-Caveat Lector- When Post-Traumatic Stress Grips Youth" By Jane E. Brody March 21, 2000, The New York Times "3-year-old girl who was sexually abused by a male relative became afraid of all men, including her own father, who was not the abuser. A college student who was abused by a teacher in high school would not ask questions in class or talk to the professor for fear she would be noticed and the abuse would happen again. A young boy who frequently saw his father beating his mother became irritable and aggressive, had difficulty concentrating and frequently lied and stole. All three are the victims of a trauma that resulted in a form of mental illness known as post-traumatic stress disorder, or PTSD. In Search of Signs The disorder may be readily diagnosed in adults who survive well-recognized traumas like bombings, plane crashes or wartime battles. But in children it often has more subtle roots and takes on symptoms that are easily confused with other conditions, leading to ineffective treatment or none at all. Although the disorder has been known for a long time (it was once called war neurosis), even in adults its many causes and manifestations often go unrecognized. The disorder is characterized by three main symptom complexes that can be socially and emotionally crippling. In children, the symptoms can impair social development and interfere with learning. The symptoms are repeatedly re-experiencing the trauma, often as nightmares, sometimes as flashbacks; persistently avoiding any thing, situation or place that reminds the person of the trauma; and the hyperarousal of the nervous system, characterized by easy startling, hypervigilance, sleeping problems and sometimes by irritability, outbursts of anger or difficulty concentrating or completing tasks. An estimated 13 million people are disabled by this disorder, making it the fifth most common psychiatric problem in the country. Over the course of a lifetime, one person in 12 is likely to develop the disorder, twice as many women as men, and the condition, if untreated, can last for years. These facts have prompted four organizations -- the American College of Obstetricians and Gynecologists, the Anxiety Disorders Association of America, the International Society for Traumatic Stress Studies and the Sidran Traumatic Stress Foundation -- to form the PTSD Alliance to raise awareness of this debilitating disorder. Free educational materials and referrals are available through the alliance's toll-free number: (877) 507-PTSD (7873). For PTSD to occur, a person must have been directly exposed to a traumatic event that involved an actual or threatened serious injury or death to oneself or others, and the person must have reacted to the event with intense fear, helplessness or horror. These two conditions apply to children as well as adults who develop PTSD, but among children the cause is often a less obvious form of trauma than, say, a rape or stabbing. In children, the most frequent causes of PTSD are sexual abuse, physical or emotional abuse by parents or others involved in providing care and being witness to domestic violence that threatened the safety of a parent or guardian. While in adults who experience a serious trauma, the risk of developing the disorder is one in five or one in 10, in children, a study has shown, more than half develop the disorder, often long after a trauma has ended. Dr. Susan V. McLeer, professor and chairman of psychiatry at the State University of New York at Buffalo, studied 80 sexually abused children and compared them to 150 children who were not abused. She reported that children who had been sexually abused were at great risk of developing the disorder, which, she said, is especially harmful for children because it may cause them to miss experiences that are crucial for transition into healthy adulthood. 'Children with PTSD may shrink from people and things that aren't dangerous and are often critical for their social and cognitive development. These youngsters experience a triple whammy: the initial sexual abuse, the direct effects of the PTSD symptoms themselves and then the avoidance behavior that may result in lost experiences important for success throughout life.' Treating PTSD in Children Dr. McLeer cautioned that standard treatments used with emotionally disturbed children, like play therapy and talk therapy, are not effective in countering the symptoms of the disorder. Rather, as with adults with the disorder, children respond best to 'very special targeted treatment, such as cognitive behavioral therapy,' she said. She starts by asking children to identify the five worst things that happened, then asking them to think about each event as if it was actually happening and rate each event on an anxiety scale. Then the youngsters are asked to retell the events over and over again, with more detail each time, until they can talk about the events with at least a 75 percent reduction in the initial level of anxiety provoked. Next the children are helped to conquer avoidance symptoms, using techniques of gradual desensitization like the method used to treat phobias. The child is given 'homework' assignments to start approaching situations gradually, with or without a parent or guardian, that had previously been avoided. Dr. McLeer explained that with the disorder a person's memories are fragmented: the actual memory of the event and the emotion associated with it are separately encoded in the brain. She said, 'We try to unite the emotion with the memory so the child can experience the event as an unfortunate thing that happened and be able to talk about it without becoming distressed to the point of becoming dysfunctional.' Based on her own research and that of other experts, Dr. McLeer said she found a far higher incidence of the disorder than she had expected. 'Children are not being routinely screened for PTSD,' she added. ''Pediatricians should be asking them specific questions, not 'Has anything awful ever happened to you?' but 'Have you ever seen anyone die?' 'Were you ever in a bad accident?' 'Did you ever see anyone shot or stabbed or killed?' And once a trauma has been identified, children need to be asked specifically about symptoms, such as 'Is there something you now avoid that you used to do?' and 'Do you often have nightmares?' " <A HREF="http://www.ctrl.org/">www.ctrl.org</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. 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