Wednesday, July 31, 2019
Post Traumatic Stress Disorder in Children Essay
Abstract Post Traumatic Stress Disorder affects not only adults but also children. There are four major ways by which traumatic events may affect the psychological state of children: cognitively, affectively, behaviorally and psychosomatically. There are questions as to the sufficiency of the instrumentation used in determining and measuring of the disorder. Studies also show that the fear experienced by adults in seeing signs of aggression in children may be affecting adversely affecting the possible therapeutic benefits of normal child’s play and physical activity. There may be a need for programs specifically geared toward educating parents and primary care givers of children suffering from PTSD in how to handle and deal with the child’s disorder and psychological needs. Post Traumatic Stress Disorder in Children as a Result of Violence, Crime and War It is not unusual for most adults, particularly those who are parents, to keep bad things away from children. As much as possible, childhood should remain a time of innocence and joy without the responsibility or care for matters that trouble the world. But what if it just cannot be avoided and bad things happen to children? In the aftermath of unhappy events, how do children display trauma and what are the things that people should know in dealing with children suffering from post-traumatic stress disorder?            For example, the September 11, 2001 terror attacks left behind families and children who have lost moms and dads in that instant. Even adults and children who were indirectly affected by the attacks have grown to suffer feelings of anxiety and shattered security in their personal and familial safety (Smith & Reynolds, 2002). Besides the inevitable feelings of grief, children especially were left behind and often contend with nightmares and morbid pictures of the traumatic deaths their loved ones experienced as well as the stress and difficulty of trying to picture lives without mom or dad. It is also important to remember that the effects of trauma are not limited to those who suffer it directly (Sims, Hayden, Palmer & Hutchins, 2000, p. 41) The ubiquity of television also afforded children at home not only news of the attacks but also vivid pictures and descriptions of the tragedy and all its violence. The case of a 7-year old boy named Johnny is cited in the study (2002) by Smith and Reynolds.: Following the 9/11 attacks, Johnny developed a constant fear of his parents leaving home and getting killed by â€Å"bad men.†He also developed a phobia of elevators and would throw tantrums whenever his parents tried to make him use one. Johnny admitted to his therapist that his fear of elevator stemmed from a story he heard of how â€Å"people in the Twin Towers were trapped and killed while riding in the elevators.†(Smith & Reynolds, 2002)            Neither Johnny nor his family were directly involved or affected in the terror attack. The mental and emotional strain suffered by survivors and those affected by this very high profile event led to the American Psychiatric Association’s setting up of counseling services â€Å"focusing on grief, acute stress and Post Traumatic Stress Disorder (PTSD) (Smith & Reynolds, 2002). What is PTSD? Originally associated with survivors and veterans of the Vietnam War, PTSD refers to an impairment of an individual’s capability to function in everyday following exposure or experience of an exceptionally disturbing event. Besides war, this has grown to cover the ill mental and emotional effects of â€Å"natural and civilian catastrophes, criminal assault, rape, terrorist attacks and accidents.†(Murray, 1992, p. 315) The DSM IV presents a more broadened definition of traumatic exposure as â€Å"the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,†and which evoked â€Å"intense fear, helplessness, or horror†(Mcnally, 2003). This broadened definition also qualifies extreme horror at what other people’s experience or events outside their environment as possible causes of PTSD. Symptoms of PTSD include vivid and morbid imagery, numbing, disruptions in thoughts and cognition, delayed response and reaction, strong feelings of anxiety, persistence of nightmares and difficulties in dealing with and solving problems. (Foa & Meadows, 1997) Saylor and Swenson, et.al state that before the late 80’s there was minimal attention given to how children were affected by traumatic events. It took two powerful hurricanes, one devastating earthquake and the bombing of the Oklahoma Center before it was realized that there were very little preparedness in ministering to the psychological needs of traumatized children (Saylor, Swenson, Reynolds & Taylor, 1999, p. 70). In 1999, psychologist Barbara Lowenthal pegged the number of children in America being exposed to traumatic events each year at four million. These traumatic events include â€Å"physical, sexual and emotional abuse; neglect; accidents; severe injuries; and natural disasters.†Lowenthal also says that these children are at a high risk of suffering from PTSD and may cause them to be prone to developing phobias and other neuro-psychiatric disorders including anxiety and depression (Lowenthal, 1999). The National Center for Posttraumatic Stress Disorder (NCPTSD, 2001) reports that there is a higher likelihood of psychological symptoms associated with PTSD to be found among children who have experienced traumatic events before the age of 11 compared to those who suffer trauma at later ages. (Alat, 2002) Lowenthal also says that besides the general symptoms of PTSD, children who have suffered trauma are likely to develop difficulties in forming relationships, cognition and learning, as well as a â€Å"numbing†that may make affected children experience difficulty in understanding and expressing their feelings in addition to regulating their emotions. This often leads to â€Å"provocative behaviors†and avoidance of intimacy. (Lowenthal, 1999). In his article in the Journal of Multi-cultural Counseling and Development in 2004, Clinical psychologist and Fellow of the American Psychological Association (APA) Gargi Roysircar studied the case of 20-year old Yugoslavian à ©migrà © Stephen, who at the age of 10 witnessed the height of the civil war between Christians and Muslims in Kosovo in 1990. Stephen remembers witnessing about 80% of his classmates get killed by bombs, sniper shots and gunfire as they walked to and from school. At age 14, Stephen was taken by his father to the frontlines and be trained in combat to fight with the Serbian army. The next two years wold take Stephen all over the Balkans and would expose him to all kinds of privation and war atrocities. Eventually migrating as political refugees in the United States, in 1999, Stephen demonstrated difficulty in acculturation and adjustment. The constant displacement he experienced in war along with the mistrust bred by his past and cultural paranoia fostered by the Croatian community they lived with made it difficult for Stephen to acclimatize to peacetime setting.            Roysircar describes Stephen as having â€Å"recurrent thoughts and images of his violent experience in the Balkans. He experienced nightmares, hostility and a profound sense of a lack of belonging. Stephen also often recounted the difficulties he experienced including â€Å"hiding in a basement and eating rats†especially when angry. He also displays a deep-seated hatred for the Muslims and believes â€Å"the Middle East should be wiped off the face of the Earth†(Roysircar, 2004).            This kind of behavior can very well be treated as expected according to an study published in the Australian Journal of Early Childhood in 2000. The researchers posit that in war-torn times, children are forced to adjust out of necessity for survival. This experience develops the idea of a dangerous world where no one can be trusted and therefore prompts children to be the aggressor rather than the victim (Sims, Hayden, Palmer & Hutchins, 2000, p. 41). According to Vazquez there are many conditions that fit the general description of PTSD. There are however differences in â€Å"depth, complexity and intensity†that require appropriate and often differing treatments (Vazquez, 2005). In Stephen’s case, the therapy method that worked for him involved deep self-reflection and existential therapy sessions with his counselor where he was able to open up and tell stories of his experiences and thoughts of his past and present, and dreams for the future (Roysircar, 2004). Effects and Treatment of Post Traumatic Stress Disorder It is important to remember that not every child who is exposed to or experiences trauma develops PTSD. Since the 1980’s there has been marked growth in the development of instrumentation in the measurement and treatment of PTSD in children. These assessment methods designed for children of different age groups include â€Å"structured interviews, questionnaires, self-report scales, inventories, and psychophysiological evaluation †(Alat, 2002) There are four major ways by which PTSD can affect children: cognitively,affectively, behavioral and physiological-somatically (Lowenthal, 1999; Alat, 2002). Cognitively, children experience fear at a possible repetition of the traumatic event. Some may even feel responsible for the traumatic event’s occurrence. There may also be confusion, academic and developmental problems, lowered IQ and diminished abilities in language and communication. In its affective effects, children with PTSD become emotionally fragile and are given to fits of outburst and anger. They develop low thresholds for stress and fear. They become nervous, compulsive and often feel a sense of futility. Behaviors can also become extreme. Affected children may become either very loud or very shy. It is not unusual for children to revert to juvenile behavior such as thumb sucking or regression in academic knowledge. They may also develop self-destructive behavior and become vulnerable to alcohol, drugs, and self-abuse. Children may also manifest PTSD in the form of physical sickness such as high temperatures, â€Å"vomiting and headaches†(Alat, 2002). There may also be instances of sleep and eating disorders, fatigue and â€Å"biochemical alterations in the brain†(Alat, 2002) Family members and teachers generally notice these symptoms first. At this time, it is important that both come together and develop ways of supporting the affected child. A school counselor may be able to help evaluate whether a child indeed has PTSD or not. Therapy with a professionally trained psychiatrist, psychologist, counselor or therapist is the treatment for persons diagnosed with PTSD. The methods employed however, may vary according to the severity of the disorder as may be observed in the individual. Majority of the suggested therapies that parents and educators are encouraged to employ with children suffering from PTSD are physical and social expression/reflection through group and one-on one interaction as well as play based therapies (Alat, 2002). This particular therapy however has encountered difficulties particularly after the 9/11 attacks and the idea that aggression addressed in the earlier stages will stave off future violent behavior. For example, a child who builds a tower of blocks and flies an airplane into them may be viewed as at-risk for future violence. This child’s behavior, in fact, may be a healthy and developmentally appropriate way to gain mastery over the child’s fears, anger, and confusion about Sept. 11. Smith and Reynolds (2002) decry this repression of a child’s possible â€Å"venting†or anger and state that instead of suppressing the aggression manifested by children at play, parents and educators should let children be within certain limits. As long as children do not cause harm to themselves, others or objects within their surroundings, it is best that they be allowed to express their anger and whatever negative feelings they have in a â€Å"therapeutic manner.†(Smith & Reynolds, 2002) Conclusion            The researcher observes that while there is an acceptance and awareness of the existence of Post Traumatic Stress Disorder among children, there still seem to be a lot of confusion as to what are the indicators of such disorder as well as the methods by which it should be addressed and treated. While Lowenthal (1999), Alat (2002) and other psychologists have managed to simplify such symptoms in four main categories, it is also stated in most studies that childhood trauma does not necessarily result in PTSD. There is still a question as to how the average lay person may be able to distinguish between delayed PTSD and natural defiance and common anxiety. The researcher also noticed that several of the symptoms listed in determining PTSD can also be found listed as symptoms of other psychological disorders in the DSM IV. The only difference is that with PTSD, there is a requisite traumatic event that is supposed to act as a trigger for the disorder. Smith and Reynolds (2002) make a valid point as to how adult paranoia of events that could possibly happen could seriously hinder the coping mechanism of children and therefore cause more harm than good. Logic dictates that feelings left unexpressed often come out one way or another. Alat also makes a good suggestion in encouraging teachers /educators to help children express their feelings in group discussions. As adults benefit largely in group therapy, there is no reason why children should not be able to do the same. Recommendations            Despite its many advancements in instrumentation and awareness, there are still many gray areas in how people can support and help children suffering PTSD. The researcher recommends that further studies be done with the objective of clarifying and further distinguishing PTSD symptoms from other psychological disorders so that those affected may receive the appropriate treatment.            The researcher further recommends that programs designed to educate teachers, primary care givers and parents in the impact of PTSD on children as well as the many ways they can help support the child’s treatment. Most of the child’s time is spent with family and school. It may perhaps speed up progress of therapy is extended beyond the time they spend with their clinical therapists.            There is the observation that adults may feel fear at what they perceive to be early signs of violence and aggression. The very fact that this sort of thinking exists stands as proof that attention to educating the people in a child’s environment with regard to what is natural and not in children’s behavioral patterns must be emphasized. Constant communication between parents and other people their children interact with particularly in the period following a traumatic event may also be helpful in gauging any effects the vent may have had.            Children exhibiting changes in behavior must also be carefully observed. As in the case of little Johnny who suddenly developed a fear of elevators, there may just be something behind the changes in a child’s behavior. Forcing them to face fears without completely understanding the root of these fears may only cause irreparable damage. These are just a few things that psychologists and behaviorists must educate parents and the other people in close contact with a child possibly suffering from post traumatic stress disorder in. References Alat, K. (2002). Traumatic Events and Children: How Early Childhood Educators Can Help. Childhood Education, 79(1), 2+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002498529 Foa, E., & Meadows, E. (1997). Psychosocial Treatments for Posttraumatic Stress Disorder: A Critical Review. 449+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5000413895 Lowenthal, B. (1999). Effects of Maltreatment and Ways to Promote Children’s Resiliency. Childhood Education, 75(4), 204+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002315362 Mcnally, R. J. (2003). Progress and Controversy in the Study of Posttraumatic Stress Disorder. 229+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002051892 Murray, J. B. (1992). Posttraumatic Stress Disorder: A Review. Genetic, Social, and General Psychology Monographs, 118(3), 315-338. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=96430362 Roysircar, G. (2004). Child Survivor of War: A Case Study. Journal of Multicultural Counseling and Development, 32(3), 168+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5012181947 Saylor, C. F., Swenson, C. C., Reynolds, S. S., & Taylor, M. (1999). The Pediatric Emotional Distress Scale: a Brief Screening Measure for Young Children Exposed to Traumatic Events. Journal of Clinical Child Psychology, 28(1), 70-81. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=81021655 Sims, M., Hayden, J., Palmer, G., & Hutchins, T. (2000). Working in Early Childhood Settings with Children Who Have Experienced Refugee or War-Related Trauma. Australian Journal of Early Childhood, 25(4), 41. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5001127890 Smith, S., & Reynolds, C. (2002). Innocent Lost: The Impact of 9-11 on the Development of Children. Annals of the American Psychotherapy Association, 5(5), 12+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5002560442 Vazquez, S. R. (2005). A New Paradigm for PTSD Treatment: Emotional Transformation Therapy. Annals of the American Psychotherapy Association, 8(2), 18+. Retrieved November 21, 2007, from Questia database: http://www.questia.com/PM.qst?a=o&d=5011704316  Â
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