Viewing Volume 10 Issue 2 Summer 2007
“POST-TRAUMATIC STRESS DISORDER IN CHILDHOOD”
In the past two decades, post-traumatic stress disorder (PTSD) after exposure to a variety of traumatic or particularly threatening experiences has gained recognition as a significant contributor to morbidity in children. The basic features involve the development of impairing stress symptoms, including re-experiencing of the event in the form of ‘‘flashbacks’’ (distressing images, thoughts or perceptions) or nightmares, avoidance of thinking or talking about the event, of places or people associated with the event and of things that remind one of the event. Hyperarousal, or feeling on edge, irritability and exaggerated ‘‘startle’’ responses to stimuli, and emotional numbing (sufferers feeling cut off and detached) have also been described.
PTSD in children was originally described after particularly traumatic events such as physical and sexual abuse and the witnessing of violence. It has been recognised following both natural and man-made disasters, and extensively documented in refugees, war situations and in response to terrorism-induced trauma.
More recently, attention has focused on PTSD occurring as a consequence of a variety of paediatric conditions, some life threatening, including cancer, head injury and motor vehicle accidents as well as mild to moderate paediatric trauma, acute illnesses resulting in admission to paediatric intensive care units, children who undergo organ transplantation and after diagnosis of diabetes mellitus type 1.20 Stressful experiences related to serious paediatric illness in children may be expected to affect parents psychologically. Accordingly, high levels of symptoms of PTSD have been reported in parents of children with a variety of problems such as meningococcal infections requiring admission to paediatric intensive care units, in family members of adolescent cancer survivors and of children with newly diagnosed type 1 diabetes.
Early identification and appropriate referral of these children and their families is important and is dependent on the awareness of general practitioners and paediatricians. This paper describes the main features of PTSD, its incidence and prevalence as well as the natural course of the illness. It also covers identification and assessment of sufferers and provides a brief overview of management.
Recently, the UK’s National Institute for Health and Clinical Excellence (NICE) has produced guidelines for the management of PTSD in adults and children, in both primary and secondary healthcare settings.
The guidelines recommend that when a child who has been involved in a traumatic incident is treated in an accident and emergency department, healthcare professionals should inform the parents or guardians about the risk for PTSD. This should be accompanied by a brief description of the most likely symptoms such as bad dreams, difficulty sleeping, increased anxiety and clingy behaviour, and avoidance or anxiety related to what they were doing at the time of the traumatic event (eg, travelling in acar in the case of a road traffic accident).
Amina Tareen, M Elena Garralda, Matthew Hodes, Academic Department
of Child and Adolescent Psychiatry, Imperial College School of Medicine
(St Mary’s Campus), London, UK
By:
MABF Autumn Courses.
Helping Young People Cope with Loss & Change Skills.
October 10th, 17th & 24th 2007.
Introduction to Bereavement Counselling Skills.
November 21st, 28th & December 5th 2007.
These three day courses are ‘Awarding Body Consortium’ validated. They are designed to be experiential, and utilise a range of theories, models and current evidenced based practice.
The cost of each three day course is £198-00 including validation.
By:AT