Supporting Children with Post Tramautic Stress Disorder

A Practical Guide for Teachers and Profesionals

David Kinchin, Erica Brown

• Publisher: David Fulton Publishers
• Year: 2012
• eBook ISBN: 9781136627484
• Edition: 1
• Topic: Education
• Subtopic: Education General

It is estimated that at any one time around 135,000 school children are suffering from post-traumatic stress disorder (PTSD). They may be survivors of abuse (physical, emotional or sexual) or bullying. Some may have been involved in a road accident, an accident at home or any other traumatic event. This book provides teachers, support staff and other educational professionals with the information they need to, really understand the implications of PTSD, ably and effectively support and educate a traumatized child, address questions such as what can cause PTSD in young people? and understand how PTSD might affect the education of children at school.

Chapter 1

Children and Trauma: An Introduction to PTSD

Traumatic events strike unexpectedly, turning everyday experiences upside-down. They destroy the belief that ‘it could never happen to me’. The impact and the human response to any event which is unexpected, violent or otherwise, is as horrific as it appears to the individual person at the time and in the days and weeks which follow. In the aftermath of a disaster people may believe that they were in the wrong place at the wrong time. The authors of this book do not adhere with the philosophy that it is only survivors of major disasters who suffer trauma. Once a person has experienced trauma it may be extremely difficult to believe that life can ever be the same again. Survival is not just to do with living – it is to do with the quality of life.

Research demonstrates that adults are deeply moved by their exposure to agonising, life-threatening events. It should come as no surprise that children’s resilience is challenged as they struggle to understand and respond to traumatic events. Despite this great need to provide understanding and support for traumatised children, the literature and information available to professionals is sparse and camouflaged within the abyss of general research and study. This book sets out to provide information and guidance to teachers, professionals, carers and parents who deal with traumatised children; it also strives to provide these supportive carers with strategies to sustain them in their work.

The Literature

In recent years there has been a wealth of literature which has documented disasters, and accidental deaths but with the exception of a few writers (Kinchin 1998, Rando 1993, Raphael 1986, Redmond 1989) interests in the effects of trauma on people’s lives (and particularly the lives of children) has been extremely limited. Rando says that it is this incomplete perspective that has contributed to a persistence in complications, preventing victims adjusting to trauma.

Post-Traumatic Stress Disorder (PTSD) in adults has been recognised for some years. In contrast, far less has been written about the responses of children to trauma. Indeed, prior to the work of Garmey and Rutter (1985) there was little attention paid to children’s reactions to trauma. It was assumed that young people’s adverse reactions were short-lived. This failure to recognise the extent of children’s responses has largely been for three reasons. Firstly, because the use of generalised screening tests did not identify childhood responses and secondly, because primary carers and professional persons tended to underestimate the extent of childhood disturbances. Thirdly, emotional ‘numbing’ is often difficult to detect in children. In recent years this view has been revised as more children who have experienced trauma have been the subject of research studies.

Indeed, formal recognition of children’s suffering of PTSD was made by the American Psychiatric Association’s Diagnostic and Statistical Manual 1987 (see References section). In 1993 Udwin advocated more information was needed about the range of different reactions of PTSD in children and the likely duration of their responses. At the beginning of the new millennium it is widely accepted that the effects of trauma on children are very similar to responses shown by adults. There is an increased recognition of the intensity and persistence of children’s traumatic responses (Yule and Williams 1990).

It should however be remembered that not all children will suffer PTSD after a trauma. Other disorders such as anxiety disorder, depression and phobias are also commonly experienced.

In School

Schools may be excellent at celebrating joyful events and special achievements but often they have greater difficulty handling children’s feelings of anger, sadness and guilt. Furthermore, the emotional effects of trauma on children and adolescents may not be immediately obvious to parents or school staff. Children often try to protect adults by hiding their feelings of distress. But in some cases, the effects of the trauma may last months or years, significantly affecting pupil’s academic attainment (Yule and Udwin 1991).

Like adults, children may worry that they are going mad when they start experiencing some of the symptoms associated with reliving a trauma when, in fact, they actually are suffering from PTSD (Kinchin 1998).

The History of PTSD

Since the nineteenth century, and the advent of railways, researchers have been aware of the lasting effects of traumatic events in people’s lives. In 1866 trauma was described as ‘railway spine’ when survivors of a rail crash showed symptoms. Since then, the names attached to traumatic reactions have changed to suit the circumstances of the events and many of the terms have related to military combat. ‘Nervous shock’ and ‘traumatic neuroses’ were terms used at the end of the nineteenth century and these were followed by labels such as ‘fright neuroses’ and ‘shell-shock’ to describe victims of warfare and disaster. The term ‘shell-shock’ was most commonly associated with the Great War of 1914—18. Originally it referred to the belief that combat-related disorder was caused by minute brain haemorrhages occurring as the result of excessive exposure to explosions and bomb blasts. Observations that soldiers could develop shell-shock even in the absence of explosions, led to the belief that shell-shock implied a weakness of character with the consequence that many soldiers of the Great War (who today would have been diagnosed as suffering from PTSD) were executed for cowardice. Very recently some survivors have been pardoned and a diagnosis PTSD has been recognised. Nevertheless, the suggestion that PTSD may be attributed to character weakness has lingered in the minds of some people. More than eighty years after the Great War some PTSD sufferers still fear they are being labelled as weak and cowardly.

By the Second World War a more detailed description of post-traumatic stress was considered by psychiatrists. However, there were still a wide variety of names used to describe the disorder including post trauma syndrome, traumatophobia and war neurosis. Moreover, civilians were also seen to be suffering similar symptoms following events which had nothing to do with combat.

The battle for full recognition and understanding of what PTSD was about continued well into the 1960s and 1970s and the Vietnam War. It was this theatre of war, and the high number of traumatised combat troops, which provided the impetus for the current interest in Post-Traumatic Stress Disorder, A definition of the condition appeared in a US diagnostic and statistical manual of mental disorders (DSM) in 1980. The definition was revised in 1987, and again in 1994 (DSM—IV). This book is largely concerned with the increased understanding of the effects of PTSD from 1994 onwards.

Progression of PTSD by Definition, through Diagnostic and Statistical Manuals

• DSM I 1952 ‘Gross Stress Reaction’
• DSM II 1968 ‘Adjustment Reaction to Adult Life’
• DSM III 1980 ‘Post-Traumatic Stress Disorder’ (following the Vietnam War)
• DSM IIIR 1987 ‘Post-Traumatic Stress Disorder’ (enhanced the 1980 definition and added the ‘one month’ criterion and suggested that children might be affected.)
• DSM IV 1994 ‘Post-Traumatic Stress Disorder’(a shift in the thinking of what can be considered ‘traumatic” allowed for the individual person’s perception of the event to add a subjectivity to the traumatic nature of any situation).

PTSD and Children

The first in-depth study of the effects of trauma on children was undertaken as recently as 1979. The studies by Lenore Terr (1981) focused on a group of 26 children aged between 5 and 14 years who were kidnapped while on their school bus.

More recent commentators have suggested that children suffer far more violent victimisations than adults do (Calouste Gulbenkian Foundation 1995). Their uniquely dependent status renders them more vulnerable to conventional crimes such as murder and assault; to family violence including violent punishments, sexual abuse and assaults by siblings; to institutional violence and particularly to bullying in schools. There are also marked gender differences: boys are more vulnerable than girls to physical abuse and non-family assaults, while girls are three times as likely to be sexually abused (Creighton 1992, NSPCC 1995).

PTSD – The Definition

Six criteria need to be met before a diagnosis of Post-Traumatic Stress Disorder can be made.

1. The person must have been exposed to a traumatic event or events that involve actual or threatened death or serious injury, or threat to the physical integrity of themselves or others. The person’s response must involve fear, helplessness or horror.
2. The traumatic event must be persistently relived by the person.
3. The person must persistently avoid stimuli associated with the trauma.
4. The person must experience symptoms of increased arousal, or over-awareness, not present before the trauina.
5. The disturbance must cause significant distress or impairment in social, occupational, or other areas of functioning important to the person.
6. Symptoms, linked to 2, 3 and 4 above, must last more than one month.

When are Events Described as Traumatic?

The most obvious causes of trauma are accidents and incidents which cause physical injury to people. A road accident may well be responsible for physical injuries. The same incident may also cause psychological injuries which are unrecognised by everyone except the victim of the trauma.

Maxim’s story. I saw my cousin on a life support machine. His face was white and kind of transparent. He was eleven and I was eight. The night I saw him I had a terrible scary dream about the way he looked. I wish someone had told me what to expect and also that I would never see him alive again. I am glad I saw him but it would have been good if my uncle had asked me if I wanted to go before I got to the hospital.

Common Stressors Causing PTSD in Children

Four types of situations are the most likely stressors:

• Serious threat or harm to the child’s life.
• Serious threat or harm to a child’s loved ones.
• Sudden destruction of the child’s home or community.
• Seeing another person who is being or has been recently seriously injured or killed as the result of an accident or physical violence.

Incidents Which Can Traumatise

Incidents which can traumatise adults and children can be divided into five groups:

• criminal incidents – assaults, burglary, robbery, kidnapping, terrorism;
• accidents – at home, on the roads, at school;
• abuse – sexual, emotional, physical, bullying;
• natural disasters – floods, land slips, freak weather conditions;
• major disasters – train and plane crashes, ships sinking, acts of war.

This is not an exhaustive list and does not include such extreme cases as the Chernobyl nuclear accident, or the Hillsborough stadium disaster. Neither does it recognise incidents which have not previously been associated with PTSD such as poor school inspection results or a drop in student examination grades. Any incident responsible for causing the sequelae of criteria listed above can be described as a traumatic incident.

Death caused by accidents, disasters, war, suicide or murder qualify as traumatic stressors. For some children reactions will be minimal or short-lived depending on factors such as individual personality, shortened exposure to the event or support from older persons. Circumstances associated with severe reactions include:

• the suddenness of the event;
• the severity of threat to life;
• the degree to which the child was rendered powerless during the trauma;
• the intensity, proximity and duration of exposure to the imagery involved.

Pre-existing vulnerability from earlier trauma may also have a part to play, but complications do not inevitably occur. Some commentators have suggested that those children and adolescents previously thought to be suffering from attention deficit hyperactivity disorder (ADHD), conduct disorder, or substance abuse disorders may be at greatest risk: of being traumatised (Dwivedi 2000).

Over time many symptoms of PTSD fluctuate in severity but they may persist for weeks or months. Anniversaries or stressful times such as examinations may exacerbate difficulties. Sleep disturbances are common in children suffering PTSD. They include:

• problems getting to sleep;
• frequent awakening;
• night terrors;
• fear of being alone;
• fear of the dark.

Children and Trauma

The events described in the next chapter would cause adults deep distress. Some anecdotal evidence suggests that children recover from trauma more speedily than adults. Somehow it is felt that the invisible injury brought about is less serious if the victim is a child. Advocates of this view claim that children very quickly convert from being victims to being survivors. There is, however, no reliable research to support this anecdotal view and our experience does not support it because the evidence to substantiate that hope is absent.

Moreover, research suggests that children need more, not less, understanding and care. Following the Chowchilla kidnapping in 1976 (see Chapter 2) th...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Dedication
• Introduction
• 1. Children and trauma: an introduction to PTSD
• 2. Traumatic events involving children
• 3. Symptoms of Post-Traumatic Stress Disorder
• 4. The trauma of abuse
• 5. The trauma of bereavement
• 6. The trauma of chronically ill and life-limited children
• 7. Faith and cultural aspects of care
• 8. Recovery from PTSD
• 9. Managing trauma in school
• References
• Index