What the research says about how our kids heal.

When parents ask us why the fund pays for pumpkin patches and pizza days and pajama parties instead of something that looks more like treatment, this is the answer. It is not a hunch. It is what the evidence says children who were in the building that day need — now, and for years.

Every child who was there was exposed. The dose is different.

The first careful study of children after a school shooting followed 159 elementary students after a sniper attack on their playground in Los Angeles in 1984. How close a child was to the violence — physically and emotionally — predicted their symptoms more than age, sex or anything else. A month later, 38% of the children had moderate-to-severe post-traumatic stress, 22% mild, and 40% none.¹

Fourteen months on, exposure was still the strongest predictor: about three in four of the directly exposed children still had symptoms, compared with one in five of those who weren't there. Two things raised symptoms even in children who weren't physically close: knowing the child who died, and feeling guilty. Grief showed up at every level of exposure.²

Hearing it counts. The National Child Traumatic Stress Network lists heightened sensitivity to sound — loud noises, screaming — and strong reactions to reminders (classmates who were there, police, memorials, news images) as expected responses after a school shooting.³ Hundreds of our kids heard it, hid from it, and were walked out. They are all in.

What it looks like in a seven-year-old

Trauma in young children does not look like trauma in adults. Child trauma specialists describe nightmares about monsters, play that re-enacts what happened over and over, going back to bedwetting or thumb-sucking, trouble concentrating, sleepwalking, headaches and stomachaches, and a worry that never quite switches off.⁴ Young children may become clingy, cry more, sleep worse, play less, or lose skills they already had.⁵

Very young children tell the story through play — making popping sounds, hiding in a closet to show what sheltering in place was like. Having a story helps a child make sense of what happened.⁶ And changes in play are themselves a signal: re-creating the event, or playing less often, less freely, less creatively.⁷

Most children recover. Some will need help later than you'd expect.

Across the research on young people after school shootings, most show resilience with no long-term dysfunction, while a minority develop severe, lasting symptoms. Which path a child takes depends on how they were doing before, what happened to them that day, and what happens after.⁸ A 2026 review found that most child survivors of mass shootings show acute stress at first — about a third meet criteria for acute stress disorder — but only a few go on to persistent PTSD, and most return to how they were. Children show higher rates than adults exposed to the same event. Social support is one of the strongest protective factors.⁹

The clearest picture of the paths comes from a campus shooting where researchers happened to already be studying the students, so they knew how everyone was doing beforehand. Over the next 31 months:¹⁰

The resilient group had less prior trauma, less exposure, and stronger skills for managing big feelings. People who felt supported by those around them were the most likely to recover from the initial spike.¹¹ In a Finnish school-shooting study that followed students at 4, 16 and 28 months, the students with secure, trusting relationships recovered best; those without still carried intrusive memories and jumpiness two years later.¹²

Two more things the evidence is clear on. First, the course is not a straight line. Some children show distress right away; others seem fine for months and then struggle; some get better and then have it come back — at a first sleepover, the start of middle school, the next time a school shooting is on the news. Disaster psychiatrists estimate 10–15% of survivors will need some form of help at some point in the months and years ahead.¹³ After Sandy Hook, needs were still emerging two years out, and Newtown built a support plan to run 12 to 15 years — until the youngest survivors were adults.¹⁴ Second, it reaches into school and life: children exposed to a shooting at school miss more days, repeat grades more often, and are less likely to finish high school and college.¹⁵

What helps, according to the people who study it

• A calm, supported parent. Children's reactions track their caregivers'. The single most powerful tool for helping a child feel safe is a steady adult.⁷ That is why we fund parents, too — the dads group, the parent groups, the CVC help.
• Routines. Knowing what comes next restores safety. Pizza night stays pizza night.⁷
• Being with the people who went through it. After 9/11, researchers found the support of those who shared the experience to be enormous.¹⁶ Until Silver Rail reopens, our kids are apart from their classmates. Our events exist to put them back together.
• Permission to tell the story — through words or play — without being grilled.³
• Less news. After the Oklahoma City bombing, how much coverage a child watched predicted their stress — even in children with no direct exposure at all.¹⁷
• Lifting the guilt. Young children often believe they could have stopped it. They need to hear, more than once, that they did not cause any of it.³
• Real treatment when it's needed. If reactions are intense or last more than a couple of months, the therapies with the strongest evidence for children who witnessed violence are Trauma-Focused CBT and, for the youngest, Child-Parent Psychotherapy.¹⁸ Oregon's Crime Victims' Compensation pays for it. We help parents apply.

Why play is medicine, not a distraction

The American Academy of Pediatrics says it plainly in its clinical report The Power of Play: play is a buffer against toxic stress; when a child has been through adversity, play becomes more important, not less; and the shared joy between a child and a caring adult during play regulates the body's stress response. The Academy tells pediatricians to prescribe it.¹⁹

Eliana Gil, the clinician who literally wrote the book on posttraumatic play, draws the line every parent should know. In dynamic play, a child re-enacts what happened but the story moves — the child takes control, changes the ending, and relief follows. That play is healing, and it should be welcomed. In stuck play, the same scene repeats rigidly, nothing changes, and the child stays distressed. That play is a signal the child needs a trained therapist to help it move.⁴ After Sandy Hook, Georgetown child psychiatrist Matthew Biel put it the same way: playing it out is how children gain mastery over something overwhelming, and it is only a concern if the child is clearly distressed while playing.²⁰

The evidence that play-based support works after collective violence is consistent. A review of children's play after disasters and political violence found that how children play tracks how they are adapting; that prevention after a community trauma must give children safe places to play with supportive adults; and that play works best when parents are part of it.²¹ Play-based programs with children who have lived through war reduce trauma responses, and when parents or teachers join in, the adults' stress drops and their parenting gets more trauma-informed.²² In one 2025 study of child survivors of violence, the strongest evidence for play was in trauma recovery itself — less anxiety and depression, better attention, and positive memories coming back online. The children described play as the thing that made them feel at home again.²³

Play therapy more broadly has a deep evidence base: meta-analyses covering more than 90 controlled studies and 3,000 children find meaningful, significant effects on anxiety and behavior, strongest when caregivers are involved.²⁴ We will be honest about one thing, because honesty is how we keep your trust: play therapy is not yet formally classed as an evidence-based treatment for diagnosed PTSD the way Trauma-Focused CBT is. The experts' consensus is that play and clinical care are complements, not substitutes.²⁵ That is exactly how we use it.

So this is what the fund does

1. Protected, joyful, adult-supported play for every child who was there — the universal layer. Pumpkin patches. Pizza days. The floor is lava. Sensory-safe rooms for our special-education kids, bilingual volunteers, and a counselor in the building at every event.
2. Together, with the kids who shared it. Group play with classmates is not a nice-to-have; it is one of the most protective things in the research.
3. Parents in the room. Because a regulated caregiver is the active ingredient, we support parents directly — groups, Crime Victims' Compensation help, and a volunteer protocol that puts trained, background-checked adults around our families.
4. Trained eyes on the play. Our events include a therapeutic presence so that the child whose play isn't moving gets noticed, and gets routed to real clinical care — paid for, and for as long as it takes.

Children who were at school that day didn't all experience the same thing, and they won't heal on the same timeline. Most will recover. The ones closest to it — who saw it, heard it, lost a classmate or a teacher, or carry guilt about it — are the ones most likely to struggle, and sometimes not until a year or two later. What helps most is steady adults, routines, being together, and play — not as a distraction from what happened, but because play is how children process what they can't yet say. Pediatricians prescribe it. Child trauma therapists watch it to know who needs more. That is what this fund is built to provide, for as long as our children need it.

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Sources

1. Pynoos RS, Frederick C, Nader K, et al. Life threat and posttraumatic stress in school-age children. Archives of General Psychiatry 1987;44:1057–1063. ojp.gov
2. Nader K, Pynoos R, Fairbanks L, Frederick C. Children's PTSD reactions one year after a sniper attack at their school. American Journal of Psychiatry 1990;147:1526–1530. psychiatryonline.org
3. National Child Traumatic Stress Network. Parent Guidelines for Helping Youth after the Recent Shooting; Parent Guidelines for Helping Youth after Mass Violence. nctsn.org (PDF)
4. Gil E. Posttraumatic Play in Children: What Clinicians Need to Know. Guilford Press, 2017. guilford.com
5. Scheeringa MS et al., summarized in Garcia AR et al. Utilization of evidence-based treatment models at community-based mental health settings for young children exposed to violence. Children and Youth Services Review 2020. sciencedirect.com
6. Ghosh Ippen C, Lieberman AF, Van Horn P. After the Shooting: Helping Young Children Heal. UCSF Child Trauma Research Project / NCTSN, 2005. PDF
7. Boston Medical Center, Child Witness to Violence Project. Understanding Trauma and Exposure to Violence. bmc.org
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13. Psychiatric News (American Psychiatric Association), 2013. Conn. community will need ongoing MH vigilance, say experts (Kraus, Cozza, North). psychiatryonline.org
14. CBS News, Dec 2014. Mental health problems still emerging two years after Sandy Hook (Brymer, UCLA-Duke National Center for Child Traumatic Stress). cbsnews.com
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16. Brymer M (NCTSN), quoted in AP coverage, Dec 2012. Experts: kids are resilient in coping with trauma. link
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18. Humble JJ, Summers NL, Villarreal V, et al. Child-centered play therapy for youths who have experienced trauma: a systematic literature review. Journal of Child & Adolescent Trauma 2019;12:365–375. pmc.ncbi.nlm.nih.gov
19. Yogman M, Garner A, Hutchinson J, et al. The Power of Play: a pediatric role in enhancing development in young children. Pediatrics 2018;142(3):e20182058. healthychildren.org · full report (PDF)
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21. Cohen E, Gadassi R. The function of play for coping and therapy with children exposed to disasters and political violence. Current Psychiatry Reports 2018;20:31. springer.com
22. Exploring play-based interventions with war-affected children: a scoping review. Children and Youth Services Review 2025. sciencedirect.com
23. "Playing helps you feel at home": recovery and reintegration of child victims of political and social violence. 2025. pmc.ncbi.nlm.nih.gov
24. Lin Y, Bratton SC. A meta-analytic review of child-centered play therapy approaches. Journal of Counseling & Development 2015;93:45–58; Bratton SC, Ray D, Rhine T, Jones L. The efficacy of play therapy with children: a meta-analytic review. Professional Psychology 2005;36:376–390. a4pt.org
25. Ray D. Trauma, Play Therapy, and Research. Psychology Today, 2020. psychologytoday.com

Written by Silver Rail parents from the published research. It is general information, not medical advice. If you're worried about your child, talk with their doctor or a counselor — and email hello@silverrailchildrensfund.org; we'll help you find one, at no cost to you.