Prevention of post-traumatic adjustment problems in children and adolescents

What is PTSD? PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event. When in danger, its natural to feel afraid. This fear triggers many splitsecond changes in the body to prepare to defend against the danger or to avoid it. This fight-or-flight response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when theyre no longer in danger. Who gets PTSD? Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. What are the symptoms of PTSD? PTSD can cause many symptoms. These symptoms can be grouped into three categories: 1. Re-experiencing symptoms: Flashbacksreliving the trauma over and over, including physical symptoms like a racing heart or sweating Bad dreams Frightening thoughts. Re-experiencing symptoms may cause problems in a persons everyday routine. They can start from the persons own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing. 2. Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience Feeling emotionally numb Feeling strong guilt, depression, or worry Losing interest in activities that were enjoyable in the past Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. 3. Hyperarousal symptoms: Being easily startled Feeling tense or on edge

Having difficulty sleeping, and/or having angry outbursts.

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. Its natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD dont show any symptoms for weeks or months. Do children react differently than adults? Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults.1 In very young children, these symptoms can include:

Bedwetting, when theyd learned how to use the toilet before Forgetting how or being unable to talk Acting out the scary event during playtime Being unusually clingy with a parent or other adult.

Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. How is PTSD detected? A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the person who has symptoms of PTSD. To be diagnosed with PTSD, a person must have all of the following for at least 1 month:

At least one re-experiencing symptom At least three avoidance symptoms At least two hyperarousal symptoms Symptoms that make it hard to go about daily life, go to school or work, be with friends, and take care of important tasks.

How is PTSD treated? The main treatments for people with PTSD are psychotherapy (talk therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health care provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal. What works? The goal of psychotherapeutic intervention is to provide the child and the adult with the opportunity to work through and integrate the traumatic experiences, and its associated feelings and thoughts. A review of PTSD intervention programs revealed that the most successful intervention programs include the following important therapeutic aspects: Graded exposure - Psychoeducation explaining the nature of anxiety and PTSD; the inevitability of intrusive anxiety-provoking thoughts and images; the natural tendency to try to avoid these; the exacerbating effect of using avoidant coping strategies; the graded exposure process as a healthy alternative to avoidant coping; the need for parents, peers and teachers to be supportive of children during graded exposure and recovery. - Exposure to increasingly anxiety-provoking situations - Imaginal exposure (talking, writing, drama, painting, drawing) - Exposure to cues or external stimuli (trauma site, video or audio recording - Provision of support and encouragement to use coping skills during graded exposure (therapists, family, and teachers) Coping skills training - To manage anxiety evoked during exposure to trauma-related cues and memories - Relaxation skills training techniques to reduce muscle tension - Cognitive coping skills training challenge fearful or threatening cognitions Safety skills training (especially in CSA survivors) - Recognizing potentially abusive situations - Avoiding potentially abusive situations - Escaping from potentially abusive situations Behavioural parent training - To help parents manage trauma-related behavioural problems including aggression, defiance and over sexualized behaviour. - manage childrens anxiety and avoidant behaviour - Training in using reward systems, time out and response cost procedures Grief work - Traumatic events may involve major losses

- Children may struggle to integrate traumatic experiences and information about trauma-related losses into their overall worldview and self-image grief work may facilitate integration - Aim to have losses associated with trauma accepted rather than denied or exaggerated -avoidant coping style: denial of significance of traumatic event and losses entailed by them and the effects there off lead to - Adjustment problems - Difficulty experiencing tender emotions - Difficulty regulating emotions - Drug and alcohol abuse - Incorporating the traumatic experience and losses without processing it sufficiently childs view of the world and self is permeated by danger, threat, powerlessness and guilt. May result in - Beliefs in foreshortened future - Difficulties in career planning - Difficulties forming long term relationships - Survivor guilt How can it be implemented at TygerBear? 1 Psychoeducation: The therapist must be familiar with anxiety and post traumatic stress symptoms. - how does it manifest? All children who have been sexually molested will present some signs of anxiety and stress symptoms called post traumatic stress symptoms because these symptoms appear after the trauma. These symptoms need to be discussed and explained to the child and the childs family. These are common reactions that the child needs to work through. The therapist will help the child and the family to work through these anxieties and symptoms.