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What a year 2005 was! Hurricanes, flood and war, just to name a few. In this age of technology and communication, we get to see these disasters up close and personal, with graphics and sound to make any tragedy even more real, in our own living room. And now we even have it in high-definition television. And there will be more in 2006. According to the American Academy of Child Psychiatry, each year in the United States more than 5 million children are exposed to some form of extreme trauma, including natural disasters and motor vehicle accidents as well as life-threatening illness, sexual or physical abuse and loss of a close family member. What happens to children who are exposed to these highlevel stressors? Since Vietnam, post-traumatic stress disorder in adults has been identified and validated as a true psychiatric illness secondary to the stress of war. Flashbacks, avoidance of human relationships, irritability and explosiveness (“short-tempered”) were characteristics of the post-war veteran. Researchers now know that post-traumatic stress disorder (PTSD) affects both female and male civilians, and that it strikes more females than males. More recently, PTSD has been identified in children and adolescents. The symptoms in children can be less specific and may present with a combination of problems including impulsivity, distractibility and attention problems, social avoidance, lack of feelings, sleep problems and aggressive play all associated with school failure or delayed development. Since the adaptation to stress is physiologic, children may have physical signs of illness such as high blood pressure, cardiac arrhythmias, endocrine disorders or gastrointestinal complaints. In children with the wide array of symptoms, the main stressor is not always easily identifiable either by the child, family or physician. Due to this lack of information, children can be misdiagnosed with ADHD, depression or behavioral problems and incorrect therapy may be instituted. What makes some children more vulnerable to PTSD? Characteristics of the child: Different personalities and coping mechanisms are present in different children. A child may be more vulnerable at different ages. A 5-year-old who is just beginning to move from a world of fantasy to reality may have a difficult time with a family illness or discussion of dead soldiers in Iraq. Characteristics of the event: The more real or perceived physical harm is present, the more likely the situation will lead to PTSD. If the threat is recurrent, the more likely it is to produce symptoms. Characteristics of the family/ social system: If there is a strong family unit that is nurturing versus chaotic, children will better adapt to stressors in their environment. The world IS different from years ago. It is more complex. Information overload is the norm. Many people function at a level of 8 where 10 is over the top. Our children also function at high levels in their lives. The long-term effects of PTSD in children are still unknown. Helping young people avoid and overcome emotional problems as a result of violence or disaster is one of the biggest challenges for parents, teachers and healthcare professionals. Based upon what we know, parents can help manage stress in their lives and decrease the risks of PTSD. Prevention of the trauma: It is not always necessary for children to witness all the details of natural disasters and acts of terror. Controlling what your child sees on TV may avoid the trauma. Turn off the television! This gives you the opportunity to explain to the child what they hear without the graphic descriptions. Think developmentally: When talking to your child about any stressor, recognize where they are developmentally. You do not talk the same way to a 5-year-old as you do to a 14-year-old. Don’t avoid the conversation: Putting your head in the sand is not the answer. Talk to your child. Let the child guide you through the conversation. Use open-ended statements rather than direct questions. Make observations about your child’s behavior. This will validate what they are feeling. Express your own concern about what you have seen. Helping them cope with “bad news” is crucial. Keeping it all in perspective is helpful. Early intervention: If trauma has occurred, early intervention is essential. Support from parents, school and friends is important. Establish an environment of safety. Therapy that will allow expression either through words, art or play will decrease the long-term effects. Seek help: If you think your child is exhibiting signs of PTSD, don’t be afraid to seek help from medical and psychological professionals. The American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry and National Institute of Mental Health are organizations that have resources and information to help. Stress will be a part of our lives for a long time to come. Discussing the issues as a family will help all family members cope and avoid the long-term effects of post-traumatic stress disorder. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita, Ladera Ranch and San Clemente (Talega) and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children’s Hospital of Orange County. He is a member of the American Academy of Pediatrics and the Memorial Care Physician Society. If you have any questions or comments for Dr. Wesp you can email him at askdrwesp@netscape.net. |
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