Childhood Trauma: Trauma Responses
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Because the natural ability to recover from trauma is strong, the symptoms of most traumatized children decrease with time. Although there are rare cases of delayed trauma responses after six months or more, most symptoms will emerge within the first three months. 7 Approximately half of your students who have experienced trauma will develop acute posttraumatic stress disorder, meaning that their symptoms will occur and then disappear completely within three months after the trauma. 8 However, in the other half, symptoms may persist for longer periods of time, eventually becoming chronic. For students whose symptoms are prolonged, most will not meet the criteria for a diagnosis of PTSD. Nevertheless, many of them will meet the criteria for Partial PTSD (PPTSD). Although not yet recognized as a diagnosis in the DSM, PPTSD has been proposed as a sub-threshold form of PTSD in which stress-response symptoms are severe enough to interfere with school, family, and social functioning, while at the same time, they do not meet the full criteria for a diagnosis of PTSD. 9
When school-age children reexperience a traumatic event, you may observe them in play that has a compulsive quality; it is repetitive and lacking in pleasure. They may have frightening dreams and intense reactions to reminders of the event. Avoidance and numbing of feelings may be seen in students like Sandra, who try not to think or talk about the traumatic event, who stay away from situations that remind them of the event, and who are unwilling to engage in previously enjoyable activities. Like Sandra, those with increased hyperarousal may have difficulty sleeping. In the classroom, they may become easily exasperated, erupt into anger suddenly, and startle easily. 10
It is important to note that because PTSD symptoms may be similar to symptoms of other disorders, children's trauma-related behaviors can be mistaken for attention deficit disorder (ADD) or attention-deficit with hyperactivity disorder (ADHD). 11 To help avoid mislabeling and mistreatment of emotional and behavioral problems, it is critical that, whenever possible, school health records include information on students' prior and current exposure to traumatic events, traumatic reminders, and secondary stresses. 12 (See discussion of traumatic reminders and secondary stresses in the section "Retraumatization.")
There have been no studies that empirically validate developmental differences in children's reactions to trauma. However, based on clinical observations and an understanding of child and adolescent development, reactions you might observe in elementary-, middle- and high-school students have been suggested. 13
These reactions to trauma do not necessarily indicate pathology. It is only when they are intense and prolonged, and are interfering with functioning at home, school, and/or with peers that they suggest the presence of a trauma-related disorder.
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