). Post-tsunami stress: A study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. Journal of Traumatic Stress, 19(3), 339–347. http://doi.org/10.1002/jts.20121
9. CATS Consortium. (2007). Implementing CBT for Traumatized Children and Adolescents After September 11: Lessons Learned from the Child and Adolescent Trauma Treatments and Services (CATS) Project. Journal of Clinical Child & Adolescent Psychology, 36(4), 581–592. http://doi.org/10.1080/15374410701662725
Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2005). Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse & Neglect, 29(2), 135–145. http://doi.org/10.1016/j.chiabu.2004.12.005
Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually Abused Children Suffering Posttraumatic Stress Symptoms: Initial Treatment Outcome Findings. Child Maltreatment, 1(4), 310–321. http://doi.org/10.1177/1077559596001004003
10. National Child Traumatic Stress Network, N. C. T. S. (2004). How to implement Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). Durham, NC and Los Angeles, CA: National Center for Child Traumatic Stress. http://doi.org/10.1111/1475-3588.00051
11. See Note no. 3.
12. Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, L., Deppe, J., & Steil, R. (2016). Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children, Adolescents, and Young Adults: A Meta-Analysis. Clinical Child and Family Psychology Review, 19(2), 77–93. http://doi.org/10.1007/s10567-016-0202-5
13. Frazier, P., Berman, M., & Steward, J. (2001). Perceived control and posttraumatic stress: A temporal model. Applied and Preventive Psychology, 10(3), 207–223. http://doi.org/10.1016/S0962-1849(01)80015-9
14. Hobfoll, S. E., Bryant, R., Layne, C. M., Steinberg, A., Watson, P., Bell, C. C., … Gersons, B. P. R. (2007). Five Essential Elements of Immediate and Mid- Term Mass Trauma Intervention : Empirical Evidence Five Essential Elements of Immediate and Mid – Term Mass Trauma Intervention : Empirical Evidence, 70(4), 283–315. http://doi.org/10.1521/psyc.2007.70.4.283
15. See Note no. 10.
