Symptoms of PTSD

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. Classmate (N.Jon)

Stress is not an uncommon experience for humans. However, how one exhibits or manifests symptoms of stress can vary wildly, even when two individuals experience the same stressor (Flamez & Sheperis, 2015). The Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recently created a new section titled trauma and stress-related disorders to address such issues. As such, post-traumatic stress disorder was moved from anxiety disorders to the new section. Taking a look at post-traumatic stress disorder (PTSD) in children, I will explain the ways in which gender influences the manifestation of PTSD and provide an example of how that might look. Then I will describe the factor related to PTSD that would be most difficult for me to address as a professional counselor and why.

PTSD

Post-traumatic stress disorder has undergone many revisions in the DSM-5 and currently can be used to diagnose individuals ages six and up (DSM-5 Bridge Document). There are three criterion that break down into three categories: stress-inducing experiences, symptoms present, and the varying reactions to stimuli (DSM-5 Bridge Document). In order for a diagnosis of PTSD to be given, the individual must have experienced violation, serious injury, or threatened or actual death (Flamez & Sheperis, 2015). In addition, the individual must be experiencing distressing symptoms that cause significant impairment that lasts for at least six months (Flamez & Sheperis, 2015).

Gender Influences

The influence of gender on presenting symptoms and risk factors associated with PTSD is an interesting topic that is still being researched (Doron-LaMarca, Bogt, King, King, & Saxe, 2010). There has been much discussion regarding prior claims (such as being female resulting in a risk factor) and there is still much to be understood. However, one notable difference between the genders is the evidence that girls are more likely to exhibit internalization of symptoms and boys are more likely to exhibit externalization of symptoms (Doron-LaMarca, et. al., 2010). For example, two siblings of different genders might have both experienced severe abuse by their father. For several months following, after having been removed from the home, the children have been exhibiting PTSD symptoms. However, the children exhibit different symptoms from one another. The girl may shy away from men, be fearful of her male teacher, and startle easily when men speak. Her brother, on the other hand, may appear disrespectful and angry towards men, frequently yelling at his male teacher, having outbursts, and displaying acts of violence.

Cause and Effect

When working with individuals diagnosed with post-traumatic stress disorder there can be many manifestations and symptoms that are challenging to deal with. When reflecting upon the possible gender differences in manifestations I am not sure which one would be more difficult to counsel. Both would have their challenges, particularly if you are of the gender the child is struggling with. However, I believe that the most difficult challenge in working with PTSD clients is the potential for secondary trauma in the hearing of their stories. Secondary exposure on behalf of counselors is a very real concern, so much so that the DSM-5 revisions expanded the trauma criterion to include the potential diagnosis of PTSD for professionals repeatedly exposed trauma narratives (Flamez & Sheperis, 2015). I believe this aspect of working with PTSD clients would be the most difficult.

References

DSM-5 BridgeDocument: Trauma, Stress, and Adjustment

Doron-LaMarca, S., Vogt, D. S., King, D. W., King, L. A., & Saxe, G. N. (2010). Pretrauma

Problems, Prior Stressor Exposure, and Gender as Predictors of Change in Posttraumatic Stress Symptoms among Physically Injured Children and Adolescents. Journal of Consulting and Clinical Psychology, 78(6), 781–793. Retrieved from https:// ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=eric&AN=EJ907068&site=eds-live&scope=site

Flamez, B. & Sheperis, C. J. (2015). Diagnosing and treating children and adolescents: A guide

for clinical and school settings. Hoboken, NJ: John Wiley & Sons, Inc.

Sengün, G., & Ögretir, A. D. (2018). Investigation of Some Variables of Posttraumatic Stress

Disorder (PTSD), Empathy and Depression in Syrian Children. Universal Journal of

Educational Research, 6(6), 1348–1357. Retrieved from https://ezp.waldenulibrary.org/

login?url=https://search.ebscohost.com/login.aspx?

direct=true&db=eric&AN=EJ1181149&site=eds-live&scope=site

2. Classmate (K.Kil)

High Crime Area Trauma

As mentioned in a previous discussion (Kilpatrick, 2018),  a local news channel recently reported that an 11-year-old was shot in the eye by a 16-year-old (“Neighbors Pray”, 2018). The neighborhood in the news article is a high-crime area but also home to many children. The children in these areas, similar to the 11-year-old in the article, experience trauma like this regularly either by personal experience or as a bystander. It has been found to be a direct relationship with exposure to the type of violence found in these high crime areas and PTSD (Gillikin et al., 2016).

Two Common Symptoms of PTSD

Two common symptoms of PTSD associated with this type of trauma are avoidance/numbing symptoms and intrusive symptoms (Gillikin et al., 2016). Children and/or adolescents may describe the numb feeling as not having good feelings, feeling nothing, or just saying that they don’t care about others due to not knowing that they are feeling numb about their trauma (Pynoos et al., 2009). A child may avoid or become numb to the trauma because the situation is too fearful or maybe to hurtful to process. The intrusive symptoms may come through thoughts about the trauma, nightmares, and flashbacks which come from reminders of the event (Gamwell et al., 2015).

Counseling Children & Adolescents

One thing I would find difficult about counseling this population would be transference. I have three children, and now 1 grandchild, I would not want to keep them from experiencing things, positive things, due to fear of them running into the negative things that could harm them. I, of course, want to guide them to make the right decisions and choose good over evil but I never want to stunt their growth due to fear of living life.

It is already hard to raise kids without imposing my concerns and worries on them but to hear that kids are suffering due to bad things that are happening in high crime areas, knowing that the same thing could happen in any area is difficult for any parent.  Counseling children who have experienced any type of trauma would be very difficult for me. The hardest part about seeing a child going through something painful is not being able to delete the event out of their lives. If I was to work with this population I would definitely be practicing my own coping skills, doing a lot of praying.

References:

Gamwell, K., Nylocks, M., Cross, D., Bradley, B., Norrholm, S., & Jovanovic, T. (2015). Fear conditioned responses and PTSD symptoms in children: Sex differences in fear-related symptoms. Developmental Psychobiology, 57(7), 799-808. https://doi.org/10.1002/dev.21313

Gillikin, C., Habib, L., Evces, M., Bradley, B., Ressler, K. J., & Sanders, J. (2016). Trauma exposure and PTSD symptoms associate with violence in inner city civilians. Journal of psychiatric research, 83, 1-7.

Kilpatrick, K. (2018). Stress and Adjustment Issues. Week 6 discussion post. Retrieved fromhttps://class.waldenu.edu/webapps/discussionboard/do/message?action=list_messages&course_id=_16485089_1&nav=discussion_board&conf_id=_2961918_1&forum_id=_6747053_1&message_id=_94134342_1

Neighbors pray for change after 11-year-old shot in the eye [Video File]. (2018, December 28). Retrieved fromhttps://www.newschannel5.com/news/neighbors-pray-for-change-after-11-year-old-shot-in-the-eye

Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A., & Fairbanks, J. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22(5), 391-398. Ⓒ American Psychological Association Journals. Used with permission from the American Psychological Association via the Copyright Clearance Center.

3. Classmate (H.Plo)

A traumatic event threatens injury, death, physical safety of oneself or others (American Psychological Association, 2008).  It also causes terror, helplessness, and panic at the time of occurence (American Psychological Association, 2008). Many students will experience some sort of trauma during their time in school.

Description of Traumatic Event

According to a news broadcast from WTHR, on December 30, 2018, 3 bodies were found inside a Marion home (Carter, 2018).  Two of the bodies belonged to Javon Blackwell, Jr. (12) and Jayzon Blackwell (11). The two boys and their father were shot to death.  Javon and Jayzon attended a charter school in Anderson, Indiana. The school released a statement providing counseling services for students, faculty, and families (Family Remembers Victims, 2018).

Symptoms of PTSD

Reactions of a traumatic event varies greatly between children and adolescents (American Psychological Association, 2008).  According to the American Psychological Association, level of development, ethnicity, culture, prior exposure to trauma, resources available, and preexisting problems in family and individual are factors that influence the symptoms of an individual’s PTSD (2008).  However, children and adolescents demonstrate their anguish various ways as an attempt to cope with the event (American Psychological Association, 2008). One symptom that could be demonstrated from the above scenario is the interpretation of the threat as horrific (Katoaka, Langley, Wong, Baweja, & Stein, 2012).  This could represent itself as disorganization or agitation (Katoaka et.al., 2012). Another symptom is numbing or avoidance (Katoaka et. al., 2012). The students closest to the victims could want to avoid school to prevent remembering their friend(s). Finally, hyperarousal could be a third symptom of PTSD (Katoaka et. al., 2012).  Students could express anger towards others due to the sudden loss of their friend.

Interventions

Interventions when treating children and adolescents should include cognitive-behavioral therapy (CBT) with straightforward analyzation of the trauma, coping strategies for stress, and correcting cognitive distortions (American Academy of Child and Adolescent Psychiatry as cited in Katoaka et. al., 2012).  In order to assist the students from the above scenario to relax, this writer would provide coloring pages, blank paper, and a multitude of colored gel pens. The student could choose to color or draw. I would color too in order to help create a relaxed atmosphere. Once the student is relaxed, I could begin to ask questions about his or her observed behavior in the classroom, his or her thoughts and/or feelings about what happened to his or her friend, etc.  In this way would be working toward analyzing the trauma and correcting cognitive distortions while the activity of coloring and/or drawing would be modeled as a coping strategy for stress.

Parents/guardians should have a collateral session (Katoaka et. al., 2012).  Two ways I could educate and support the parents/guardians of the students could be psychoeducation about PTSD and to meet with the parents/guardians during the last 15 minutes to explain strategies to help their son or daughter to cope with the sudden loss of his or her friend.  I would provide a information about children with PTSD on a paper for the parents/guardians to take home. This information could include an explanation of PTSD and its causes, types of behavior one could expect, strategies to help their child to adapt after the trauma, and resources for more information.

References

American Psychological Association. (2008). Children and trauma update for mental health professionals. Retrieved from https://www.apa.org/pi/families/resources/update.pdf

Carter, A. (2018, December 30).  Man and 2 children shot to death in Marion, coroner says [Video File]. Retrieved from https://www.wthr.com/article/man-and-2-children-shot-death-marion-coroner-says

Family remembers victims in Marion triple homicide as investigation continues. (2018, December 31). Fox 59.  Retrieved from https://fox59.com/2018/12/31/victims-in-marion-triple-homicide-identified-as-investigation-continues/

Katoaka, S., Langley, A. K., Wong, M., Baweja, S., & Stein, B.D. (2012). Responding to students with posttraumatic stress disorder in schools.  Child and adolescent psychiatric clinics of North America, 21(1), 119-33.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287974/

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Required Resources

Learning Resources

Please read and view (where applicable) the following Learning Resources before you complete this week’s assignments.

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of the assigned resources for this week. To view this week’s media resources, please use the streaming media player below.

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Readings

  • Gil, E., & Rubin, L. (2005). Countertransference play: Informing and enhancing      therapist self-awareness through play . International Journal of Play Therapy, 14(2),      87–102.      © 2005 by AMERICAN PSYCHOLOGICAL ASSOCIATION. Reprinted by permission of      AMERICAN PSYCHOLOGICAL ASSOCIATION via the Copyright Clearance Center.
  • Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs,      E. C., Ostrowski, S. A., & Fairbank, J. A. (2009). DSM-V PTSD diagnostic criteria for children and      adolescents: A developmental perspective and recommendations . Journal of Traumatic Stress, 22(5),      391–398.      © 2009 by BLACKWELL PUBLISHING. Reprinted by permission of BLACKWELL      PUBLISHING via the Copyright Clearance Center.
  • Stover, C. S., Hahn, H., Im, J. Y., & Berkowitz, S.      (2010). Agreement of parent and child reports of trauma exposure      and symptoms in the early aftermath of a traumatic event. Psychological Trauma: Theory, Research,      Practice, and Policy, 2(3), 159–168.      © American Psychological Association Journals. Used with permission from      the American Psychological Association via the Copyright Clearance Center.
  • Document: Child and Adolescent Counseling Cases
  • DSM-5 Bridge Document: Trauma, Stress, and Adjustment

Media

  • Laureate Education (Producer). (2011). Child      and adolescent counseling [Video file]. Retrieved      from https://class.waldenu.edu
    • “Trauma and Post-Traumatic Stress Disorder”       (approximately 32 minutes)

Optional Resources

  • Kiselica, M. S., & Morrill-Richards, M. (2007).      Sibling maltreatment: The forgotten abuse. Journal of Counseling      & Development, 85(2), 148–160.      Retrieved from the Walden Library databases.
  • Mellin, E. A. (2009). Responding to the crisis in      children’s mental health: Potential roles for the counseling      profession. Journal of Counseling & Development, 87(4),      501–506.      Retrieved from the Walden Library databases.
  • Putman, S. E. (2009). The monsters in my head:      Posttraumatic stress disorder and the child survivor of sexual      abuse. Journal of Counseling & Development, 87(1),      80–89.      Retrieved from the Walden Library databases.

 

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