Transcript PTSD - Being Proactive

POSTTRAUMATIC STRESS
DISORDER (PTSD):
A PERSPECTIVE FOR EDUCATORS
Glendon Rayworth, Psy.D., C.Psych.
TDSB Psychological Services
Caring and Safe Schools
E-mail: [email protected]
Presentation Outline
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(B)
(C)
(D)
(E)
(F)
(G)
(H)
PTSD Defined
PTSD In Children
Group Trends
Technical Criteria
Technical Case Study
Practical Criteria
Practical Case Study
Odds and Ends
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).
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
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)
PTSD: DSM-IV-TR Criteria
A.
B.
C.
D.
E.
F.
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.
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-IVTR.
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
(A)Re-experiencing: Reliving
what happened
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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
(B)Avoidance:
Staying Away From Reminders
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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
(C)Hyper-arousal:
Feeling Anxious or Jumpy
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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
Other Concerns
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Pain or discomfort that does not
get better
Trouble returning to school or
other activities
Changes in your child’s usual
behavior
Other Symptoms
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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
Accommodating PTSD in
the Classroom
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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?”
Resources
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http://ptsdassociation.com/about-ptsdassociation.php (London, ON)
http://www.aftertheinjury.org/quick-quiz
(Philadelphia, PA)
http://www.camh.net/About_Addiction_Men
tal_Health/Mental_Health_Information/ptsd
_refugees_brochure.html (For refugees and
new immigrants)
http://www.ptsd.va.gov/public/pages/ptsdchildren-adolescents.asp (USA)