Survivors and mental health experts share what they know about the long-term impact of school shootings on children

(CNN) — Rebekah Schuler was walking to her 10th grade history class with her best friend, each with a shared headphone in her ear, blasting their favorite song, when gunshots and bloodcurdling screams sent them running for their lives.

It has been nearly three years since the 2021 Oxford High School shooting in suburban Detroit that killed four of her classmates, but time has shown her little mercy.

Sometimes she can restrain the flashbacks, tucking away the disturbing reminders into the darkest corner of her mind, but on other days she finds herself helplessly falling into the nightmare of her vivid memories. As if trapped in quicksand, every desperate attempt to crawl out of the flashback lodges her deeper into it.

Schuler, who was 16 at the time, is one of an estimated 3 million children and teens exposed to shootings every year in America. More than 1,300 of them have occurred in schools in the past decade, leaving students deserving of a nurturing education with trauma, according to Everytown for Gun Safety, an anti-gun violence advocacy non-profit organization.

One of the latest shootings, at Apalachee High School in Winder, Georgia, killed two 14-year-old students and two teachers and injured nine others. There have been at least 46 school shootings in the United States so far this year, as of September 6.

Mental health professionals who are studying the effects of shootings on young people have highlighted in their research an urgent need to provide survivors like Schuler with access to resources, like therapy, to manage resulting mental health issues that can permanently alter the trajectory of their adult lives.

“We are growing a whole population of kids who will eventually be adults with anxiety disorders, post-traumatic stress disorder, and lack of trust and fear in the world around them, all which they wouldn’t have had if it were not for the shootings,” Dr. Gail Saltz, a psychiatrist and clinical associate professor of psychiatry at the New York-Presbyterian Hospital and Weill Cornell Medical College, told CNN.

“Without help, this causes avoidance, avoidance of school, the very thing that they need to be able to truly grow as adults and be successful in life,” Saltz said. “We need to be really coming in right away with resources, with money to ensure their access to treatment, treatment that might need to go on for long periods of time.”

By responding to their mental health needs quickly and early, parents and educators can help survivors of school shootings find stability in their futures as they learn to live with their new reality.

“Do not wait,” Saltz warned. “Ignoring it and hoping that it goes away won’t work.”

Recognizing and responding to trauma

Immediately following a school shooting, survivors who were in the direct vicinity of the attack – such as in the classroom where it happened – as well as students who were in the building at all may begin to exhibit signs of distress.

“They can develop some sort of an anxiety disorder. Some of those who were in close proximity will also develop symptoms of an acute stress reaction. If that persists and they continue to have anxiety, depression, difficulty sleeping or intrusive flashback memories of the event, it may make them want to avoid things that remind them of that time,” Saltz said.

The signs of mental distress can turn into an urge to avoid what is causing the distress, in this case, going to school where the traumatic event occurred, which can eventually lead to a disruption in their education.

“You may see their grades start to drop. You may see them retreat into their room or not socialize with friends as they used to, not enjoy things that they were formally enjoying, sort of isolate themselves more. They may also have difficulty with sleep, with appetite,” Saltz added.

Signs of distress will appear in children differently, depending on their age. Some may not appear distressed or unhappy at all, but will show serious symptoms of regression in behavior and developmental milestones.

“They had been able to go for sleepovers at their friend’s house. They can’t do that anymore,” Saltz said. “They had been able to sleep through the night. They can’t do that anymore. They had been able to separate from you. They can’t do that. For very young kids, they’ve been toilet trained, but now they regress and they’re having accidents.”

Along with seeking professional help, parents can aid in their children’s trauma response by allowing them to express their feelings through various outlets aside from verbal communication, like journaling or drawing.

“Let your child talk to you about what they’re feeling. You don’t need to demand that they tell you what went on or repeat it if they don’t want to, but that you understand and just sort of be with them,” Saltz said. “Be comforting, make it clear their safety is everything.”

If weeks after the shooting the child remains severely anxious or exhibits a low mood and avoids regular habits, hobbies and routines, Saltz urges parents to find them a therapist. She does not advise parents whose children want to avoid school to encourage them to stay home or skip classes.

“If your child is academically disengaging in any way, having difficulty sleeping, having a change in appetite, not able to be with friends in the way they had before, if you are seeing symptoms, bring them in for an evaluation, but I would not encourage avoidance,” she said. “If you say to your child, ‘Oh, you’re scared, don’t go to school’ then you’ve validated it’s dangerous to go to school, and it worsens their anxiety in the long run.”

Long-lasting mental health issues

For many survivors of school shootings, their mental health can continue deteriorating over time and have a severe impact on their normal development, school functioning and relationships.

“If their symptoms begin to disrupt their life, then we might say they have post-traumatic stress disorder,” Saltz said.

Maya Rossin-Slater, an associate professor of health policy in the Stanford University School of Medicine, authored a 2022 policy brief analyzing the detrimental impact school shootings have on the mental health, education and earnings of American youth.

“We found that in the aftermath of a fatal shooting, we see a heightened rate of antidepressant prescriptions amongst youth under age 20, and that persists for a long time,” Rossin-Slater told CNN, adding prescriptions for anxiety, PTSD and depression related to the shock and trauma persist for at least five years after the shooting.

One month after the Oxford High School shooting, Schuler was diagnosed with PTSD. Throughout the years, she has tried a variety of therapeutic treatments to help her navigate uncontrollable flashbacks and severe anxiety.

“I can still see them running, I can remember in detail the screams, the sounds, every detail,” Schuler said. “Yes, I have coping skills, and have worked through trauma, but it’s still there and present and affecting my day-to-day life.”

This fall, she started college at the Rochester Christian University, where she is majoring in communications. Despite her excitement as a freshman, Schuler says she is struggling to manage the anxiety and fear that comes with the unfamiliarity of her new campus.

“I wasn’t always like this, constantly looking around wherever I go, monitoring my surroundings,” Schuler said. “I never thought this would happen to me.”

Crowds, loud noises and sirens sometimes still trigger flashbacks and panic attacks, despite attending weekly counseling, practicing coping skills she learned in therapy, and undergoing eye movement desensitization and reprocessing therapy, an evidence-based treatment that can help reduce negative emotions associated with traumatic events.

In Denver, Stella Kaye, a senior at East High School where there were two shootings in 2023, also struggles with long-term anxiety. She avoids movie theaters due to being unable to examine the people around her and easily reach a safe exit. When visiting her favorite farmer’s market, she walks along the outskirts, ready to run if needed. Big crowds, including concerts, pep rallies and parties, are difficult and sometimes impossible for her to attend.

Both Kaye and Schuler said the latest school shooting in Georgia has left them “heartbroken” for the victims and survivors, like themselves, who have a long road ahead.

“You are not alone, you have unfortunately but kind of fortunately, joined this network of and community of incredible survivors,” Kaye said, speaking to survivors of school shootings. “It’s hard to cope with what has happened to you or to people you know, but it’s OK to not know how to feel, and it’s OK to not know what to do next, and it’s OK to take time and to just be confused and to just be sad and to just be angry and to just be grieving the loss. And it’s OK to feel all the things that you’re feeling, because what happened to you is not natural.”

The risks of ignoring early signs of mental health issues

An urgent response to mental health issues arising in children and teens who survive a school shooting, or gun violence in general, is critical to preserving their future, both Saltz and Rossin-Slater caution.

“What we found is that for these kids, we see lasting impacts on their educational trajectories,” Rossin-Slater said. “They’re more likely to start being chronically absent, more likely to need to repeat a grade, they’re less likely to graduate high school, they’re less likely to go into college, they’re less likely to graduate from college, and then they have lower earnings as young adults.”

The sooner they receive treatment, it reduces their chance of relapsing into avoidant behaviors that affects their mental health and ability to focus on their passions, futures and dreams, according to Saltz.

“When you take a child and you give them a mental illness, their functioning in all domains will suffer,” Saltz said. “The goal is to treat that as soon as possible, so that you can put them back on the developmental path that they would have been on if it weren’t for the shooting.”

The effects of the trauma can take time to appear in some people, and ignoring signs of mental health issues in children can result in the consequences surfacing years later when they’re adults and suddenly developing anxiety and mood disorders or PTSD related to the shooting, according to Saltz. The impact may also be evident in their ability to function normally in college or work, and they will struggle to maintain social relationships.

While some might need mental health treatment for the rest of their lives, even just 10 therapy sessions “can make a lifetime trajectory difference” for children, she added.

“Having a mental health issue is the same as having a health issue,” Saltz said. “You can’t just will your way out of it. It isn’t a moral failing. Your brain is an organ, and there was a problem in that organ, and it needs treatment – just like if you have diabetes, you need insulin. If your child broke a bone, you wouldn’t say ‘well, too bad we’re not going to the doctor.’”

Along with early detection of the warning signs and appropriately responding to them by seeking professional help, both mental health professionals say long-term support from family, schools and communities will play important roles in helping children recover and manage their trauma.

School and community leaders should prioritize easy and affordable access to mental health care so families can quickly find professionals for their children without struggling to pay for them, Rossin-Slater said.

In America, where millions of youth have been impacted by gun violence, a growing community of survivors – like Schuler and Kaye – have united in activism against gun violence and solidarity with other survivors. Both now volunteer with Students Demand Action, a part of Everytown for Gun Safety, which is made up of high school and college students who are working toward a future free from gun violence.

“Ask for help. Don’t be afraid to say no, you don’t have to share your story, you don’t have to tell the whole family what happened. You have so many people who want to support you, find those people you are comfortable having around, and lean on them,” Schuler said.

“Your trauma doesn’t define you and you’re not supposed to move on from it. It’s still going to be a part of you, it’s still going to be with you, but you can do it and you won’t have to do it alone.”

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