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##  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 trauma. PTSD RELATED TRAUMABy 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                           situations 
*    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, and 
*    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 EXPERIENCESSurvival 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                   down) 
*    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 touches them) 
*                     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 times). 
* Presence of                   appropriate vs. inappropriate people (i.e., the teacher on                      playground duty vs. a prowling stranger). SKILLS TO MITIGATE                  PTSDWhile 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 future. 
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. IDENTIFYING PTSDEveryone 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                     CHILDMaking 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 chain. 
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. REFERENCESAmerican 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               http://www.nimh.nih.gov/publicat/violence.cfm 
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. 
RESOURCES 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 (800-443-ERIC). 
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              376 386. 
Karcher, D.R. (1994). Post-traumatic stress disorder in              children as a result of violence:  A review of current                          literature (doctoral research paper). ED 379 822. 
Motta,                      R.W. (1994). Identification of characteristics and causes of                    childhood posttraumatic stress disorder.  Psychology in the Schools,            31(1), 49-56.  EJ 480 780. 
Richards, T., & Bates, C. (1997).                  Recognizing posttraumatic stress in children. Journal of School                 Health, 67(10), 441-443. EJ 561 961. 
OTHER RESOURCES 
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, 202-682-6000;                                 http://www.psych.org 
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 
Federal Emergency                 Management Agency http://www.fema.gov/kids 
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 
National Center for            PTSD, 215 N. Main Street, White River Junction, VT 05009;                       802-296-5132; http://www.ncptsd.or 
National Center for                        Post-Traumatic Stress Disorder of the Department of Veterans Affairs            http://www.ncptsd.org/ 
National Institute for Mental Health (NIMH)            6001 Executive Boulevard, Rm 8184, MSC 9663, Bethesda, MD                       20892-9663; 301-4513, Hotline 1-88-88-ANXIETY,                                  http://www.nimh.nih.gov 
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This digest is co-produced with               the ERIC Clearinghouse on Counseling and Student                                Services. 
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This project has been funded at least in part               with Federal funds from the U.S. Department of Education, Office of             Educational Research and Improvement, under contract number                     ED-99-COO-0007.  The content of this publication does not                       necessarily reflect the views of or policies of the U.S. Department             of Education nor does mention of trade names, commercial products,              or organizations imply endorsement by the U.S. Government.                   **Title:** Children and Post Traumatic Stress Disorder: What Classroom Teachers            Should Know. ERIC Digest.                                                    **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Clearinghouse on Teaching and Teacher Education, American                  Association of Colleges for Teacher Education, 1307 New York Ave.,              N.W., Suite 300, Washington, DC 20005-4701. Tel: 202-293-2450; Tel:             800-822-9229 (Toll Free); e-mail: [email protected]. For full text:               http://www.ericsp.org.                                                       **Descriptors:**  Coping, Elementary Secondary Education,  Posttraumatic Stress                  Disorder,  Stress Management, Stress Variables, Teacher Role                 **Identifiers:** ERIC Digests,  Survival Skills,  Traumas                                     
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