Posttraumatic Stress Disorder in Children

1. Trauma has long been associated with psychological symptoms and disability. Various labels have been used for war-related trauma including: irritable heart in US Civil War, Shell Shock in World War I, Battle Fatigue in World War II and Post Traumatic Stress Disorder in the Vietnam War. Since the Vietnam War the diagnosis of Post Traumatic Stress Disorder has been extended to non-war trauma. Posttraumatic Stress Disorder in Children

2. Outline 1. PTSD Defined 2. DSM IV Diagnostic Criteria for PTSD 3. PTSD Subtypes 4. Causation 5. Prevalence 6. Comorbidity 7. Psychological Treatments 8. Cultural Perspective 9. Coping with PTSD at Home 10. Future Research

3. PTSD Defined Posttraumatic stress disorder is an anxiety disorder in which fear and related symptoms continue to be experienced long after a traumatic event. PTSD in children and adolescents occurs as a result of a child�s exposure to a traumatic event that is life threatening or is perceived to be likely to cause serious injury to self or others.

4. PTSD Defined The exposure to the traumatic event causes the individual to respond with intense fear, helplessness, or horror. Children will experience disorganized or agitated behaviour.

5. DSM IV Diagnostic Criteria for PTSD A. Exposed to traumatic event with both present: Experienced, witnessed, or confronted with event. Child responds in a disorganized or agitated behaviour.

6. DSM IV Diagnostic Criteria for PTSD B. Must have at least one of the following criteria: Distressing recollections. Recurrent dreams. Reliving experience. Psychologically distressed in cues that symbolize the traumatic event. Physiological distressed in cues that symbolize the traumatic event.

7. DSM IV Diagnostic Criteria for PTSD C. Avoidance Patterns: Must have at least three present Persistent avoidance of thoughts, feelings and reminders Inability to recall some aspects of trauma Withdrawal from others and normal activities Markedly diminished interest in significant activities Emotional numbing Sense of foreshortened future Restricted range of mood

8. DSM IV Diagnostic Criteria for PTSD D. Arousal Symptoms. Must show 2 or more of the following: Insomnia Irritability Difficulty concentrating Hyper vigilance Heightened startle response

9. DSM IV Diagnostic Criteria for PTSD E. Re-experience, avoidance and arousal symptoms must occur for more than a month to be diagnosed with PTSD. F. Symptoms have to impair social, occupational or other important areas of functioning.

10. PTSD Subtypes

11. Causation Children are often exposed to trauma as a result of the following kinds of events: Physical or sexual assault Family and community violence Traumatic death of a loved one Experiencing or witnessing severe accidents Natural or man-made disasters Life threatening illnesses War

12. Prevalence One in 10 people develop PTSD (Canadian Mental Health Association, 2002). Children are more at risk of developing PTSD than adults when enduring the same stressor. Females are twice as likely than males to develop PTSD. The incidence and course of PTSD vary and depend on: the nature of the event, social support, family history, childhood experiences, personality, and any existing mental health problems or stress.

13. Comorbidity Up to 80% of patients with PTSD also experience other disorders, such as: Major Depressive Disorder, Substance Related Disorders, Panic Disorder, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, and Bipolar Disorder. These disorders can precede, follow, or emerge concurrently with the onset of PTSD.

14. Psychological Treatments RELAXATION THERAPY Instruct patients in a variety of relaxation exercises to use when they are experiencing anxiety or distress. INSIGHT THERAPY & SUPPORT GROUPS Reduce negative emotions in order to decrease anxiety, depression, anger, and guilt. COGNITIVE INTERVENTIONS Systematically examine and change their dysfunctional attitudes and styles of interpretation that emerge as a result of the traumatic event.

15. Psychological Treatments Continued COGNITIVE BEHAVIOUR THERAPY Exposure Therapy Behavioural treatments in which a person with fears are exposed to their dreaded objects or situations Eye Movement Desensitization and Reprocessing Behavioural exposure treatment in which clients move their eyes in a rhythmic manner from side to side while flooding their minds with images of objects and situations they ordinarily avoid

16. Psychological Treatments Continued COMBINATON APPROACHES Use a combination of psychological interventions and/ or medications to address a wider range of symptoms.

17. Medication Selective Serotonin Reuptake Inhibitors (SSRIs) Beta-Adrenergic-Blocking Agents Alpha-Adrenergic Agonist Mood Stabilizers

18. Cultural Perspective Clinicians need to be aware of the cultural considerations impacting children such as: Ethnicity Gender Age Language Spirituality

19. Coping with PTSD at Home Child must live a healthy lifestyle, eating healthy meals, exercising regularly and getting enough rest. Set aside time for the child to reflect on the trauma, rather than allow a constant stream of worrying thoughts throughout the day. Get your child professional help. Educate yourself and your family about reactions to trauma

20. Future Research Research needs to continue to focus on treatment that can be specific to a child�s age and developmental stage. Contextual factors, such as the child�s environment, their parents/guardians and the trauma leading to the disorder, are important in conceptualizing, assessing, and treating PTSD.

21. Review Anticipation Guide

22. Conclusion With the sensitivity and support of families and professionals, children with PTSD can learn to cope with the memories of the trauma and go on to lead healthy and productive lives. Dealing with PTSD can be very challenging and may require a lot of patience and support, but just remember that getting good help for the family can help everyone recover.

23. QUESTIONS??

24. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Cloitre, M., Cohen, L., Koenen, K., & Han, H. (2002). Skills Training in Affective and Interpersonal Regulation Followed by Exposure: A Phase-Based Treatment for PTSD Related to Childhood Abuse. Journal of Counsulting and Clinical Psychology, 70(5), 1067-1074. Comer,R., (2007). Abnormal Psychology (6th ed.). New York, Worth Publishers. Courtosis, C. (2008). Complex Trauma, Complex Reactions. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86-100. eMedicine-Posttraumatic Stress Disorder in Children (2008). Retrieved November 13 2008 from www.emedicine.com/PED/topic3026.htm Feldner, M., Monson, C., & Friedman, M. (2007). A critical Analysis of Approaches to Targeted PTSD Prevention. Behaviourial Modification 31(1), 80-116. � Jaycox, L., Foa, E., Morral, A. (1998) Influences of Emotional Engagement and Habituation on Exposure Therapy for PTSD. Journal of Consulting and Clinical Psychology, 66(1), 185-192. �Salmon,K., Bryant,R. (2002). Posttraumatic stress disorder in children: The influence of developmental factors. Clinical Psychology Reivew, 22(2), 168-188. Stein MB, Walker JR, Hazen AL, Forde DR. (1997) Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 154(8):1114-9. Thordarson, S., Taylor, S., Fedoroff, I., Ogrodniczuk, J., Maxfield, L., & Lovell, K. (2003). Comparative Efficacy, Speed, and Adverse Effects of Three PTSD Treatments: Expsoure Therapy, EMDR, and Relaxation Training. Journal of Consulting and Clinical Psychology, 71(2), 330-338. The Workplace Safety and Insurance Appeals Tribunal, Posttraumatic stress disorder (2004) Retrieved November 18 2008 from http://www.wsiat.on.ca/english/wsiatDocs/mlo/post_traumatic_screen.htm