Mitigating Traumatic Stress Reactions in Young People

Abstract

Journal of Child and Adolescent PsychopharmacologyVol. 22, No. 6 EditorialsFree AccessMitigating Traumatic Stress Reactions in Young PeopleJamie M. HowardJamie M. HowardSearch for more papers by this authorPublished Online:12 Dec 2012https://doi.org/10.1089/cap.2012.2265AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The continued effects of Hurricane Sandy and the risks they pose to children who experienced the storm necessitate that clinicians be sensitive to the classic signs of traumatic stress, which include: • Foggy, dazed, detached demeanor, difficulty remembering parts of the event• Intrusive thoughts and/or distress when reminded about the traumatic event• Avoidance of reminders of the traumatic event• Anxiety or hyperarousal• Difficulty with basic tasks (school, friendships)And given these risks, we must also be available to counsel caregivers and educators on how best to encourage resilience in children, including: • Communicating honestly, concretely, and briefly• Helping kids create a narrative of the event to promote agency and understanding• Keeping the focus on the child's emotions and modeling adaptive coping• Maintaining routines or establishing well-defined temporary ones• Contributing actively to efforts to return to normalcyHowever, this disaster also presents an opportunity to address our evolving understanding of traumatic stress reactions in young people. It is helpful to know what is on the horizon in the upcoming revision to the Diagnostic and Statistical Manual (DSM-5) and how the approach to child traumatic stress is turning towards less restrictive criteria, a more nuanced consideration of developmental stages, and the provision of effective short-term treatment to more children at risk.This issue was raised at the recent International Society for Traumatic Stress Studies (ISTSS) conference. A summary of the thinking of two or three leading clinicians in this area can clarify how to use this knowledge and ensure that we help more children sooner rather than later.Michael Scheeringa at Tulane does work on posttraumatic stress disorder (PTSD) in preschoolers and was central to reformulating the DSM approach, most notably relaxing the criteria for diagnosis in young people and making certain developmental modifications. Currently for a PTSD diagnosis, intrusive thoughts must be experienced as “distressing.” However, young kids will often simply say something like, “Hey, did you know my dad hit my mom last night?” without any apparent distress—they don't seem bothered by it. But that is developmentally typical. They don't know how to label all their emotions. So that “distressing” criteria will change.Another developmental difference that will be addressed concerns avoidance. Adults have to have multiple symptoms of avoidance or emotional numbing, but that is a difficult concept to observe in children. In DSM-5 a child will only have to display one symptom.The rationale behind these changes is particularly appropriate now. People in the field are finding that we are missing a lot of kids who are having difficulty in the aftermath of a trauma by using adult diagnostic criteria and trying to apply them to children. This is developmentally ill-advised. We are missing kids who would benefit from care, and therefore clinicians need to keep an open mind and think more broadly when evaluating children who have experienced a disturbing event or situation.Additionally, Nancy Kassam-Adams at Children's Hospital of Philadelphia has been studying acute stress disorder (ASD), another timely topic. Her work has contributed to the new ASD criteria that eliminate the need for symptoms of disassociation and simplify the symptom list, based on an analysis of the sensitivity and specificity of DSM-IV symptom criteria. The hope is that the new criteria will more accurately describe children with functional impairments secondary to significant stress and trauma exposure.This means that we should be giving acute stress care to more kids. The idea here is not to pathologize typical reactions to stress but that we are missing some children who can benefit from new, time-limited interventions that have demonstrated efficacy, such as Steven Berkowitz's Child and Family Traumatic Stress Intervention (CFTSI).Finally, Scheeringa's research suggests that PTSD does not tend to remit in children. For this and many other reasons, it is more than worth it to intervene early, and we now have the tools to do so.FiguresReferencesRelatedDetailsCited ByPosttraumatic Stress Symptoms, Intrusive Thoughts, and Disruption Are Longitudinally Related to Elevated Cortisol and Catecholamines Following a Major Hurricane4 March 2014 | Journal of Applied Biobehavioral Research, Vol. 19, No. 1 Volume 22Issue 6Dec 2012 InformationCopyright 2012, Mary Ann Liebert, Inc.To cite this article:Jamie M. Howard.Mitigating Traumatic Stress Reactions in Young People.Journal of Child and Adolescent Psychopharmacology.Dec 2012.408-408.http://doi.org/10.1089/cap.2012.2265Published in Volume: 22 Issue 6: December 12, 2012PDF download