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The world is a changed and frightening place for children today. Incidents like the bombing of the Federal Building in Oklahoma City in 1995 and most recently, the attack on the World Trade Center have contributed to the perception that the world is no longer a safe place. This perception has been compounded by a number of natural disasters such as earthquakes in California, floods in the Midwest, and the devastation left by Hurricane Andrew in South Florida. Many children were traumatized directly by those events; others were traumatized by witnessing the events or the aftermath on television.
It has taken 25 years for the American public to understand the effects of the Vietnam War and the posttraumatic stress reactions in soldiers who fought there. The child welfare system is facing the same type of uphill battle as it tries to change society's approach to children who are fighting their way back from their own terrifying experiences.
Childcare professionals work with children who have been traumatized by parental abandonment, abuse, or neglect. These youngsters fear for their physical or emotional integrity, and can become overwhelmed by their own physiological, emotional, and behavioral responses to stress. Their responses are similar to those demonstrated by Vietnam veterans. Other children who have experienced trauma in the form of natural disasters or terrorism can also be included.
Posttraumatic Stress Disorder (PTSD) is a relatively new medical diagnosis. Before 1970, it was largely considered by doctors to be a psychological rather than physiological problem. Recent advances in research, however, confirm that PTSD is traced to a disruption in normal brain functioning.
Traumatized children develop habitual stress responses such as explosive temper, sexualized behavior, flashbacks, nightmares, addictions, bed-wetting, and a host of other problems. Treating these particular “wounds” requires an understanding about how traumatic experiences create defensive reactions in children.
The old saying, “It's just in the head”, is true when it comes to understanding PTSD. Researchers believe that a terror experience can disrupt normal brain functioning. Following an inescapable (actual or perceived to be inescapable) catastrophic event, a person's brain chemistry is altered, creating heightened sensitivity to adrenaline. This “surge” causes humans (and animals) to become aroused in order to prepare to fight or flee from danger. The person's heart may pound, they may have sweaty palms, headaches, loss of bowel or bladder control, have an upset stomach, teariness, insensitivity to pain, or any number of other physical reactions.
PTSD is the emergence of symptoms that surface when a child feels he is re-experiencing the trauma; and to persistently avoid any associations with the trauma. Traumatized children can be stimulated by triggers or stressors, and may feel they are going through the trauma again. The triggers can effect one child and not another.
Some examples of triggers:
PTSD arises after a child has experienced trauma. Symptoms usually appear around one to three months following the traumatic experience. Approximately half of the children diagnosed with PTSD recover after three months. Others, however, are affected much longer. The family environment impacts how a child interprets the traumatic experience. The quality of emotional support and appropriate problem-solving skills demonstrated by caregivers can positively or negatively influence a child's reaction to trauma.
An understanding of PTSD is necessary when caring for children who are affected. The children are not usually “making up” their moods and behaviors. There is a physiological link between a terror experience and the body's adaptation to that experience. We can help children understand that their bodies and minds may react to a perceived threat, but they are not in danger now.
Following a traumatic experience, a child may develop adaptive responses or reactions as a defense mechanism. Common responses are:
The most common treatment for PTSD in children is called Cognitive Behavioral Treatment. This is a combination of talking therapy and anxiety management techniques. It generally involves direct discussion of the traumatic events that occurred, relaxation, assertiveness training, and correction of the distorted memories or thoughts to enable children to recover a sense of safety and trust and become less afraid of their memories. Family therapy is also frequently used to help children with PTSD work through the issues.