(NEW YORK) — As the United States reels from yet another mass school shooting, experts warn that young children are suffering from its devastating impacts.

A total of three children, all age nine — as well as three adults — were killed at the Covenant School in Nashville in what President Joe Biden referred to as “sick” and “heartbreaking.”

Children can respond in a wide range of ways including being numb to the event, being more angry or irritable, suffering from high anxiety and being fearful of going back to school, according to mental health experts.

“As a pediatrician, and as a father, I think it makes common sense that when kids are exposed to this sort of thing, that it would have potentially long-term consequences for them,” Dr. Marc Gorelick, president and CEO of Children’s Minnesota hospital, told ABC News.

He continued, “And the research actually bears that out, that there are, in fact, significant behavioral and psychological impacts on children who either are victims of or witness to or even around events, such as this shooting in Nashville.”

Doctors told ABC News what signs parents can look out for and how to best help their children cope.

Mental health impact of witnesses to a shooting

Dr. Daniel Marullo, a clinical psychologist from Children’s of Alabama Hospital, told ABC News that many children develop resilience, or an ability to overcome serious hardships.

However, he says gun violence can impact a child’s mental health, especially if they are witness to such an event.

“What would be considered a typical reaction could range everywhere from changes in mood, including being sad, angry, irritable, lowered frustration tolerance to having sleep problems,” he said. “Certainly, a child may be more prone to having some nightmares or scary dreams, you might see changes in appetite.”

Marullo said children who experience a traumatic even such as a shooting may have more trouble focusing and concentrating or are more easily distracted.

Experts said responses can depend on age, as well.

‘The impacts on them tend to fall into two categories,” Gorelick said. “Like older kids, they will often have symptoms of post-traumatic stress, that could be nightmares, sleep problems, avoiding certain locations, including avoiding school, because of the associated trauma.”

“Younger kids tend to have symptoms that reflect in things like withdrawal, depression, anxiety…in response to being a party to or witness to community violence, gun violence,” he added.

Wide scale of emotional response
Dr. Scott Krakower, a child and adolescent psychiatrist at Northwell Health in New York, told ABC News that children can experience a wide range of emotions following a traumatic event.

Some children may be affected but may not show any emotion because they’re numbed or withdrawn after the event, he explained.

“Everybody’s different they might have more emotions, heightened levels of emotional states, avoidant behaviors, avoidance of the actual event itself, or memories related to the event, or going into even school itself, where they know that that’s the trigger of them,” Krakower said.

He continued, “Some of them probably have feelings of survivors’ guilt, like, what if they could have done things differently for themselves?”

Children impacted indirectly

The effects are not just on the children who attended a school where a shooting occurred, but those who live in the surrounding community or even in another state.

About four in 10 Americans believe they may become a victim of gun violence within the next five years, according to a UChicago Harris/AP-NORC Poll released in August 2022.

“One of the sad things, for kids, you don’t have to be that close to it to be affected by it and even just hearing about it on the news, knowing that it happened to kids like yourself, kids that you might know or kids in your community can have those same effects,” Gorelick said.

“What parents should be looking for in their children in the aftermath of event like this is showing signs of anxiety, showing signs of fears, showing signs of being worried about themselves because of what they saw or heard about,” he continued.

Resuming a normal routine

Experts say it’s important to make sure children are provided as much structure as possible after a traumatic event to help with their development and well-being.

Amidst the chaos that follows a shooting, routines either at school or home can help reassure children that they will be okay.

“One thing is to get back to normal, get back to routine,” Marullo said. “Getting back to that kind of structure is very important. That really provides a sense of security for kids.”

However, resuming routines doesn’t mean pretending the event didn’t happen, Marullo said, adding that adults should make sure children feel safe talking about their feelings.

“If a child brings up feeling scared, really validating that it’s okay to feel that way and helping them understand that they are safe, and here’s what we’re doing to help you out,” he said. “Just kind of recognize that this was scary, and you’ve got a right to be afraid, but giving them the tools to help them cope and manage.”

The experts say some children may benefit from at least brief therapy, either working with a psychologist or a counselor to process any feelings or fears they’re experiencing, even if they don’t develop a psychological disorder.

Help support adults’ needs

Experts say it’s important that adults take care of their own needs after a traumatic event because helping them will, in turn, help their child.

“If you want to help your child, you’ve got to help yourself,” Marullo said. “By an adult taking care of themselves, they are showing and demonstrating to their child or if they were a teacher to their class, how to cope and manage.”

He explained that because children look to adults for safety and security, how adults cope with a traumatic event will influence how children do the same,

“So, it’s not that you hide your emotions, but you manage your emotions, and it’s okay to say, ‘Look, I’m scared too, but this is what I’m going to do to feel better’ or ‘I’m upset, I’m angry, but here’s how I’m going to use my anger,'” Marullo said.

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(NASHVILLE, Tenn.) — After authorities said the Nashville school shooter identified as transgender, anti-trans sentiment about the community surged from far-right political figures.

Gun reform advocates and LGBTQ activists say the transgender community is being used as a “scapegoat” and that focusing on the shooter’s reported trans identity is a distraction from what they say is the root of the issue: guns.

“Despite what the gun industry and their political allies want, attempting to find a scapegoat isn’t going to take away from the fact that what is causing gun violence in America is our easy access to firearms,” said Kris Brown, president of the Brady Campaign to Prevent Gun Violence.

Advocates say transgender people have historically and falsely been categorized as violent or dangerous – perpetuating anti-transgender sentiment and further ostracizing a vulnerable and small population.

“Every study available shows that transgender and non-binary people are much more likely to be victims of violence, rather than the perpetrator of it,” the Human Rights Campaign said in a statement following the shooting.

“Regardless of the reason for this shooting, the use of violence is reprehensible and we renew our call for common-sense gun safety.”

Three students and three staff members were shot and killed at the Covenant School in Nashville on Monday morning. The Metropolitan Nashville Police Department identified the victims as Evelyn Dieckhaus, 9; Mike Hill, 61; William Kinney, 9; Katherine Koonce, 60; Cynthia Peak, 61; and Hallie Scruggs, 9.

Several conservative political figures, including Sen. J.D. Vance, Rep. Marjorie Taylor-Greene, and Donald Trump Jr., were among the personalities on social media who implicated the role of the shooter’s transgender identity in the shooting. The motive for the shooting remains unknown, according to authorities.

Transgender people are more than four times more likely than cisgender people to experience violent victimization, according to a study by the Williams Institute at UCLA School of Law. Because of this, activists fear anti-trans sentiment will only lead to more violence against transgender people in a time when state legislators across the country have been targeting this community through legislation, restricting access to gender-affirming care and spaces.

James Alan Fox, a professor of criminology at Northeastern University, maintains a database on shootings dating back 17 years. He said he’s been studying the topic of shootings for 41 years, and defines a mass shooting as four or more killed in a single event, not including the shooter.

He says he has not seen another case of a mass shooter being transgender in that time. The overwhelming majority of mass shootings are committed by cisgender men.

“I’m not aware of other cases like that,” Fox said. “Unless it was not reported, I would have known about it.”

“When you talk about mass killing it’s even more of a male activity,” Fox told ABC News.

He told ABC News that, according to his database, there have only been four female mass shooters who have killed four or more people in a single event in the United States since 2006.

Anti-gun violence activists are instead turning their attention to the national debate around guns and gun violence.

“I am devastated and angry,” said former Arizona Congresswoman Gabrielle Giffords, who was shot in the head in 2011 while meeting with constituents and now runs the gun violence prevention organization GIFFORDS.

“At least three innocent children and three adults lost their lives to another incident of senseless gun violence. Countless people, including young kids, will be left traumatized by this tragedy. No parent, student, or teacher should live in fear of a mass murder at school. Enough is enough. Our leaders need to act. We stand with the Nashville community and remain committed to fighting gun violence. We owe it to our children and future generations.”

ABC News reporter Bill Hutchinson contributed to this report.

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