1. Psychic Trauma & Children’s Mental Health Robert L. Johnson, MD, FAAP Professor and Chair of Pediatrics Professor of Psychiatry Director of Adolescent and Young Adult Medicine Keith Bratcher Administrative Aide

3. Psychic Trauma  Experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.  A normal response to an extreme event.  Involves the creation of emotional memories about the distressful event that are stored in structures deep within the brain.

4. Psychic Trauma  In general, it is believed that the more direct the exposure to the traumatic event, the higher the risk for emotional harm.  But even second-hand exposure to violence can be traumatic.

5. Traumatic events  Violence personal assaults such as rape or mugging exposure to violence in the home or on the streets can lead to emotional harm directly or indirectly witnessing or experiencing a violent or catastrophic event  Natural or human-caused disasters  Accidents  Military combat

6. Reactions to Psychic Trauma  Some suffer only worries and bad memories that fade with emotional support and the passage of time.  Others are more deeply affected and experience long-term problems.

7. Reactions to Psychic Trauma: Children And Adolescents  Children 5 years of age and younger: Fear of being separated from the parent Crying Whimpering Screaming Immobility and/or aimless motion Trembling Frightened facial expressions and excessive clinging.

8. Reactions to Psychic Trauma: Children And Adolescents  Children 5 years of age and younger: Returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.

9. Reactions to Psychic Trauma: Children And Adolescents  Children 6 to 11 years old : extreme withdrawal disruptive behavior inability to pay attention regressive behaviors, nightmares, sleep problems, irrational fears irritability refusal to attend school or poor school performance outbursts of anger and fighting

10. Reactions to Psychic Trauma: Children And Adolescents  Children 6 to 11 years old : Stomach aches Somatic symptoms that have no medical basis Depression Anxiety Feelings of guilt Emotional numbing or "flatness"

11. Reactions to Psychic Trauma: Children And Adolescents  Adolescents 12 to 17 years old: Responses similar to those of adults ATOD abuse Problems with peers Anti-social behavior Withdrawal and isolation Physical complaints Suicidal thoughts School avoidance, academic decline

12. Reactions to Psychic Trauma: Children And Adolescents  Adolescents 12 to 17 years old: Feelings of extreme guilt over his or her failure to prevent injury or loss of life Revenge fantasies that interfere with recovery from the trauma.

14. Post-traumatic stress disorder (PTSD)  An anxiety disorder  Exposure to a terrifying event or ordeal  Grave physical harm occurred or was threatened

15. Prevalence of PTSD  3.6 percent of U.S. adults ages 18 to 54 (5.2 million people) have PTSD during the course of a given year.  Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. 2% after a natural disaster (tornado) 28% after an episode of terrorism 29% after a plane crash

16. Symptoms of PTSD  Symptoms last more than 1 month  Repeatedly re-experience the ordeal in the form of Flashback episodes Memories Nightmares Frightening thoughts

17. Symptoms of PTSD  Emotional numbness  Sleep disturbances  Depression  Anxiety, irritability  Outbursts of anger  Feelings of intense guilt  Poor concentration  Startle reaction  Regressive behavior

18. Symptoms of PTSD  Symptoms worsened by exposure to events (anniversaries) or objects reminiscent of the trauma.  Routine avoidance of reminders of the event or a general lack of responsiveness (e.g., diminished interests or a sense of having a foreshortened future).

19. When Does PTSD First Occur?  PTSD can develop at any age, including in childhood.  Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later.  Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others suffer much longer.

20. Co -morbidities  Depression  Alcohol or other substance abuse  Anxiety disorder  Headaches  Gastrointestinal complaints  Immune system problems  Dizziness  Chest pain  Discomfort in other parts of the body

21. Predilections  Characteristics of the trauma exposure Proximity to trauma Severity Duration

22. Predilections  Characteristics of the individual Prior trauma exposures Childhood abuse Family history/prior mental illness Gender Family support

23. Predilections  Post-trauma factors Availability of social support Emergence of avoidance/numbing Hyperarousal Re-experiencing symptoms

24. Treatment  Trauma/grief-focused psychotherapy cognitive-behavioral therapy group therapy exposure therapy  Medications  Counseling soon after a catastrophic event