POSTTRAUMATIC STRESS DISORDER (PTSD): A PERSPECTIVE FOR EDUCATORS

1. POSTTRAUMATIC STRESS DISORDER (PTSD): A PERSPECTIVE FOR EDUCATORS Glendon Rayworth, Psy.D., C.Psych. TDSB Psychological Services Caring and Safe Schools E-mail: glendon.rayworth@tdsb.on.ca

2. Presentation Outline • PTSD Defined • PTSD In Children • Group Trends • Technical Criteria • Technical Case Study • Practical Criteria • Practical Case Study • Odds and Ends

3. PTSD Defined -PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. (Wikipedia, 2012) -PTSD is a type of anxiety disorder. It can occur after you’ve seen or experienced a traumatic event that involved the threat of injury or death (U.S. National Library of Medicine).

4. PTSD In Children and Teens: An Overview Who is at risk? Anyone who has lived through en event that could have caused them or someone else to be killed or badly hurt. What are some examples? Violent crimes, car crashes, fires, war, natural disaster, a friend’s suicide. What increases the risk? -Severity of the trauma -Parental reaction to the trauma -Proximity to the trauma Source: US National Center for PTSD

5. PTSD in the Schools: Group Trends The Race Effect Post-Traumatic Stress Disorder (PTSD) is found more frequently in inner-city African American and Latino youth than in European American youth.(Zyromski, 2007) The Behavioural Effect More violence exposure/PTSD= more behavior problems and less school achievement(Thompson and Massat,2005). The Violence Effect Students with PTSD and exposure to violence are more likely to use violence. (Gellman & Delucia-Waack, 2006). The Alienation Effect Student Alienation Syndrome (SAS) is posited as a theoretical syndrome describing the effect of trauma experienced in the school setting. Symptoms include hopelessness, oppositionality, and hypervigilance. (Hyman, Cohen, and Mahon, 2003)

6. PTSD: DSM-IV-TR Criteria • The person has been exposed to a traumatic event… • The traumatic event is persistently reexperienced… • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)… • Persistent symptoms of increased arousal (not present before the trauma)… • Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

7. The Case of Little Albert (John B. Watson’s ‘Poster Boy’ For Classical Conditioning 1920) US=Loud noise  UR=Fear/crying CS=White rat  CR=Fear/crying Little Albert generalized this fear to other furry objects, such as rabbits, dogs, and beards. In PTSD language, the furry objects became the “cues” referenced in B-4 of the DSM-IV-TR.

8. Practical Diagnostic Criteria: An ABC Approach (Adapted from “After The Injury” , Children’s Hospital of Philadelphia) (A) Re-experiencing (B) Avoidance (C) Hyperarousal aftertheinjury.org

9. (A)Re-experiencing: Reliving what happened • Thinks a lot about what happened to him/her • Has bad dreams or nightmares • Gets upset or has physical symptoms (headache, stomachache, heart beating fast) at reminders of what happened

10. (B)Avoidance: Staying Away From Reminders • Doesn’t want to talk about what happened or tries to push it out of his/her mind • Wants to stay away from people, places, or things that are reminders of what happened • Afraid of something that s/he was not afraid of before (or a previous fear or worry seems to get worse) • Not interested in usual activities, since the injury • Not interested in being with people s/he usually likes, since the injury

11. (C)Hyper-arousal: Feeling Anxious or Jumpy • Worries a lot that something else bad will happen • Startles easily – for example, jumps if there is a sudden noise • Irritable or has angry outbursts, since the injury • Has trouble paying attention to things, since the injury • Has trouble falling or staying asleep, since the injury

12. Other Concerns • Pain or discomfort that does not get better • Trouble returning to school or other activities • Changes in your child’s usual behavior

13. Other Symptoms • Anger • Sadness • Feeling alone and apart from others • Feeling as if people are looking down on them • Low self-worth • Trust issues • Out of place sexual behaviour • Self-harm • Substance abuse • Weapon possession (protection) • Impulsive and aggressive behaviours • Day dreaming • Blank stares • Fatigue • Acting out/disruptive behaviour/clowning around

14. Accommodating PTSD in the Classroom • Establish a feeling of safety. Lead by example. • Avoid exposure to triggers. • Maintain a predictable and consistent routine. Preview changes. • Make sure classroom environment is user friendly (e.g. not too cluttered/ crowded/noisy). • Validate their distress if they bring it up. E.g. “That sounds really stressful. How can we help you with that?” Don’t be dismissive or trivializing E.g. “Just try to block it out.” • Reassure them that their distress is a normal response to abnormal stress. • Program opportunities for self-soothing. E.g. Music, relaxation scripts, exercise, fidget toys, etc… • Clarify disciplinary protocol proactively. • Provide the student with a sense of control. E.g. Give them choices. • If acting out, address privately “It’s hard for you to focus today. How can I help you?”/“You don’t seem to be yourself today. What’s up?”

15. Resources • http://ptsdassociation.com/about-ptsd-association.php (London, ON) • http://www.aftertheinjury.org/quick-quiz (Philadelphia, PA) • http://www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/ptsd_refugees_brochure.html (For refugees and new immigrants) • http://www.ptsd.va.gov/public/pages/ptsd-children-adolescents.asp (USA)