Even before a knife-wielding man attacked a group of elementary school students in Kawasaki on Tuesday, Japan had already seen news of children dragged into dreadful circumstances this year.

Earlier this month, a vehicle plowed into a group of toddlers on a sidewalk in Shiga Prefecture, killing two 2-year-olds and injuring 13 people. In April, an 87-year-old driver rammed into pedestrians in the Ikebukuro district of Tokyo, fatally striking a 3-year-old girl and her mother and injuring nine.

Although Tuesday’s attack, which left an 11-year-old girl and a 39-year-old father dead, differed in that it was a mass stabbing, all could be described as distressing events. And children are more at risk of suffering severe mental trauma, said Dr. Toshiko Kamo, a Tokyo-based psychiatrist.

“There are statistics and studies that have been done that show that the younger a child encounters a traumatic occurrence, the longer symptoms related to post-traumatic stress disorder tend to stay,” Kamo said.

Victims of the Tuesday attack were mostly students at Caritas Elementary School, a nearby private Catholic school, waiting for a school bus to arrive. The government has recommended schools employ school buses for safety.

The grisly incident stunned the world, as Japan is known for having one of the lowest violent crime rates among developed countries. Japan also has strict gun control laws that some say prevent mass killings from happening in the first place.

But according to 2013 statistics by the Justice Ministry, children under 9 years old comprise the largest group of victims of indiscriminate attacks by age group. The research examined random attacks whose suspects were convicted between March 2000 and March 2010.

Of the 126 victims, 32 were children age below 9, or 25.4 percent. Fifteen were boys and 17 were girls.

Since a man stabbed eight students to death at an elementary school in Osaka in June 2001, schools nationwide have tightened up security.

Tami Yanagita, an associate professor of clinical psychology at Taisho University in Tokyo, said following the 2001 Osaka attack, professionals have become more ready to respond to tragedies.

“I believe (Caritas Elementary School) is taking appropriate measures regarding care,” Yanagita said, emphasizing how the school was in touch with Kawasaki’s mental health team and Kanagawa Prefecture’s emergency response team within the same day.

At this point, the victims of the Kawasaki attack are likely going through acute stress, which usually lasts up to a week depending on individuals, Kamo said. The symptoms — appearing 80 percent of the time — include nightmares, sudden flashbacks to the episode and memory loss.

Counselors usually perform an assessment shortly after a tragic event instead of diving straight into treatment, Kamo said.

If such symptoms last for more than a month, Kamo said doctors would diagnose PTSD. In some cases, the effects of PTSD persist for years, the psychiatrist added.

“If a child is scared to go to school, it is effective if a guardian accompanies the child to and from the school,” Kamo said.

The children and family members affected by Tuesday’s attack are in a great state of shock, Yanagita said, so it is important for local residents to step up to support them in regaining normalcy. She advised people to not be inquisitive about the case, to avoid engaging in rumors and to reach out to help with daily tasks.

“(The children) experienced an extraordinary event,” Yanagita said. “What is ordinary for those children are their lives at home and school. Thus, I think it is important for the local community to help them feel at ease and function well in those places.”

For households with a child, Yanagita suggests parents avoid exposure to graphic images and explain what happened.

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