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November 3, 2004

November 3, 2004. Questions Handouts Cases Childhood PTSD History of Diagnosis Descriptions and Definitions History of the Study of Children’s Stress Reaction Prevalence/Incidence Developmental Course Individual Characteristics Social Characteristics Treatment The Future.

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November 3, 2004

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  1. November 3, 2004 • Questions • Handouts • Cases • Childhood PTSD • History of Diagnosis • Descriptions and Definitions • History of the Study of Children’s Stress Reaction • Prevalence/Incidence • Developmental Course • Individual Characteristics • Social Characteristics • Treatment • The Future

  2. Childhood PTSD • History of the Diagnosis • Odysseus-flashbacks from Trojan War (M & B). • U.S. Civil War • WW I and WW II, etc. • Terms used varied: survivor’s guilt, nostalgia, melancholy, physioneurosis, traumatophobia, war neurosis • Prior to 1980, traditional psychoanalytic explanation, if symptoms do not abate and are enduring, blames lies with premorbid characteristics of individual.

  3. Childhood PTSD • History continued • DSM-I (1952) –”gross stress reaction”, a transient, situational, personality disorder (M & B). • DSM-II (1968)- “ adjustment reaction of adult life” little explanation of what this was (M & B) • Ten years of debate over posttraumatic responses of Vietnam veterans. • DSM-III (1980)- Three criteria for PTSD that became the foundation for all later editions of DSM. Criterion A-the BIG difference-Criterion A-exposed to “a recognizable stressor….”

  4. Childhood PTSD • History continued • DSM-IV (1994) 6 Criteria • Criticism of DSM-IV and ICD-10 Definitions of PTSD • Too restrictive, especially for children • Symptom lists not inclusive enough • Should study PTSD as a continuous variable, not a dichotomous one • The Study of Children’s Stress Reactions • WW-II • Surge in research in 1980’s following DSM-III • Children’s stress reactions in DSM-II-R (1987)

  5. Childhood PTSD • Early evidence-1970’s and 1980’s • Children of Chowchilla, CA (Terr, 1979, 1883b, 1991) 26 kidnapped children, ages 5-14, in school bus that was buried underground for 27 hours. • 1983 Australian Bushfire-808 children, ages 8-12 • 1985-present –school shootings • Prevalence/Incidence of PTSD in Children • Dependent on the traumatic stressors, age, (sometimes gender) (ranges 3-58% for persons exposed to traumatic event) • Table 7.2 in M & B, average incidence rates for all but 2 DSM-IV symptoms among traumatized children > 20%.

  6. Childhood PTSD • Associated Symptoms and Disorders • Table 7.2 • Difficult to determine whether these are due to pre-existing conditions or the traumatic experience • Few studies of these associated S & D’s • Developmental Course and Prognosis • Progression-single occurrence- symptoms usually within first year after occurrence • Duration-great deal of variation • Jupiter-Greek ship sinking, 6 significant predictors of later PTSD: seeing blood, being trapped, fear of no escape, panic & fear during disaster, high anxiety 5 months after disaster • No longitudinal studies of development and course for repeated, multiple, or abusive stressors present

  7. Childhood PTSD • Working Model of PTSD (M&B), Chapter 7, Figure7.1 • Traumatic Events-determination of “outside the range of usual human experience and that would be markedly distressing to almost anyone” (DSM-III-R, Criterion A, 1987) • Inherent Stressfulness • Generic Stressful Dimensions (Table 7.3, M & B) • Unique Stressful Dimensions

  8. Childhood PTSD • Types of Stressors (Table 7.4 in M & B) • Acute, non-abusive stressors • Chronic and/or abusive stressors • Emotional Reactions to Traumatic Events • Appraisals • Beliefs • Attributions • Neurobiological Changes • Adults- changes in brain structure and function • Children-fewer studies, but some of same changes noted

  9. Childhood PTSD • Conditioned Responses • UCS, CS • CR • Individual Characteristics • Biological Vulnerability • Psychological Vulnerabilities and Strengths • Gender • Prior Difficulties • Ethnic and Cultural Variations • Developmental Differences • Coping Behaviors

  10. Childhood PTSD • Social Characteristics • Social Support • Parenting Style • Family Discord Vs Cohesion • Other-(financial status of family, psychiatric history, etc.) • Treatment • CBT-greatest # of controlled studies • Involve Parents in Treatment • Relaxation and Sleep Hygiene • Imaginal Exposure • In- Vivo Exposure • Cognitive Restructuring

  11. Childhood PTSD • The Future-Better Designed Research • Traumatized versus non-traumatized children • Descriptive Studies across ages/developmental stages • Effectiveness Studies • Neurobiological Correlates • Randomized Controlled Studies Across Treatments • Follow-up Studies of Treated and Un-treated Children

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