Post-traumatic stress disorder in children: school-based intervention and assessment

Posttraumatic Stress Disorder (PTSD) in Children

In contemporary United States (U.S.) culture, according to C. Cook-Cottone (2004), in "Childhood Posttraumatic Stress Disorder: Diagnosis, Treatment, and School Reintegration," memories of childhood frequently include exposure to trauma. As a result of "sexual abuse, physical abuse, natural disaster, urban violence, school violence, and terrorism," (Cook-Cottone Abstract section, ¶ 1), significant numbers of children in the U.S. suffer posttraumatic stress disorder (PTSD) symptomatology.

The Challenges PTSD Presents

The first challenge for helping children cope with PTSD, according to Cook-Cottone (2004), is to identify children who may be experiencing PTSD symptomatology. For this initial stage in beginning to help these children, school psychologists prove vital. "The school psychologist can facilitate therapeutic and supportive conditions in the school setting through use of cognitive behavioral techniques such as stress management and cognitive restructuring, as well as by the implementation of school reintegration protocol" (Cook-Cottone, ¶ 31). Particular care needs to be invested when therapeutic interventions for children with PTSD are implemented within the school setting.

Therapy for children with PTSD should only be conducted, Cook-Cottone (2004) stresses when the school psychologist:

Completes a comprehensive assessment of the child;

Determines that school-based support proves to be the suitable, least restrictive level of intervention;

Informs the child's parents of all treatment options;

Confirms the child is experiencing adequate adjustment and academic success with intervention; and Readily utilizes consultation, supervision, and referrals (Cook-Cottone, 2004).

Research indicates that "children who have experienced traumatic stress may be at-risk for academic problems...," as the child's "normal development of neurobiological modulatory systems may be compromised, thereby negatively affecting activity level, capacity for reflection, and focused attention"(Cook-Cottone, 2004, ¶ 15).

Preschool children diagnosed with PTSD, research reveals experience a greater risk for developmental delay than children who have not been exposed to traumatic stress.

Strengths/Weaknesses Pertaining to PTSD primary strength for the article by Cook-Cottone (2004), the researcher notes, evolves from specific details regarding factors that contribute to symptomatic expression of children who experience PTSD. The challenges this article stress, which specifically relate how to best apply strategies for helping children with PTSD, also contribute to its inherent strength.

Reflection

In a large school setting, where a school psychologist proves to be the norm, information in this article would likely make a difference to students. In smaller school settings, albeit or in schools with teachers may be grossly understaffed, information presented by Cook-Cottone (2004) may proffer little or no real-life benefits for helping children with PTSD.

Consideration of Cognitive Behavioral Techniques

E. J Brown, J. Mcquaid, L. Farina, R. Ali, and a. Winnick-Gelles (2006) point out in "Matching interventions to children's mental health needs: Feasibility and Acceptability of a pilot school-based trauma intervention program. Education & Treatment of Children, 29(2), 257+. Retrieved March 12, 2009, from Questia database: http://www.questia.com/PM.qst?a=o&d=5016613285" Brown, J. Mcquaid, L. Farina, R. Ali, and a. Winnick-Gelles (2006) recount details of their pilot study which developed and implemented a school-based, trauma-specific intervention program for inner-city children exposed to the World Trade Center attacks on September 11th, 2001. In "Matching interventions to children's mental health needs: Feasibility and acceptability of a pilot school-based trauma intervention program," Brown et al. report that they assessed 63 children/participants, utilizing "measures of posttraumatic stress disorder (PTSD), generalized anxiety, depression, and externalizing symptoms, and provided a 10-session, skill-based classroom intervention" (Brown et al., Abstract section, ¶ 1). After classroom interventions, utilizing cognitive behavioral techniques (CBT), Brown et al. re-assessed the children/participants, and offered individualized interventions to those children/participants who continued to meet criteria for PTSD. After the children/participants completed the individualized intervention, Brown et al. (2006) repeated the assessment. Findings from the differential influence of the classroom and individual interventions indicate that each intervention may aim to address a separate group of symptoms the child may experience. According to Brown et al., contemporary research advocates the value of school-based cognitive behavioral interventions for traumatized youth.

Brown et al. discuss results from four previous studies relating to school-based interventions relating to PTSD. Some investigators recounted percentages of students that revealed significant improvement, while contrary results surfaced in other studies, revealing that some studies continued to exhibit symptomatology at post-treatment. Questions arose in some instances whether or not the ongoing PTST symptomatology may be attributed to imaginal exposure. The creation of a narrative of the trauma, known as an efficacious intervention for PTSD, Brown et al., contend, CBT, Brown et al. (2006) contend, currently reveals the most promise in effectively treating children with PTSD. Therapy interventions help to establish desensitization of trauma-reminiscent stimuli, a reduction of avoidance-related symptomatology, and more normative neurological processing (Brown et al., 2006, Intervention Strategies section, ¶ 2). Ultimately, the study by Brown et al. (2006) finds that along with CBT, program attendance and treatment components explicitly designed to address PTSD may contribute to the of improvement of children with PTSD.

Strengths and Weaknesses Pertaining to PTSD

Several particular points of strength of this article that appealed to the researcher included the documentation of not only the study Brown et al. (2006) completed, but the noting of other studies. Details questioning whether some students actually experienced symptomatology even after continued interventions intrigued this researcher. A weakness the researcher noticed revolved around the lack of more specific details in regard to the participants. The researcher would also have appreciated a specific example of CBT, utilized in different settings.

Application to the School Setting

CBT, implemented in the school setting, would likely contribute to benefits children in the school setting could gain, especially if the PTSD occurred in a school or public setting.

Reflection

Although the article by Brown et al. (2006) proved informative, the researcher felt something more needed to be related. As noted earlier, the inclusion of more specifics regarding the implementation of CBE in school settings, along with more details regarding the children/participants included in this study may have made the article more satisfying.

Strengths and Weaknesses Pertaining to PTSD

This strength of the article by Haeseler (2006), the researcher asserts, comes from the touch/heart of the educator who wrote it. This study drew the researcher inside with its warmth and obvious care for children. One weakness, the researcher notes, however, is the implementation of a specific example of implementing related literary techniques.

Application to the School Setting

The implementation of specific literacy strategies appropriate to aid children of abuse, as Haeseler (2006) recommends, the researcher contends, would prove to be a positive practice. The researcher would be concerned if this would add to the teacher's current stress and/or work load.

Reflection

The article by Haeseler (2006) enhanced the researcher's appreciation of the value and versatility of literature. The researcher experienced second thoughts regarding the role of the teacher as a school psychologist, albeit, in addition to his/her current responsibilities. Perhaps, schools should consider contracting with professional writers to regularly implement this type therapeutic intervention for children with PTSD.

CONCLUSION

Comparing and Contrasting

The articles by Cook-Cottone (2004), Brown et al. (2006), and Haeseler (2006) present pertinent information for teachers in regard to children with PTSD, with the first two directed toward the school psychologist.

Each article, however, the researcher asserts, appears to place all responsibility for dealing with a child's PTSD. This particular point needs to be reconsidered, the researcher contends, with more focus on the involvement/interventions of the parent.