HOW KIDS COPE WITH TRAGEDIES

How well can a child cope with tragedy? 

Two British psychiatrists think they know.  They say that after a traumatic event (witnessing the murder of a family member, being raped, surviving a fatal car crash, etc.), one of three tests administered to a child survivor can predict whether or not that child will cope successfully with the trauma. 

In the early evening of October 21st, 1988, a party of 400 British school children along with 60 teachers and other adults set sail on an educational excursion of the Mediterranean aboard the cruise ship, Jupiter.  Twenty minutes out of the Greek harbour of Piraeus, the Jupiter inexplicably collided with an oil tanker.  The Jupiter rapidly took on water, listed, and sank.  The children, most of whom were aged between fourteen and sixteen, were thrown into the water while others had to negotiate treacherously sloping decks in order to reach life boats.  Some children, non-swimmers among them, jumped into the dark, oily water strewn with debris.  Most feared they would drown and were terrified that the sinking ship would pull them down.  Although only four people died, nearly all found the experience extremely traumatic and were, therefore, at great risk of suffering childhood post traumatic stress disorder (CPTSD). 

Twenty-four girls who survived the Jupiter tragedy were intensively studied by Dr. William Yule of the Institute of Psychiatry at the University of London and Dr. Orlee Udwin of the St. Thomas Hospital in London.  They argue that it is now possible to recognize which children are most likely to suffer CPTSD---and which are most in need of treatment.

Drs. Yule and Udwin tested the ability of three tests, the Impact of Events Scale, the Birleson Depression Scale, and the Revised Children's Manifest Anxiety Scale, and discovered that each was able to clearly distinguish which girls were more likely to suffer from CPTSD and which were not.  They say, “the battery seems useful in screening post-traumatic stress disorders in teenage children.”

CPTSD occurs when the child suffers long-term physical and psychological effects, including psychosomatic symptoms, after witnessing or experiencing a distressing event outside the realm of everyday life.  The event producing this disorder would be markedly distressing to almost any child and usually involves intense fear, terror, and helplessness.  Many suffering with CPTSD find it impossible to function normally and remained scarred for the rest of their lives. Interestingly, PTSD in adults was officially recognized as a disorder in 1980, but not until 1987 was it recognized in children too. 

Some of the signs of CPTSD that doctors look for are as follows:

*There is often a persistent re-experiencing of the traumatic event.  Often this involves recurrent distressing dreams of the event.  In young children, distressing dreams of the event may, within weeks, change into generalized nightmares of monsters, of rescuing others, or of threats to self or others.

*There often is a persistent avoidance of stimuli associated with the trauma or a numbing of general responsiveness.  For example, if the event was a fatal car crash, the child may refuse to enter a car. 

*There is often a persistent increased arousal.  For example, a child may be easily upset if reminded of the traumatic event.    

*Recurrent and intrusive distressing recollections of the event often occur.  In young children, repetitive play often takes place in which themes or aspects of the trauma are expressed.

*Sudden acting or feeling as if the event were recurring often occur.

*Intense psychological distress at exposure to events that symbolize or resemble an aspect of the event often occur.

*There are efforts to avoid thoughts, feelings, or activities associated with the trauma

*There is often an inability to recall important aspects of the trauma.

*There is often a major decline in performance or interest in significant activities or acquired developmental skills.  For example, in young children there may be a loss of toilet-training or language skills.

*There are often feelings of attachment, estrangement, or a restricted range of affect [an inability to express loving feelings].

*Occasionally, a child may be mute or refuse to discuss the trauma, but this should not be confused with the inability to remember what occurred.

*There may be a marked change in orientation toward the future.  This includes the sense of a foreshortened future.  For instance, the child may not expect to have a career, marriage, or children.

*There may also be "omen formation".  This is the belief in one's ability to prophesy future negative events.

*Children may exhibit various physical symptoms such as headaches, stomach-aches, and so on.  These may last indefinitely.

Drs. Yule and Udwin contend that, following such calamities as the Jupiter disaster, emergency medical procedures [triage] are often only “geared up to deal with physical injuries.”  However, “by contrast, there are few studies of psychological triage with adults and none with children.  Yet in the immediate aftermath of a disaster there is need to provide psychological first aid and then to consider which survivors are at highest risk of developing further symptoms.”

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“PTSD is increasingly recognized to be a prevalent and disabling disorder in children and adolescents, in both the developed and the developing world.  Although much remains to be learned, there have been important advances in understanding its risk factors and pathogenesis.  Research on the management of PTSD in this age group is itself relatively young, and there is an urgent need for additional randomized controlled trials.  Nevertheless, we now have a number of interventions at our disposal.”

---Drs. Debra Kaminer (Department of Psychology, University of Cape Town), Soraya Seedat, and Dan J. Stein in “Post-traumatic stress disorder in children”, WORLD PSYCHIATRY, June 2005, volume 4, number 2, pp. 121-125.

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“More research is needed on the diagnosis and treatment of PTSD in children and adolescents.”

---Drs. F. Najjar (Institute for Juvenile Research, University of Illinois at Chicago), R. Weller, J. Weisbrot, and E. Weller in “Post-traumatic stress disorder and its treatment in children and adolescents”, CURRENT PSYCHIATRY, April 2008, volume 10, number 2, pp. 104-108.  

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