The memories of a lifetime

To be abandoned by your mother in a strange town, or witness her murder, or that of your classmates, is a terrifying ordeal. How do very small children recall such events? Should they be encouraged to do so, or is time the only healer?best forgotten. By Liz Hunt

"Ma was a tall woman who will forever for me wear long black gloves up to her elbows. On the night of the commercial travellers' ball she and my father would come into my room and cuddle me. Even now as I write there's a sense of unbearable loss," wrote Bob Geldof in his 1986 autobiography, Is That It.

His mother had cuddled him on her knee before he went to bed, and the next day he was woken by his father who told him to say a prayer for his "mammy because she's gone up to see God and she might not be coming home for a while". She had died suddenly in the night from a brain haemorrhage aged 44. That day seven-year-old Bob Geldof played with the neighbour's children, and on the afternoon she was buried, he was taken to the cinema.

It was the early 1960s and children were thought to be tough, resilient, little beings, able to bounce back from anything - even the death of an adored parent. It was, more often than not, an excuse for distressed adults who could not bring themselves to talk about a painful subject. The child's loss and the reasons for it, their sense of abandonment, were not addressed. For many, like Geldof, who has described his family's reticence on the subject, the loss of a mother had a lasting impact still evident a quarter of a century later.

In more enlightened times, the trauma suffered by children such as four- year-old Steven Lane, abandoned by his distraught mother under some bushes in a park in Bournemouth last week, is no longer underestimated. His loss was temporary - Julie Lane, 33, was found on Friday and Steven is likely to be reunited with her soon - but it was no less traumatic an event for the child. The M40 coach crash which left 12 children dead in 1993; the massacre at Dunblane in March; the machete attack at a school in Wolverhampton, and the double murder of a mother and daughter in Chillenden in Kent recently, have emphasised how difficult it now is to safeguard children from horrific events that may have a lasting impact. That children are as vulnerable as any adult to post-traumatic stress disorder (PTSD) after experiencing or witnessing death or the disappearance of a primary carer, injury or violence, is no longer in doubt.

The turning point was the realisation that the memory of a child, even as young as three or four, is as good as that of an adult, although it may be hidden by the fact that they do not have the language to convey what they have experienced, and are unable to place the events in context. "Very young children can be as traumatised as older ones. They have less cognitive understanding. They remember everything but they can't let you know what they remember," says to Dr Dora Black, a consultant psychiatrist, director of the Traumatic Stress Clinic in London and a world authority on children and PTSD.

The key to healing is to draw out these experiences and to help the child to process the information and understand it, Dr Black says, so that the memory can be pass from the short-term to the long-term memory store in the brain. "If a child hasn't been able to do that, the traumatic event might pop back as a 'flashback' [in which the child relives the event] every time he or she is in a frightening situation."

Because memory is intensely visual at a young age, what emerges may be very graphic and intrusive, according to Dr Shamim Nahmud, a consultant clinical psychologist at Canada House, an NHS child and adolescent mental health unit in Medway, Kent. A child might not take in the full scene, but certain disturbing details will stand out in his or her memory. Sounds and smells linked with the event, for example, have a strong imprint - the olfactory and aural centres in the brain are highly developed - which can trigger unpleasant thoughts years later unless they can be placed in context. Nightmares, bedwetting, and clinging behaviour with an adult, are all common in children who have suffered PTSD. In severe cases the child may regress so far that for a while they will only eat babyfood or take a bottle.

Experts believe that the younger the child, the more severely they will feel their own helplessness in any traumatic situation. In addition, before the age of seven, children are egocentric creatures, for whom nothing happens which they are not at the centre of. If a parent is hurt or assaulted in their sight and hearing, or if their carer suddenly disappears, then the child may blame him or herself.

This vulnerability intensifies the need for preventive intervention - or as Dr Black has described it "emotional first aid" - which developed from the pioneering work of Professor Robert Pynoos, an American psychiatrist who studied the effects on pupils and staff at a Los Angeles School after a sniper killed a teacher and injured several pupils in the 1980s. Studies by Professor Pynoos and his colleague Spencer Eth in California have confirmed that children have vivid memories of traumatic events.

With very young children who cannot express themselves verbally, game- playing, drawing pictures, or story-telling is used to draw out experiences, and help them understand. It is hoped, for example, that drawing will be therapeutic for Josie Russell, the nine-year-old survivor of an attack which left her mother, Lin, and her six-year-old sister, Megan, dead along with the family dog, in an idyllic Kent beauty spot earlier this month. The police are also relying on this approach to draw details of the murderer from Josie. Although she is older than children for whom this device is routinely used, the attack has left Josie with a speech impediment and there is also concern that her brain may have blocked out the events of that terrible day. This protective mechanism is not uncommon in child survivors but must be resolved if possible in order to limit permanent psychological damage.

Before the age of five, a child is unable to give a connected narrative of events. He or she will recall the events but not in sequence which they occurred. The effectiveness of game-playing devices in circumventing this is illustrated by a recent experiment conducted by the Medical Research Council's Cognitive Development Unit at University College, London. A group of four-year-olds were presented with a complex and exciting (rather than traumatic) event in which a witch visited their nursery school. The following day researchers talked to the children about the events of the day before, and got monosyllabic answers, predominantly "yes" and "no", to their questions. A week later, the MRC scientists returned, and one of them sat down with the class to tell them a story about a witch visiting a school which prompted a cascade of information, along the lines of "Yes, that happened here too," from the children, says Professor John Morton, director of the Unit, and an expert on memory development. "Young children have no difficulty with complex information. The primary record is laid down at the time of the event, and what I call the secondary record, when the subject is talked or discussed with the child." That reinforcement of events with a toddler is something most parents will recognise.

Memory is largely dependent on language, vocabulary and the appreciation of other people's mental states, Professor Morton says. "The memory does not have the same kind of milestones in development that other functions of the human brain have. It is affected by other things and it develops as experience of life develops. The differences in people's memory are largely to do with their emotional development."

This does not mean that older children and teenagers are not vulnerable to PTSD too, despite having a greater cognitive understanding or ability. Their reactions may be complicated by guilt that they were unable to stop something happening, or fantasies of revenge or retaliation against the perpetrator of a violent action against themselves or someone close to them.

The devastating long-term effects of trauma if left untreated in this age group are apparent from a recent study of the survivors of a British school's cruise ship disaster. The SS Jupiter sank in just 40 minutes after being rammed by a freighter in October 1988. Four people died, including a pupil and a teacher. Psychologists at the Institute of Psychiatry in London, found that one in 10 of nearly 200 survivors who were 14 or 15 at the time of the accident, had since attempted suicide, and more than half had suffered severe psychological distress. Now in their early twenties, they are at least a year behind their peers in their studies, and fewer of them have gone on to university or obtained degrees. Julie Nurrish, a psychologist, said that the low uptake of psychological counselling and support - about 20 per cent - may have been a factor in the persistence and severity of the systems. Overall, the survivors felt they could not plan for the future because their lives could be cut short at any time, Ms Nurrish said.

Regardless of age, the foundation for effective preventive intervention is "love, comfort, and trust", according to Marion Gibson, a social worker with more than 20 years' experience in Northern Ireland and who trained some of the support workers now working in Dunblane, where 16 children and their teacher were slaughtered by Thomas Hamilton in March. She describes that event as a "landmark tragedy" because of the deaths of so many very young children which was witnessed by their peers. Younger children are often very affected by other people's response to their trauma, and will clam up if they feel someone else is shocked or distressed by what they are telling them, Mrs Gibson said, hence the need to create a secure and trusting environment to persuade them to talk about what happened.

That is certainly the approach now being adopted with Steven Lane. No one who saw pictures of the solemn-faced blonde, blue-eyed little boy last week, could doubt that he was suffering. Placed with foster parents whose brief, according to a spokeswoman for Dorset Social Services was "lots of tender loving care", and visited by his grandfather and other family members, he was described as "subdued and missing his mother desperately".

The security a young child feels is intimately bound up with the safety of his mother or primary carer. Reassurance that his mother is now safe, and explanations of why she went away from him, will be the next stage. According to reports, Ms Lane had been behaving strangely and Steven had been heard by neighbours, screaming for hours on end before his abandonment in the park. At age four, he would have been aware of the changes in his mother's mental state, according to Professor Morton. An explanation that "mummy wasn't well and the doctors were trying to make her better" would be something that had meaning to him. Talking about mummy is also vital to keep her as a real person for him; without this, other carers will replace her in his memories.

That preventive intervention does work is evidenced by one of the most horrific murder cases of recent times, the stabbing to death of Rachel Nickell on Wimbledon Common one sunny July day four years ago. Her three- year-old son, Alex, was found clinging to her body, and so traumatised that he was unable to speak for sometime after the event. Because of his importance as a potential witness, Alex, with his father Andre Hanscombe, had access to the expert psychiatric care of a team at the Royal Free Hospital, London, which specialises in child PTSD, particularly in cases where a parent has been murdered in the child's presence.

Now nearly seven, Alex lives with his father in France, and there has been no sign of post-traumatic distress disorder, say psychiatrists involved in his treatment. Recently, it has been suggested that Alex may be called on to help police with their continuing investigations into his mother's murder, by looking at photographs of suspects. While many would recoil at this, convinced that it could only do him psychological harm, Dr Black says there is an argument for it. "It is something that could be dealt with, and it may help him when he's older if he feels that he had some part in helping to catch and punish his mother's killer."