Generally, some kinds of shocking experiences, such as sudden accidents, various disasters, and physical or mental assaults and abuses bring about very harmful damages and mental problems to people. Like this the appearance of physical and psychological symptoms of caused by unmanageable calamities and incidents is called ¿½¿½PTSD(Posttraumatic Stress Disorder)¿½¿½. Recently, because of the radical changes of environment around the children, being exposed to possibilities of various incidents and events are increasing. As a result, the rate of children who suffer from PTSD increased.
Actually, the main category of trauma that can cause PTSD in children is abuse. According to some research, 3.85 million children are involved in abusive situations each year. Of those abuse cases, 65 percent are neglect, 18 percent are physical abuse, 10 percent are sexual abuse, and 7 percent are psychological abuse(United States Department of Veterans Affairs’ National Center for PTSD, 2007). Each type of abuse has lasting effects on the survivors. From this point of view, this paper will cover the cause of PTSD in children who are exposed to certain kinds of abuses: school violence, domestic abuse, and sexual abuse. Children could be easily exposed to all of these conditions. The symptoms will be mentioned mainly in this paper but assessment and treatment for PTSD in children also will be given.
PTSD in children
1. The difference between adults and children
In general, not every adult suffers from PTSD after undergoing an injury. However, in children, the rate of occurrence of PTSD was very high(S.J.Kim&H.Kim, 2000, p.79). According to researches, most of the children in abusive situations showed symptoms of PTSD. On the contrary, using the same process of assessment, only about 57% of adults who suffered from injuries showed symptoms of PTSD(Fredrick, 1985; S.J.Kim & H.Kim, 2000, p.89). Also, the characteristics of PTSD in adults and children are different from one another. The cognitive and social abilities of children are not fully developed and they are inexperienced when expressing their situation and dealing with the symptoms. Therefore, the symptoms of children should not be thought as the same with adults¿½¿½. Unlike adults, children can¿½¿½t forget the injury what they experience and also don¿½¿½t deny the situation. Their symptoms of PTSD could also appear immediately after shocking events(S. J .Kim & H .Kim, 2000, p.80). As a result of these situations, the researches studying PTSD in children have been increasing.
According to some research, the main risk factors of PTSD in children are related these factors: sexual abuse, neglects, emotional and physical abuse, domestic violence, divorce of parents, and history of mental illness of parents (Buist, 1998). When children experienced traumatic situations before the injury, it increased the attack rate of PTSD in children. Especially, the most shocking events to children are physical abuse and sexual abuse. The causes related to the environments of children have to do with the support from the family and protection from their parents. It influences the development of PTSD in children. In other words, the children, who are supported and protected by family before an injury, showed mild symptoms of PTSD. Inversely, the children who experienced divorce or mental illness of their parents had a higher chance and more severe cases of PTSD(K.E. Han, 2005; A.K. Park, 2008)
When children have PTSD symptoms, they may have emotional and behavioral problems. Children show anxiety and uncontrolled fear. That anxiety may be the source of the PTSD. Some children and teenagers develop depression, a state in which they feel hopeless or helpless. Also, they may feel isolated. Children could blame themselves for the traumatic event. Their self-esteem can be affected and they can have problems trusting others. In other case, children and teenagers may become aggressive and angry after the their trauma(Gromisch, 2010). Behavioral problems occurred while suffering from PTSD, like self-destructive behavior. Sexually inappropriate behaviors will appear in some children, especially if the children experienced sexual abuse. Some children with PTSD may have substance abuse (alcohol or drugs) problems while trying to deal with their emotional issues, but it worsens their symptoms. The symptoms of PTSD can differ in each age group. For school-aged children, they may repeat the traumatic experiences while playing, such as acting out. On the contrary, teenagers become more impulsive or aggressive as a result of PTSD(U.S. Department of Veterans Affairs’ National Center for PTSD, 2007).
Assessment of PTSD can include methods of collecting information about the environments (ex. family members and other informed adults) of children and appearance of physical symptoms, psychological and educational testing, the use of PTSD scales(McNally, R, 1991; Bruce D, 1994) and semi-structured interviews. As with adults, symptoms of childhood trauma established a spectrum. While many children may not meet the more stringent PTSD diagnostic criteria, they may have significant post-traumatic symptoms, as well as internalizing and externalizing behavior disorders. DSM-III and DSM-III-R criteria have been used to collect information for school-aged children and adolescents whereas assessment of younger children depends on direct observations and reports of caretakers(Bruce D, 1994).
PTSD of children could be cured. Early detection and intervention is very important and can reduce the severity of symptoms, enhance the child’s normal growth and development and improve the quality of life experienced by children or adolescents with PTSD.
Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy for the child. The focus of cognitive behavioral therapy is to help the child or adolescent learn skills to manage their anxiety and to help him/her master the situations that contributed to their PTSD. Some children may be also helpful from treatment with antidepressant or antianxiety medication to help them feel calmer. The child or adolescent’s recovery from PTSD is very variable and dependent on the child or adolescent’s internal strengths, coping skills and resiliency. Recovery is also influenced by the support available within the family environment. Parents play a important and supportive role in any treatment process.
And these are the examples of specific treatments could be helpful to treat children.
Cognitive-Behavioral Therapy(CBT). CBT is a successful approach for treating children. One type of CBT is called Trauma-Focused CBT(TF-CBT). TF-CBT is the process of talking with children about his or her memory of the trauma. TF-CBT also includes techniques to help lower the worries and stress(U.S. Department of Veterans Affairs’ National Center for PTSD, 2007). The therapy may involve learning to change thoughts or beliefs about the trauma that are incorrect or untrue. The child can be taught at his or her own pace which allows them to relax while they are thinking about the trauma.
Psychological first aid/crisis management. Psychological First Aid(PFA) has been used as one of treatments for school-aged children and teens that have been under abuse(U.S. Department of Veterans Affairs’ National Center for PTSD, 2007). PFA can be used in schools and traditional settings. The role of PFA is related to give comfort and support and lets children know that their reactions are normal.
Play therapy. Play therapy can be used to treat young children with PTSD who can¿½¿½t directly deal with the trauma(U.S. Department of Veterans Affairs’ National Center for PTSD, 2007). From this point of view, the therapist uses games, drawings, and other methods to help children process their traumatic memories.
Medications. Drugs have also been prescribed for some children with PTSD. However, due to the some lack of research in this area, it is too early to evaluate the effectiveness of medication therapy.
Definition of Children Abuse
Child abuse is the physical, sexual, emotional mistreatment, or neglect of children. In the United States, the Centers for Disease Control and Prevention(CDC) define child maltreatment as any series of behaviors of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. Most of child abuse occurs in a child’s home, and others occurring in the organizations, such as schools or communities the child interacting with.
Various jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of getting rid of children from their family and/or prosecuting a criminal charge. According to the Journal of Child Abuse and Neglect, child abuse is “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm¿½¿½(Herrenkohl, R.C, 2005).
Relationship between PTSD and Abuse
There is a connection between PTSD and abuse because the withdrawal is associated with many forms of abuse. People who are abused or who watched the situation of abuse may push away thoughts of what is occurring, and these submerged experiences will come out. While there are many types of abuse, including physical, verbal, and psychological, the end result of most people who bear the abuse is emotional distress. Being experienced abusive act, damaging relations mainly causes disorientation or a feeling that what is happening cannot really be real.
Unfortunately, these detached emotions may be extended to other areas of life. Long after events have happened, PTSD and abuse are still connected together because an individual may be unable to move forward either from the trauma or into what is considered normal day-to-day decision making and actions. In a way, PTSD and abuse are as related as two people may be in an abusive relationship or as victims may be at the hands of someone or something that could destroy them. If a separation occurs, the stress and post-trauma state of mind often may need retraining through therapy. Any form of abuse can lead to some isolation either in thought or in relations with the world of outside, and this separation adds to the connection between PTSD and abuse by almost feeding back on itself. People might find a different reality inside their heads about why something happened and how they might have contributed to it. Abuse often happens in isolation, and the trauma may grow in that same kind of isolation. Without outside perspective and healthy replacement thoughts, the cycle can go on for years(Schechter D.S., et al, 2007).
Main types of children abuse caused PTSD
Several researches showed high frequency of school violence. In Korea, the range of children who were exposed school violence was reported to be about 14.1%-58.8%. In other countries, about 25% school age children experienced school violence(S.W. Shin, et al. 2000; J.S. Lee & Y.S. Lee, 2006). The representative types of school violence are physical assault, fight, group fight, ostracization, rip-off, and threatening.
The school age children who were experiencing school violence showed symptoms such as fear, depression, loss of self-regard, and worries about death or injury. These symptoms(especially those connected to PTSD symptoms) have bad impacts on the formation of a child¿½¿½s character. Also, it brings about anxiety, disbelief, damage of cognitive ability, and change of personality(Green, et al. 1991; J.S. Lee & Y.S. Lee, 2006).
Coping with Abused Children
Abuse everywhere is a reason for concern across the globe and it becomes more serious when this abuse is experienced in the schools in the form of school violence. Since, this abuse is very closely related with the kids this needs to be treated more carefully as mishandling of these cases might affect the psychological development of the children. Violence in school is seen in almost all the schools these days. This problem is noticed more in the children when they are in their adolescent age as they undergo the major changes of their life and the kids need to be understood and dealt patience.
The entire school needs to work as a team to cure such children and proper strategy should be made either with the help of a counselor or a psychologist to help the child come out of his situation and start behaving as a normal child. If the child is not dealt carefully he might start feeling rejected and this might destroy his case and reduce the possibility of his getting better.
If any of the class mate notices any kind of unusual behavior from any of his friend or peer he should closely watch him first and then immediately bring it to the notice of any of his teachers or the school authorities. Also he should not stop interacting with the child thinking that he might harm him as he might them feel that the other child is trying to avoid him and this can increase his anger and can result in hatred towards the other child too, rather, speak with the child and make understand and realize that whatever is going on in his thoughts is not correct and he might have misunderstood the person.
One needs to understand that the violent behavior of a child is not a one day problem neither it has occurred due to a particular¿½¿½s day events or incidents, rather it has been going on his mind for quite sometime and so to get the things off from his head will also take some time and thus one needs to be very patient while dealing with a violent child. It will always be the combined efforts of the parents and the school authorities to help a violent child lead a healthy and normal life.
Domestic violence includes physical abuse, sexual abuse, psychological abuse, and abuse of property and even pets(Ganley, 1989; Volpe, 1996). Experience of this form of violence makes people feel a sense of vulnerability, helplessness, and in extreme cases, horror.
Domestic violence is widespread and occurs among all socioeconomic groups. Actually, over 3 million children are at risk of exposure to parental violence each year (Carlson, 1984; Volpe, 1996). Therefore, this form of violence can be viewed as a serious social issue. More than half of the school-aged children who experience domestic violence display clinical levels of anxiety or PTSD(Graham-Bermann, 1994; Volpe, 1996). Without treatment, these children are at significant risk for delinquency, substance abuse, school drop-out, and difficulties in their own relationships.
Especially younger children, generally do not have the ability to adequately express their feelings verbally. Consequently, they express these emotions through behaviors. For example, children may become withdrawn, non-verbal, and exhibit regressive behaviors such as clinging and whining. They also may show eating and sleeping difficulties, concentration problems, generalized anxiety, and physical discomfort(Volpe, 1996)
Unlike younger children, pre-adolescent children have greater ability to express negative emotions(i.e., to verbalize). Victims within this age group show symptoms such as a loss of interest in social activities, low self-concept, withdrawal or avoidance of peer relations, rebelliousness and oppositional-defiant behavior in school settings. It is also common to observe temper tantrums, irritability, frequent fights at school or between siblings, lashing out at objects, treating pets cruelly or abusively, threatening peers or siblings using violence and attempts to gain attention by hitting something, kicking, or choking peers and/or family members.
Coping with abused children
Referrals to the appropriate school personnel could be the first step in assisting the child or teen in need of support(Volpe, 1996). When there is suggestion of domestic violence with a student, consider involving the psychologists in school, social worker, guidance counselor and/or a school administrator. Although the circumstances surrounding each case are various one another, suspicion of child abuse needs to be reported to the child protection agency which in local area by teachers and other school personnel. Also, in some cases, a contact with the local police department may also be necessary for this. When in doubt, consult with school team members. If the child expresses a desire to talk, provide them with an opportunity to express their thoughts and feelings. In addition to talking, they may be also encouraged to write in a journal, draw, or paint; these are all viable means for facilitating expression in younger children.
Adolescents are typically more abstract in their thinking and generally have better developed verbal abilities than younger children(Volpe, 1996). It could be helpful for adults who work with teenagers to encourage them to talk about their concerns without insisting on this expression. Listening in a warm, non-judgmental, and genuine manner is often comforting for victims and may be an important first step in their seeking further support. When appropriate, individual and/or group counseling should be considered at school if the individual is amenable. Referrals for counseling(e.g. family counseling) outside of the school should be made to the family as well. Providing a list of names and phone numbers to contact in case of a serious crisis can be helpful.
The sexual abuse of children not only damages their self-concepts and cause depression, rage, grieve, solitude, but also brings about serious and long-term changes of their behaviors like displaying sexual behaviors improper for their age, feeling suicidal, behavior disorders, and eating disorders. It leads to diverse aftereffects in children during their process of growth. Also, it could cause difficulties to appear after becoming an adult when carrying out roles such as parents, maintaining conjugal relations and socio-economic(K.J. Hong, 1997; J.S.Lee & Y.S.Lee, 2006).
The children who experienced sexual abuse display severe symptoms in areas of emotion, social relation, behavior, learning, and sex. As for the emotional part, serious anxiety, depression, helplessness, shame, guilty, rage are often reported(Fergussion et al.,1996; Mennen & Meadow, 1994). From the viewpoint of social relation, children show alienation and isolation from people and society(Alexander, et al., 1998). Eating disorders, physical symptoms, truancy, running away from home, abuse of alcohol or drugs also appeared as part of the PTSD symptoms(H.S. Kwan, 2002 ; J.S.Lee & Y.S.Lee, 2006).
Actually, the symptoms of sexual abuses appeared differently according to the age. Preschoolers showed anxiety, nightmares, general PTSD, internalizing and externalizing issues, and inappropriate sexual behaviors. School-aged children had fears, neurotic and general mental illness, aggression, nightmares, school problems, hyperactivity, and regressive behaviors. Adolescents showed depression, suicidal behaviors, or self-injurious behaviors. The common symptoms of all age are nightmares, depression, withdrawn behaviors, neurotic mental illnesses, aggression, regressive behaviors, and learning impairment(Kathleen, Linda, and David, 1993).
Coping with abused children
If a child says she or he has been abused, try to stay them calm. Reassuring the child the abuse is not his/her fault. Also, noticing that the truth which people believe him/her and they are proud of his/her telling of abuse. Then, Children need the recovery of their mental health and they have to meet medical professional right away. Many cities have child advocacy centers where a children and their family can get help. These centers interview children and family members in a sensitive, warm place. They can help caregivers report the abuse to legal authorities and give a medical examiner and therapist skilled in child sexual abuse.
Children can recover from sexual abuse and go on to live good lives. The best predictor of recovery is support and love from their main caregiver. Therefore, the role of caregivers is really important in the process of coping abused children It is often very hard to accept that a child has been experienced sexual abuse. Caregivers often make a mistake in supporting abused child by responding in certain unhelpful ways. For example, they cannot provide support by being overwhelmed with their own emotions. They shouldn¿½¿½t downplay the abuse(e.g. “it wasn’t that bad”), but also try not to have extreme fears related to the abuse(e.g. “my child will never be safe again”). It will not help children if caregivers force them to talk, or if they blame the child. Getting therapy for caregivers can help them deal with their own feelings toward the abuse. Then it makes better the coping ability of caregivers providing support to abused child.
To sum up, children who experienced school, domestic, and sexual abuse showed the vulnerability to PTSD. Most of the children who were in abusive situations displayed the PTSD symptoms. However, it is really hard to know the seriousness of children with PTSD because the children lack the ability to describe and recognize their conditions in comparison with adults do. Therefore, in the process of treatment, proper method of assessment should be used through a viewpoint of multidimensional framework which could incorporate the many intervening variables that modify the effects of abuse.
Also, the fundamental solutions, for help children who have been abused or are being abused, have to be found. Through the research, it was found that there are no such fixed treatments for abused children. There are so many treatment theories for them, but there are little things can actually practical and helpful to children. Therefore, the systematic and fundamental treatments need for abused children. As mentioned before, the period of school children and adolescents are really important to whole life of people. If children who abused by others cannot be treated systematically by others, it would make their entire life destroyed. Finally, in other words, the organized solution is required the proper treatments considering their physical, psychological, and environmental situations in terms of families, schools, and societies. Practical treatment is not only need for abused children also importance of ¿½¿½care¿½¿½ need for children as a considerable effect on them. Every process of coping abused children needs the caregivers care. Also, children who were given warm attention before or after abusive situations resulted in the low possibility of being exposed to PTSD. In fact, the reactions of parents have appreciable influences on behavior of children coping with abusive situations and memories(S.J. Kim & H. Kim, 2000, p.81).
Therefore, the caregivers of abused children should pay attention to how the child is coping. They should listen to the children in a warm, non-judgmental, and genuine manner. In short, the circumstances have to be made in which children could be cared properly. Also, it is important to make safe and proper circumstance which children would not be abused. In this process, the children¿½¿½s caregiver attention is really required. Caregivers always should be listened to saying of children and know what they wanted. As a result, the continuing research of treatment of PTSD in children as a fundamental solution can decrease the occurrences of PTSD caused by abusive situations.
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