Transcript The Impact of Violence, Disaster, War, & Terrorism upon Teens

The Impact of Violence,
Disaster, War, &
Terrorism upon Teens
Dr. Mick Maurer
PTSD in Children and Adolescents
• The diagnosis of Posttraumatic Stress
Disorder (PTSD) was formally recognized
as a psychiatric diagnosis in 1980.
• At that time, little was known about what
PTSD looked like in children and
adolescents.
Post Traumatic Stress Disorders (PTSD)
Type I, II, III
- Associated Disorders
• Major Depressive Episode
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder
• Panic Disorder
- Associated Complications
• Suicide
• Substance Abuse
• Self-Medication
Definition:
• A diagnosis of PTSD means that an
individual experienced an event that
involved a threat to one's own or another's
life or physical integrity and that this
person responded with intense fear,
helplessness, or horror.
Children and adolescents may be diagnosed
with PTSD if they have:
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survived natural and man made disasters such as
floods;
violent crimes such as kidnapping, rape or murder of a
parent, sniper fire, and school shootings;
motor vehicle accidents such as automobile and plane
crashes;
severe burns;
exposure to community violence;
war;
peer suicide;
and sexual and physical abuse.
PTSD in adolescents may begin to more
closely resemble PTSD in adults.
However, there are a few features that have been
shown to differ.
• Children may engage in traumatic play following
a trauma.
• Adolescents are more likely to engage in
traumatic reenactment, in which they incorporate
aspects of the trauma into their daily lives.
• In addition, adolescents are more likely than
younger children or adults to exhibit impulsive
and aggressive behaviors.
Besides PTSD, what are the other
effects of trauma on adolescents?
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problems with fear,
anxiety,
depression,
anger and hostility,
aggression,
sexually inappropriate behavior,
self-destructive behavior,
feelings of isolation and stigma,
poor self-esteem,
Other effects:
• difficulty in trusting others,
• and substance abuse,
• also often have relationship problems with
peers and family members,
• problems with acting out,
• and problems with school performance.
Psychiatric Disorders that are commonly found in
adolescents who have been traumatized.
• One commonly co-occurring disorder is major
depression.
• Other disorders include:
- substance abuse;
- other anxiety disorders such as separation
anxiety, panic disorder, and generalized anxiety
disorder;
- externalizing disorders such as attentiondeficit/hyperactivity disorder, oppositional defiant
disorder, and conduct disorder.
How do children respond to
terrorism?
More severe reactions are associated with:
• a higher degree of exposure (i.e., life threat,
physical injury, witnessing death or injury,
hearing screams, etc.),
• closer proximity to the disaster,
• a history of prior traumas,
• being female,
• poor parental response,
• and parental mental health problems.
Research on children from the
September 11th, 2001 attacks & the
Oklahoma City Bombing.
• Two factors related to increased stress
symptoms were:
1) amount of television coverage viewed by
the child,
2) parental distress.
What can parents do?
Eleven to eighteen years:
• Encourage adolescents of all ages to talk about the
traumatic event with family members.
• Provide opportunities for the young person to spend time
with friends who are supportive.
• Reassure the young person that strong feelings-guilt,
shame, embarrassment, or a wish for revenge-are
normal following a trauma.
• Help the young person find activities that offer
opportunities to experience mastery, control, and selfesteem.
• Encourage pleasurable physical activities such as sports
and dancing.
How many children develop PTSD after a
terrorist attack?
Findings from Oklahoma City indicate that:
• Children who lost a friend or relative were more likely to
report immediate symptoms of PTSD than non-bereaved
children.
• Arousal and fear presenting seven weeks after the
bombing were significant predictors of PTSD.
• Two years after the bombing, 16% of children who
lived approximately 100 miles away from Oklahoma
City reported significant PTSD symptoms related to the
event. This is an important finding because these
youths were not directly exposed to the trauma and
were not related to people who had been killed or
injured.
More findings from Oklahoma City
indicate that:
• PTSD symptomatology was predicted by media
exposure and indirect interpersonal exposure, such as
having a friend who knew someone who was killed or
injured.
• No study specifically reported on rates of PTSD in
children following the bombing.
• However, studies have shown that as many as:
- 100% of children who witness a parental homicide or
sexual assault,
- 90% of sexually abused children,
- 77% of children exposed to a school shooting, and
- 35% of urban youth exposed to community violence
develop PTSD.
The Effects of Community Violence
on Adolescents
• A commonly held belief in the general population
is that community violence only happens among
gang members in inner-city neighborhoods.
• Indeed, those of lower socioeconomic status,
• those who are nonwhite,
• and those living in densely populated urban
areas do appear to bear a disproportionately
high burden of violence.
Are some youths at greater risk for exposure
to community violence?
Factors that may increase a child's risk for exposure to community violence:
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Living in poor, inner-city areas and being a minority appears to increase the
risk for community violence exposure.
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Gang affiliation appears to be a key risk factor,
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as is involvement in substance abuse,
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and exposure to domestic violence.
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Gender is another risk factor;
- males witness more community violence and are at higher risk for
physical assault and other direct forms of community violence,
- females are at higher risk for community-violence related sexual assault.
What are the effects of community violence?
• Adolescents with PTSD also experience nightmares and
intrusive thoughts about the trauma.
• They may be easily startled and avoid reminders of the
trauma.
• They can become depressed, angry, distrustful, fearful,
and alienated, and they may feel betrayed.
• Many do not feel they have a future and believe that they
will not reach adulthood. This is especially common
among adolescents who are chronically exposed to
community violence.
Other trauma-related reactions can
include:
impaired self-esteem and body image,
• learning difficulties,
• and acting out or risk taking behaviors
- such as running away,
- drug or alcohol use,
- suicide attempts,
- and inappropriate sexual activities.
How is PTSD treated in children and
adolescents?
Cognitive-Behavioral Therapy (CBT)
generally includes:
• the child directly discussing the traumatic
event (exposure),
• anxiety management techniques such as
relaxation and assertiveness training,
• and correction of inaccurate or distorted
trauma related thoughts.
• Through this procedure, they learn that
they do not have to be afraid of their
memories.
• CBT also involves challenging children's
false beliefs such as, "the world is totally
unsafe."
• The majority of studies have found that it
is safe and effective to use CBT for
children with PTSD.
CBT is often accompanied by psychoeducation and parental involvement.
• psycho-education is education about
PTSD symptoms and their effects.
• parental involvement Research shows
that the better parents cope with the
trauma, and the more they support their
children, the better their children will
function.
Several other types of therapy have been
suggested for PTSD in children and
adolescents.
• Play therapy The therapist uses games, drawings, and
other techniques to help the children process their
traumatic memories.
• Eye Movement Desensitization and Reprocessing
(EMDR), combines cognitive therapy with directed eye
movements. While EMDR has been shown to be
effective in treating both children and adults with PTSD,
studies indicate that it is the cognitive intervention rather
than the eye movements that accounts for the change.
Treatments continued:
Psychological first aid has been prescribed for
children exposed to community violence and can
be used in schools and traditional settings.
• involves clarifying trauma related facts,
• normalizing the children's PTSD reactions,
• encouraging the expression of feelings,
• teaching problem solving skills,
• and referring the most symptomatic children for
additional treatment.
Other treatments:
• Twelve Step approaches have been
prescribed for adolescents with substance
abuse problems and PTSD.
• Medications have also been prescribed
for some children with PTSD. However,
due to the lack of research in this area, it
is too early to evaluate the effectiveness of
medication therapy.
Further Treatment Options:
• specialized interventions may be
necessary for children exhibiting
particularly problematic behaviors or
PTSD symptoms. For example, a
specialized intervention might be required
for inappropriate sexual behavior or
extreme behavioral problems
The Effect of Combat-Related PTSD on
Children
• Transgenerational effects of combatrelated PTSD have critical implications for
a veteran’s interpersonal and family life
• Children of combat veterans with PTSD
generally exhibit one of three response
patterns.
The “over-identified” child.
• Through a process Rosenheck and Nathan (1985) has
termed secondary traumatization, children come to
experience an emotional disequilibrium similar to the
veteran with PTSD.
• Children with secondary traumatization are often their
father’s closest companion and are at risk for "reliving"
their father’s trauma, experiencing his flashbacks, and
sharing his nightmares.
• These children fail to develop their own friendships
because their lives revolve around their father.
• In school, they often have difficulty with concentration
because they are distracted by their concern for their
father’s well-being.
The "rescuers"
• Whereby they take on parental roles and
responsibilities.
• They often feel guilty about trouble at home and
blame themselves.
• They assume that if they are good, life at home will go
well.
• They believe it is their responsibility to keep their
parents happy and to insure nothing goes wrong.
• These children often lose spontaneity and interest in
daily activities.
• Similar to children of alcoholics, these children are
at risk for continuing this pattern into adult life.
Third pattern
• Children who are emotionally uninvolved in family life.
• They often know about their father's war experience and
need for support, but generally receive little emotional
support themselves from their parents.
• In an effort to gain recognition, they are apt to perform
well academically,
• Their emotional and social constriction may cause
symptoms of depression and anxiety,
• and later cause problems in their adulthood efforts to
form intimate relationships.
Treatment of Combat-Related PTSD on
Children
The focus of children’s treatment is the:
• strengthening of ego functions (i.e. reality
testing, frustration tolerance, and
verbalization).
• children are encouraged to recognize their
separateness,
• address their own developmental needs,
• and not assume responsibility for their
parents’ behavior and pain.