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Helping Students Cope with Trauma and Loss: Online Training for School Personnel with Helene Jackson, Ph.D.
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This course was edited by Sharon Kay. The project was developed by the Columbia University School of Social Work with support from the Bank Street College of Education.

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Course 1

Adapted from the National Institute of Mental Health (NIMH) Web site and the Diagnostic and Statistical Manual: DSM-IV. For specific criteria for each diagnostic category, please refer to the DSM-IV.

Posttraumatic Stress Disorder (PTSD)

Includes child-specific symptoms. Caused by one or a series of traumatic events in which a person experiences, directly or indirectly, a realistic or perceived physical threat of death or serious injury. Responses to the traumatic event include feelings of "intense fear, helplessness, or horror." In contrast to adults, children are more likely to demonstrate their anxiety with disorganized or agitated behavior.

Symptoms of PTSD include one or more of the following:
  • Recurring, unwelcome and disturbing memories of traumatic events. In young children these may be expressed through repetitive play thematically related to the traumatic events.
  • Acting or feeling as if the traumatic events were recurring. Includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, such as those that occur on awakening or when intoxicated. In young children, trauma-specific reenactment may occur.
  • Reactions of severe anxiety to internal or external stimuli that resemble or symbolize one or more aspects of the traumatic experience.
  • Physiological reactions (e.g., stomachaches, headaches) to internal or external stimuli that resemble or symbolize one or more aspects of the traumatic experience.
Symptoms of PTSD that were not present before the traumatic event include two or more of the following:
  • insomnia
  • irritability or elevated temper
  • inability to concentrate
  • hypervigilance
  • exaggerated startle response
In general, PTSD may be diagnosed if the above symptoms last or reoccur for a duration of more than one month and if the disturbance causes clinically significant distress or impairment in social, occupational, or other normative areas of function.

PTSD can be specified with the following designations:
  • Acute When posttraumatic stress symptoms occur and disappear within the first three months post-trauma
  • Chronic When symptoms last longer than three months
  • Delayed Onset When symptoms occur six months or more after the traumatic event

Attention-Deficit Hyperactivity Disorder (ADHD)

A diagnosis applied to children and adults who consistently conduct themselves in ways that are inconsistent with their developmental level and that persist beyond six months. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity.

  • Inattention Like adults, school-age children with ADHD are inattentive. They have a difficult time keeping their mind on one subject and may get bored with a task after a short time. They may give effortless, automatic attention to activities and things they enjoy, but find it hard to pay attention to organizing and completing a task, or learning something new.
  • Hyperactivity Children and adults who are hyperactive always seem to be in motion, whether mentally of physically. They may move quickly without direction, or they may talk incessantly without focus. Hyperactive children have difficulty sitting still; hyperactive teens and adults may experience unremitting restlessness. Both children and adults may try to accomplish multiple tasks simultaneously, without giving full attention to any of them.
  • Impulsivity People who are overly impulsive seem unable to curb their immediate reactions; they may blurt out inappropriate comments, or act without thinking.
Not everyone who is hyperactive, inattentive, or impulsive has an attention disorder. To assess whether a person has ADHD, specialists consider several critical questions:
  • Are these behaviors extreme, long-term, and prolonged? That is, do they occur more often than in other people the same age?
  • Are the problems pervasive, rather than a response to a temporary situation?
  • Do the behaviors occur in several settings or only in one specific place, as in the case of children on the playground? The person's behavior pattern is compared with a set of criteria and characteristics of the disorder set forth by the DSM-IV.
According to the DSM-IV, there are three consistent patterns of behavior that indicate ADHD: inattention, hyperactivity, and impulsivity.

Signs of inattention include
  • becoming easily distracted by irrelevant sights and sounds
  • failing to pay attention to details and making careless mistakes
  • rarely following instructions carefully and completely
  • losing or forgetting things
Signs of hyperactivity and impulsivity are
  • feeling restless, often fidgeting with hands or feet, or squirming
  • running, climbing, or leaving a seat, in situations where sitting or quiet behavior is expected
  • blurting out answers before hearing the whole question
  • having difficulty waiting in line or for a turn
Because everyone shows some of these behaviors at times, the DSM contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear before age 7 and continue for at least six months. In children, they must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. Thus, a child who seems overly active at school but functions well elsewhere does not meet the criteria for a diagnosis of ADHD.

Major Depression

Affects children as well as adults. Manifested through a combination of symptoms that interfere with the ability to work, study, sleep, eat, or enjoy once-pleasurable activities. It is a debilitating condition that affects self-esteem and cognition, and disrupts a person's usual patterns of eating and sleeping. Appropriate treatment, usually a combination of therapy and medication, can help most people who suffer from depression. Please refer to DSM-IV for specific types of depressive disorders.

In children and adults, symptoms of depression include

  • persistent sad, anxious, or "empty" mood
  • hopelessness, pessimism
  • guilt, worthlessness, helplessness
  • loss of interest or pleasure in hobbies and activities that were once enjoyed
  • decreased energy, fatigue, being "slowed down"
  • difficulty concentrating, remembering, making decisions
  • insomnia, early-morning awakening, or oversleeping
  • appetite and/or weight loss or overeating and weight gain
  • thoughts of death or suicide, suicide attempts
  • restlessness, irritability
  • persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Not all depressed children or adults experience every symptom. Severity of symptoms will vary over time, and among individuals.

Obsessive-Compulsive Disorder (OCD)

A potentially disabling condition that can occur in both children and adults and can persist throughout a person's life. Individuals who suffer from OCD become trapped in a pattern of repetitive thoughts and behaviors that are irrational and distressing but extremely difficult to overcome. OCD can range from mild to severe. When severe and left untreated, OCD can destroy a person's capacity to function at work, at school, or at home.

Key Features of OCD include
  • Obsessions Unwanted ideas or impulses repeatedly occur in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. These thoughts are intrusive, unpleasant, and produce a high degree of anxiety, and can be violent.

  • Compulsions In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. In children, the most common of these are excessive hand washing, creating rituals, and repetitive checking to make sure they have done nothing that might have dangerous consequences. Although children's symptoms are similar to those of adults, children are more likely to complain of physical ailments and become irritable and withdrawn.

    Other compulsive behaviors seen in children and adults include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise order. Mentally repeating phrases is common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and transient. Performing rituals may provide relief from anxiety, but it is only temporary.

  • Insight People with OCD show a range of insight into the irrationality of their obsessions. When they are not experiencing an obsession, they can often recognize that their obsessions and compulsions are irrational. At other times they may be unsure about their fears or, on the other hand, believe strongly in their validity.

  • Resistance Most people with OCD struggle to rid themselves of obsessive thoughts and try to abstain from engaging in compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. However, over months or years, resistance may weaken. OCD may then be so severe that it becomes crippling, making it impossible to continue activities outside the home.

  • Shame and Secrecy OCD sufferers often attempt to hide their disorder rather than seek help. They are often successful in concealing their symptoms from friends and peers. However, for the most part, children, do not usually view their symptoms as atypical.

Social Phobia / Social Anxiety

A disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. The condition is characterized by a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions. These fears may be so severe that they interfere with work, school, or other ordinary activities. Many people with social phobia recognize that their fears may be irrational, but they are still unable to overcome them. People suffering from social phobia often experience anxiety for days or weeks preceding a planned social event.

Social phobia may be limited to only one type of situation—such as a fear of speaking in formal or informal situations, or eating or drinking in front of others—or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Social phobia can be very debilitating—it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends.

Physical symptoms often accompany the intense anxiety of social phobia, including blushing, profuse sweating, trembling, difficulty speaking, nausea or other stomach discomfort, which heighten the fear of disapproval. Fear of symptoms can create a vicious cycle: as people with social phobia worry about experiencing symptoms, the chance of developing symptoms becomes greater.

For children to be diagnosed with social phobia, they must be capable of having age-appropriate social relationships with people they know. Their anxiety should be evident, not just when they are with adults, but when they are with their peers.

Panic Disorder

Characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. These sensations often mimic symptoms of a heart attack or other life-threatening medical conditions. As a result, the diagnosis of panic disorder is frequently not made until extensive and costly medical procedures fail to provide a correct diagnosis or relief.

Children and adults with panic disorder develop intense anxiety between episodes. It is not unusual for a person with panic disorder to develop phobias about places or situations where panic attacks have previously occurred, such as in schools, supermarkets, or other everyday situations. As the frequency of panic attacks increases, the person often begins to avoid situations where they fear another attack may occur or where help would not be immediately available. This avoidance may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety.

Substance Abuse

The use or abuse of illicit drugs, such as alcohol, marijuana, heroin, cocaine, PCP, and LSD, or the abuse of prescription or over-the-counter drugs for purposes other than those for which they are indicated, or in amounts other than directed. Numerous stages of drug use and their characteristics in youths and adults have been described in the literature. However, progression through the stages for adolescents tend to be faster when compared to that of adults. Among adolescents, the initial use of drugs is usually experimental, typically within a social context with peers.

The following symptoms must occur within a 12-month period:
  • Recurrent drug use that is accompanied by truancy, isolation from friends and family; abandonment of peer groups, increased tolerance and ability to "handle" the drug, and a move to be in the company of regular users.
  • Recurrent drug use that results in self-destructive behavior such as driving when intoxicated. Performing rituals may provide relief from anxiety, but it is only temporary.
  • Recurrent substance-related financial and legal problems as a result of disorderly conduct, or drug dealing.
  • Recurrent substance abuse, despite the devastating effects on social, interpersonal and/or family life.
Among adolescents behavioral changes, such as lack of motivation and indifference towards school and work, become increasingly evident as they become more and more preoccupied with drugs. Inattention to anything other than drugs precludes all prior interests and relationships. As they become more drug dependent, adolescents are likely to seek harder drugs, and, in extreme cases, they may resort to dealing drugs. These substance-related problems may result in school suspensions or expulsions. As they continue to deny the problem, their physical condition declines, relationships with family and friends are disrupted, and they may become suicidal.

Treatment requires both a physiological and psychological component. The National Institute of Mental Health initially recommends support groups and counseling. If that doesn't help, they recommend comprehensive residential treatment programs to monitor and respond to withdrawal symptoms/behaviors, behavior modification, and psychotherapy for the adolescent and his/her family, when indicated.

Conduct Disorder

A disorder of childhood and adolescence manifested in prolonged behavior problems that include oppositional, impulsive, or antisocial behavior; drug use; and/or criminal activity. In order to meet the diagnostic criteria, the behavior must be far more excessive than what is viewed as "normal" adolescent rebellion or boyish high-spiritedness.

The disorder has been associated with family conflicts, child abuse, poverty, genetic defects, and parental drug addiction or alcoholism. The diagnosis is more common among boys and is estimated to be as high as 10 percent of the general population. However, many of the criteria for the diagnosis (such as "defiance" and "rule breaking") can be subjective. Thus it is difficult to determine how common the disorder really is. Onset most often begins in late childhood or early adolescence. In childhood, the disorder is more common in males than in females. Conduct disorder is often associated with attention-deficit disorder. When these two disorders exist simultaneously, there is a major risk for alcohol and/or other drug dependence.

Children with conduct disorder tend to be impulsive, difficult to control, and unconcerned about the feelings of others. They may engage in antisocial behavior like bullying and fighting, often making no effort to hide their aggressive behaviors. They can be dishonest and can challenge rules for what appears to be no apparent reason.

Severity of symptoms vary with age, depending on the degree of physical strength, cognitive competence, and sexual development. Thus the less severe behavior problems emerge in late childhood while the more severe behavior problems occur in adolescence. The diagnosis of conduct disorder is made on the basis of a persistent pattern of the following kinds of behaviors:
  • cruel or physically abusive behavior towards people and animals
  • devastation of property, willfully or maliciously
  • lying, truancy, running away
  • flagrant violation of rules
  • heavy drinking and/or heavy illicit drug use
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, D.C.: American Psychiatric Press, 1994.

National Institute of Mental Health

Course 2

Magical Thinking

Children believe that their thoughts, words, and actions can cause or prevent things from happening in a way that is inconsistent with the normal laws of cause and effect. Convinced that thinking is the same as doing, children have an unrealistic understanding of the relationship between cause and effect.
Edgerton, Jane E. American Psychiatric Glossary. 7th ed. Washington, D.C.: American Psychiatric Press, 1994.


Individuals who unconsciously overidentify take on all the ideas, values, and attitudes of another person to the point that they seem to become the other person.

Edgerton, J. E. American Psychiatric Glossary. 7th ed. Washington, D.C.: American Psychiatric Press, 1994.


When children are parentified, they are forced or coerced to perform the role of parent to the detriment of their own developmentally appropriate needs and pursuits.

Chase, N. D. ed. Burdened Children: Theory, Research, and Treatment of Parentification. Thousand Oaks, Calif.: Sage Publications, 1999.


Splitting is a mental mechanism whereby people view themselves and others as all good or all bad. They have not integrated the positive and negative qualities of themselves and others into cohesive images that would allow them to accept themselves and others as having both good and bad qualities. Thus, individuals who "split" often alternate between idealizing (all good) and devaluing (all bad) the same person.

American Psychiatric Glossary (From Trauma Disorders Glossary- Copyright 1995-2000 by the Sidran Foundation