ERIC Identifier: ED460122
Publication Date: 2001-09-00
Author: Grosse, Susan J.
Source: ERIC Clearinghouse on
Teaching and Teacher Education Washington DC., ERIC Clearinghouse on Counseling
and Student Services Greensboro NC.
Children and Post Traumatic Stress Disorder: What Classroom
Teachers Should Know. ERIC Digest.
Post traumatic stress disorder: development of characteristic symptoms
following exposure to an extreme traumatic stressor involving direct personal
experience of an event that involves actual or threatened death or serious
injury, or other threat to one's physical integrity; or witnessing an event that
involves death, injury, or a threat to the physical integrity of another person;
or learning about unexpected or violent death, serious harm, or threat of death
or injury experienced by a family member or other close associate (APA, 1996).
School children may be exposed to trauma in their personal lives or,
increasingly, at school. Classroom teachers can help prepare children to cope
with trauma by understanding the nature of trauma, teaching children skills for
responding to an emergency, and learning how to mitigate the after-effects of
PTSD RELATED TRAUMA
By the very unexpected nature of
trauma, one can never totally prepare for it. And because each individual
responds differently to emotional upset, it is impossible to predict trauma
after-effects. Under certain circumstances, trauma can induce Post Traumatic
Stress Disorder (PTSD). Unrecognized/untreated PTSD can have a lifelong negative
impact on the affected individual. Teachers, who spend up to eight hours each
day with the children in their charge, can influence the outcome of a child's
response to trauma stress by creating an environment in which PTSD is less
likely to develop to the point of life impact.
Not all emotionally upsetting experiences will cause PTSD. Trauma sufficient
to induce PTSD has specific characteristics and circumstances, including
* perceived as life-threatening,
outside the scope of a child's life experiences,
not daily, ordinary, normal events,
during which the child experiences a complete loss of control of the outcome,
when death is observed.
Disasters, violence, and accidents are just some of the experiences that can
lead to PTSD. Preparing children for trauma involves giving them skills and
knowledge to survive the experience and emerge with as little potential as
possible for developing PTSD.
SKILLS TO SURVIVE TRAUMATIC EXPERIENCES
Survival skills for
traumatic experiences are essentially emergency action plans.Carrying out
emergency action plans not only helps a child retain some personal control, but
increases the potential for a healthy outcome. Children must know how to:
Follow directions in any emergency (i.e., stay in their classroom during a lock
Get help in any type of emergency (i.e., dial 911 or call a neighbor)
Mitigate specific emergencies (i.e., take shelter during a tornado)
Report the circumstances (i.e., tell an adult if a stranger approaches them or
Say "no" and mean it (i.e., firmly shouting "no, don't touch me").
Implementing survival skills requires knowing right and wrong. Children must
know or be able to recognize:
Appropriate vs. inappropriate touching (i.e., shoulder vs. genitals).
Appropriate vs. inappropriate information sharing (i.e., who is at home at what
Presence of appropriate vs. inappropriate people (i.e., the teacher on
playground duty vs. a prowling stranger).
SKILLS TO MITIGATE PTSD
While there is no predictability in
who will develop PTSD, it is possible to take steps to prepare children ahead of
time and by doing so, lessen the PTSD potential. Children need to be taught
lessons about trauma. Learning about people who have experienced trauma and gone
on to live healthy lives gives children role models and hope for their own
During a traumatic experience, children will survive better if they have a
structure to follow and can maintain some sense of control. Learning the
survival skills will aid in maintaining this control. Children need accurate and
specific information about their immediate safety, about what has happened and
about what will happen to them next (James, 1989). Knowledge helps them control
their thoughts and feelings.
Following a trauma, debriefing is critical. Children will vary concerning
their willingness and readiness to talk about their experiences. Some will play
out the event, while others may be more comfortable writing or drawing about the
event. What is important is the opportunity to communicate. There are different
avenues for the child to communicate, including online discussion forums for
children (Sleek, 1998).
A child's initial debriefing should be child-centered and nonjudgmental. The
adult should recognize that each child did his or her best, no matter what the
outcome, and refrain from offering advice. Adults should recognize that no two
children will have the same thoughts, feelings, or opinions. All expressions
about the trauma are acceptable.
Following a trauma, it is also important to help a child reestablish control.
Reviewing survival skills and drills and planning for "next time" reestablishes
strength. Allowing a child to make choices reestablishes their governance over
their own lives.
Everyone reacts to trauma. What
differentiates normal reaction from PTSD is the timing of the reaction, its
intensity, and the duration of the reaction. Trauma includes emotional as well
as physical experiences and injury. Even second-hand exposure to violence can be
traumatic. For this reason, all children and adolescents exposed to violence or
disaster, even if only through graphic media reports, should be watched for
signs of emotional distress (National Institute of Mental Health, 2000).
Symptoms lasting more than one month post trauma may indicate a problem.
Specific symptoms to look for include:
Re-experiencing the event (flashbacks),
Avoidance of reminders of the event,
Increased sleep disturbances, and
Continual thought pattern interruptions focusing on the event.
In children, symptoms may vary with age. Separation anxiety, clinging
behavior, or reluctance to return to school may be evident, as may behavior
disturbances or problems with concentration. Children may have self doubts,
evidenced by comments about body confusion, self-worth, and a desire for
withdrawal. As there is no clear demarcation between adolescence and adulthood,
adult PTSD symptoms may also evidence themselves in adolescents. These may
include recurrent distressing thoughts, sleep disturbances, flashbacks,
restricted range of affect, detachment, psychogenic amnesia, increased arousal
and hypersensitivity, and increased irritability and outbursts or rage.
HELPING THE CHILD
Making the diagnosis of PTSD requires
evaluation by a trained mental health professional. However, regular classroom
teachers have a major role in the identification and referral process. Children
often express themselves through play. Because the teacher sees the child for
many hours of the day including play time, the teacher may be the first to
suspect all is not well. Where the traumatic event is known, caregivers can
watch for PTSD symptoms. However, traumatic events can involve secrets. Sexual
abuse, for example, may take place privately. Sensitive teachers should monitor
all children for changes in behavior that may signal a traumatic experience or a
flashback to a prior traumatic experience.
Teachers can help a child suspected of post traumatic stress disorder by: *
Gently discouraging reliance on avoidance; letting the child know it is all
right to discuss the incident;
Talking understandingly with the child about their feelings;
Understanding that children react differently according to age - young children
tend to cling, adolescents withdraw;
Encouraging a return to normal activities;
Helping restore the child's sense of control of his or her life; and
Seeking professional help.
Professional assistance is most important since PTSD can have a lifelong
impact on a child. Symptoms can lie dormant for decades and resurface many years
later during exposure to a similar circumstance. It is only by recognition and
treatment of PTSD that trauma victims can hope to move past the impact of the
trauma and lead healthy lives. Thus, referral to trained mental health
professionals is critical. The school psychologist is a vital resource, and
guidance counselors can be an important link in the mental health resource
Although professional assistance is ultimately essential in cases of PTSD,
classroom teachers must deal with the immediate daily impact. Becoming an
informed teacher isthe first step in helping traumatized children avoid the life
long consequences of PTSD.
American Psychiatric Association. (1996).
Diagnostic and statistical manual of mental disorders IV. Washington, DC.
American Psychiatric Association.
James, B. (1989). Treating traumatized children: new insights and creative
interventions. Lexington, MA: D.C. Heath.
National Institute of Mental Health (2000). Helping children and adolescents
cope with violence and disasters. Washington, DC: NIMH. Available online at
Sleek, S. (1998). After the storm, children play out fears. APA Monitor,
29(6). Available online at http://www.apa.org/monitor/jun98/child.html.%20
AVAILABLE FROM ERIC
These resources have been abstracted and are in the ERIC database. Journal
articles (EJ) should be available at most research libraries; most documents
(ED) are available in microfiche collections at more than 900 locations.
Documents can also be ordered through the ERIC Document Reproduction Service
Demaree, M.A. (1995). Creating safe environments for children with
post-traumatic stress disorder. Dimensions of Early Childhood, 23(3), 31-33, 40.
EJ 501 997.
Demaree, M.A. (1994). Responding to violence in their lives: Creating
nurturing environments for children with post-traumatic stress disorder
(conference paper). ED 378 708.
Dennis, B.L. (1994). Chronic violence: A silent actor in the classroom. ED
Karcher, D.R. (1994). Post-traumatic stress disorder in children as a result
of violence: A review of current literature (doctoral research paper). ED 379
Motta, R.W. (1994). Identification of characteristics and causes of childhood
posttraumatic stress disorder. Psychology in the Schools, 31(1), 49-56. EJ 480
Richards, T., & Bates, C. (1997). Recognizing posttraumatic stress in
children. Journal of School Health, 67(10), 441-443. EJ 561 961.
American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Avenue,
NW, Washington, DC, 20016-3007, 202-966-7300, http://www.aacap.org
American Psychiatric Association, 1400 K Street, NW, Washington, DC 20005,
American Psychological Association, 750 First Street, NE, Washington, DC
20002, 202-336-5500, http://www.apa.org
Anxiety Disorders Association of America (ADAA), 11900 Parklawn Drive, Suite
100, Rockville, MD 20852, 301-231-9350; http://www.adaa.org
Disaster Stuff for Kids, http://www.jmu.edu/psychologydept/4kids.htm%20
Federal Emergency Management Agency http://www.fema.gov/kids%20
International Society for Traumatic Stress Studies (ISTSS), 60 Revere Drive,
Suite 500, Northbrook, IL 60062, http://www.istss.org
National Center for Kids Overcoming Crisis, (includes Healing Magazine
online) 1-800-8KID-123, http://www.kidspeace.org/facts%20
National Center for PTSD, 215 N. Main Street, White River Junction, VT 05009;
National Center for Post-Traumatic Stress Disorder of the Department of
Veterans Affairs http://www.ncptsd.org/%20
National Institute for Mental Health (NIMH) 6001 Executive Boulevard, Rm
8184, MSC 9663, Bethesda, MD 20892-9663; 301-4513, Hotline 1-88-88-ANXIETY,