Childhood_Ptsd

According to the National Institute of Mental Health, Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. The DSM-IV has four different criteria for diagnosing a child or adult with PTSD. These include: the individual experienced, witnessed, or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and the response involved intense fear, helplessness, or horror. In children, this may be expressed instead of disorganized or agitated behavior; The trauma is persistently re-experienced; The individual persistently avoids stimuli associated with the trauma, or revels psychological numbing of general responsively; and the individual presents with symptoms of increased arousal (Augustyn et al., 1996). Symptoms of PTSD include repeatedly re-experiencing the event through intrusive thoughts, dreams or flashbacks or intense fear on exposure to similar circumstances, persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness, increased arousal symptoms such as sleep problems and irritability, duration of more then 1 month and significant functioning impairment (Turk et al, 2005). The objective of the first article was to examine the psychiatric comorbidity between children presenting with PTSD and traumatized children not developing this disorder. The sample size of the study was made up of 117 children ages 6-12, who were before a juvenile/family court secondary to experiencing significant child abuse and/or trauma (Augustyn et al., 1996). The parents were also asked to participate in the study and 87.3% of them agreed. With the parents consent, the testers were able to do a child examination (clinical and structured), have access to parent and child protective service worker history, and a review of the court and protective service records. The measures of the questions came from clinical interviews, child structured interviews, and the diagnoses of the mood disorders of the children. According to the DSM criterion, these included: Mood disorders (dysthymic disorder, major depressive episode, and bipolar disorder), Anxiety disorders (panic disorder, specific phobias, generalized anxiety disorders, and social phobia), brief psychotic disorder, schizophrenia, and psychotic disorder NOS, conduct disorder, oppositional defiant, enuresis, encopresis, anorexia, bulimia, ADHD, and suicidal ideation. After the children were examined using the Wilcoxon Sum Ranks and Fisher’s Exact tests, the results were as follows: 27 % of the African American students were diagnosed as PTSD and 46% of the Caucasian students were diagnosed. There were no differences in mother’s education or family income. The difference in gender was 22 of the 48 males met criteria and 19 of the 69 females. In terms of the comorbidity, ADHD, brief psychotic disorder NOS, and anxiety disorders were most common among PTSD children relative to the comparison group (Augustyn et al., 1996). It should also be noted that 14.6% of the PTSD children have had suicidal thoughts compared to the 1.3% traumatized children not diagnosed with PTSD. The study found no link between oppositional defiant disorder, conduct disorder, and PTSD. The second article I chose focuses on the treatment practices for childhood posttraumatic stress disorder. The objective of the article is to study surveyed practices in treating childhood PTSD among child psychiatrists and non- M.D. therapists with self-identified interest in treating traumatized children. The instrument used was a 4 page survey, 19 medical and 20 non medical item questionnaire written by the investigators to identify clinical practices used by psychiatrists and on medical therapists to treat children and adolescents with PTSD (Cohen et al., 2001). The survey was mailed to 667 participants with 240 being completed and returned. Of those 240, 89 were medical responses and 151 of them were non medical responses. Out of the completed surveys, 81 of them said they did not treat children with PTSD. Of the surveys that did treat children with PTSD, 13 different types of therapy were mentioned (Psychodynamic, family, group, EMDR [Eye Movement Desensitization and Reprocessing], Crisis Counseling, Creative Art, CBT, Supportive, Nondirective Play, Pharmacology, Hypnosis, Biofeedback, and other). The respondents were first asked which type of therapy they would recommended or have used. 89.6% of medical respondents said pharmacology versus 23.1% of non medical respondents. Another significant difference was in the psychodynamic therapy. 67.5% of medical respondents said they used or would recommend psychodynamic therapy versus 40.2% of non medical respondents. SSRI’s were by far the most popular medication used, according to the survey by the medical respondents. Cognitive Behavioral Therapy (CBT) was the most preferred first line treatment among non medical and the second preferred among medical respondents for treating childhood symptoms of PTSD (Cohen et al., 2001). There was also an open ended section of the survey were the respondents could provide any other information about what particular therapy they used and why they chose it. Several of the respondents said that each individual situation is different and it all depended on the case. The third article I chose focused on post traumatic stress disorder in young people with intellectual disability. They reported on two people with intellectual disability (ID) who experienced PTSD but I am only going to talk about one of them because the other one is adult and I decided to focus my paper on childhood PTSD. There was modified assessment in this study because diagnosis usually requires detailed history of the event and experiences but ID and communication difficulties hindered the descriptions (client with fragile x syndrome and ID). The child, DC, is a 13 year old boy with fragile X syndrome, severe ID, and ADHD experienced a traffic accident when he was 8 years old. DC’s mother was driving the car and ran into another car, sideways and was trapped, but not seriously injured. Right after the impact, DC started vomiting and screaming. At first, DC talked about the accident all of the time, but then avoided the situation and would not talk about it. Once he quit vocalizing about the event, he became aggressive if he was pushed to talk about it. He developed enuresis and also resisted getting into any car and once they got him inside the car, he would scream, “We’re going to crash!” He had trouble sleeping at night, would re-enact the car crash with his toy cars, became insecure in all of his abilities, and started biting his hands. DC could accurately describe the accident and reported his nightmares about it. Thinking about the accident triggered urgent need to micturate, nausea, sweating, facial flushing, and tearfulness (Turk et al., 2005). His symptoms slowly started to diminish but a year after the incident he was still having problems. DC improved with cognitive behavioral therapy (aimed at combating avoidance and using exposure therapy). The article focuses on the importance of not denying the possibility of PTSD in children with ID because of failure to fulfill criteria requiring sophisticated language skills and lack of advanced abilities to identify and name emotional states (Turk et al., 2005). There are many ways you can accommodate a child with PTSD in your classroom. One way is to establish a feeling of safety and acceptance within your classroom. If you treat the child warmly and let them know that they are valued it can make an impact on the child’s self perception. An important thing to keep in mind as a teacher is to avoid activities that can trigger thoughts of the incident to the child. Also, if you have a predictable routine in your classroom, this can restore the normalcy in the life of the child. Reassuring children that their reaction to the incident is normal and their behavior is not “bad”. Augustyn, M., Famularo, R., Fenton, T., Kinscherff, R. (1996). Psychiatric comorbidity in childhood post traumatic stress syndrome. Child Abuse & Neglect, 20 (10), 953-961. Cohen, J.A., Mannarino, A.P., Rogal, S. (2001). Treatment practices for childhood posttraumatic stress disorder. Child Abuse & Neglect, 25, 123-135. Robins, I., Turk, J., Woodhead, M. (2005). Post-traumatic stress disorder in young people with intellectual disability. Journal of Intellectual Disability Research, 49 (II), 872-875.