Trauma and Post Traumatic Stress Disorder (PTSD) in Children.

The more I look at the factors impacting on a child’s ability to learn to read, the more I find out that we may not be paying enough attention to psychological and emotional factors.
Trauma is one of these, which affects children in all aspects of their school work, not only in learning to read. I obtained the information for this post from “Surviving Childhood: An Introduction to the Impact of Trauma” on http://www.childtraumaacademy.com/ .You may be interested in visiting this site to learn more, but for those readers who would like a summary, here it is.

Trauma is a psychologically distressing event that is outside the range of usual human experience. It often involves a sense of intense fear, terror and helplessness. Examples of traumatic events are physical abuse, hurricanes, fires, traffic accidents, witnessing violence, multiple painful medical procedures, sudden death of a parent, threat of violence at school or home.

Threat!

Humans respond to threats with what is called the ‘fight or flight’ reaction—heart races, palms sweat, mouth becomes dry and stomach churns. With an increase in the threat level, the response moves from vigilance to alarm, then fear and finally terror. During a traumatic event, all of the person’s thinking, behaving and feeling are directed by more primitive parts of the brain, and the person tunes out all non-critical information. (So much for people telling us not to panic—do we have a choice?)

A second common reaction pattern to threat is dissociation—the mental mechanism by which one withdraws attention from the outside world and focuses on the inner world. A person may have the feeling that he is an outside observer of what is happening to him. In extreme cases, children may withdraw into an elaborate fantasy world where they may assume special powers.

When the trauma ends, there should be a return to normal within a month. The child moves from terror to fear, then vigilance and with time and support, back to calm. The brain will resume pre-trauma styles of thinking. The child that has dissociated will begin to pay attention to external stimuli.

During this time also, the child will remember the event and play it over and over in his mind, as he tries to make sense of what has happened. He may feel more fear at this time than during the actual threat. All of us can identify with this—we think of what might have happened and are fearful of a repeat. Traumatic memory involves the storage and recall of memory at several levels, not only what, where and when, but also memories of feelings such as fear, dread and sadness, which are stored in sub-conscious parts of the brain. The more life-threatening the experience, the more difficult it will be for the normal mental mechanisms to work efficiently to process and master that experience.

Long after children have experienced a severe traumatic event, about half of them still suffer from confusion, emotional pain, distress and fear so severe that they are not able to function normally. They are suffering from post traumatic stress disorder, (PTSD). This is because, when the child remembers the event, they can recall and relive the emotional and physiological changes that were present in the alarm reaction. They remember how they were feeling and what state they were in, causing a state of hyperarousal. There is an increased startle response, increased muscle tone, a fast heart rate and elevated blood pressure. In addition, the fearful child has a tendency to be defiant and aggressive.

Trauma can have a devastating effect on an individual child, profoundly altering physical, emotional, cognitive and social development. Ultimately we all pay the price exacted by childhood trauma, whether we are dealing with individual children or large numbers of scarred adults assuming their places in society. Social problems of traumatized children can manifest in teenage pregnancy, drug abuse, school failure, victimization and anti-social behavior. The escalating cycles of abuse and neglect of children in some communities can, in turn become a major contributor to many other social problems, such as proliferation of violence and social disintegration.

However, early and aggressive treatment of traumatized children decreases the risk of developing PTSD and other stress-related problems seen later in life. Typical approaches include individual and group therapy. In individual therapy, the child has one-on-one contact with a clinician.

We can also do our part. Here are some guidelines for living or working with traumatized children.

1. Don’t be afraid to discuss the traumatic event when the child brings it up.

2. Provide a consistent, predictable pattern for the day.

3. Be nurturing, comforting and affectionate when the child asks for it.

4. Discuss your expectations for behavior and your style of discipline with the child—use positive reinforcement and rewards.

5. Talk with the child, giving age-appropriate information.

6. Watch closely for signs of reenactment, avoidance and hyperreactivity. Record the behaviors and try to notice a pattern.

7. Protect the child. Stop activities that are upsetting or retraumatizing for the child.

8. Give the child choices and some sense of control.

9. If you have questions, ask for help.

How many of our Jamaican children are suffering from PSTD? Are there any statistics on this? We only have to watch the evening news (which is certainly not suitable for children) to see that children witness or are involved in motor vehicle accidents, and acts of violence with knives and guns, and have their houses burnt down. The available support services are certainly insufficient to cope with the numbers of children, many of whom may receive no help whatsoever. Teachers may be unaware of their condition, regarding them as lazy or badly behaved.

Please help to spread knowledge of PTSD in children by recommending this post to people you know.

Interview with psychologist Dr. Pearnel Bell on ADHD

        A few years ago, I was asked to help a boy with ADHD (Attention Deficit Hyperactivity Disorder) with preparation for the Grade Six Achievement Test. At his initial interview with me in the presence of his mother, he appeared quite normal. He was able to read a story silently and answer questions about it. When he came for class, we decided to look at his homework. I left the room to get a reference book, and when I came back, he had disappeared! I found him hiding in a cupboard! This was not out of fear, but was a practical joke on his part. He was testing my reactions. I learnt that I had to have everything prepared before he came, to include practical activities and not to spend too long on any one activity.
       This boy had made great strides before I met him, and continued to improve, especially with the help of his speech therapist, Winsome Stewart. He was fortunate in being diagnosed and treated early, but there are many who are not so lucky. Having this condition can be a reason why a child doesn’t learn to read, so I asked Dr. Bell to answer some questions about it. I was excited to learn that she has written a book entitled A Teacher Guide to Understanding the Disruptive Behaviour Disorders which will soon be available in books stores in the USA.




Dr. Pearnel Bell



Dr. Pearnel Bell is a practicing psychologist in Montego Bay, Jamaica. She works with children, adolescents, and adults. She is also affiliated to Committee for the Upliftment of the Mentally Ill (CUMI). Her book entitled Words Once Unspoken: Poetry Inspired by Friendship, a book of therapeutic poems, is in books stores in the USA and on amazon.com.

Helen: What is ADHD?
Dr. Bell: ADHD is a neurobiological disorder that results in impulsivity, hyperactivity and inattention.

Helen: How is ADHD diagnosed and can it be misdiagnosed?
Dr. Bell: Sometimes a child may present with predominantly inattentive type or hyperactive. When the disorder manifest as inattention, the ADD diagnosis is given. Several other medical problems can present with symptoms of ADHD and so it can be misdiagnosed.

Helen: What is the prevalence of ADHD Jamaica?
Dr. Bell: Dr. Audrey Pottinger, consultant clinical psychologist at the University of the West Indies, reported that it is as high as 25% of the population.
Helen: That sounds awefully high.

Helen: I believe you have done some research on ADHD with children in Jamaican schools. Were principals and teachers receptive to your enquiries?
Dr. Bell: Yes they were –I have now published a book entitled “ A Teacher Guide to Understanding the Disruptive behaviour Disorders”.

Helen: What was the outcome of your research?
Dr. Bell: The research indicates that there is a high incident of ADHD in schools and teachers were unprepared to deal with the disorder.

Helen: What is the best approach for teachers to take with children with ADHD?
Dr. Bell: It is a multi-disciplinary approach that should be taken but teachers must become aware of the diagnosis and recognize it as a disorder and develop strategies that are covered in my book.

Helen: What is the best approach for parents to take with children with ADHD?
Dr. Bell: Understand what it is and help to regulate the child’s behaviour with a variety of techniques that involve showing unconditional positive regards, behaviour modification strategies that have to be taught to them by a professional

Helen: Are there any foods or drinks which exacerbate ADHD?
Dr. Bell: No- There is a widely held myth that sugar increases hyperactivity this is not true.

Helen: What is your opinion on drug treatment for children with ADHD?
Dr. Bell: Drug treatment is an important part of the treatment because of the neurobiological causation of the disorder. In my book I have a chapter that speaks to drug therapy.

Helen: What alternatives are there to drug treatment?
Dr. Bell: There are computer based programs- One called the Sharper Brain Program that help with the child concentration. There is also biofeedback that helps the child to regulate activity level.

Helen: Do you think that Jamaican schools provide enough outlets for normal children’s need for free movement?
Dr. Bell: Recess, lunch time are seen as play time. Physical education - other than that I cannot say if they get free movement. For the ADHD student, teachers need to provide this outlet.

Helen: Is there anything else which you think parents and teachers should know about ADHD?
Dr. Bell: Please let them know about my book as it addresses all the questions you have raised.

Helen: Thank you Dr. Bell. I look forward to reading your book, and hope it will soon be available in Jamaica.

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Early Literacy

     My main concern is with the high level of illiteracy in Jamaica and the fact that children can pass through the school system without learning to read. It doesn’t have to be so. I believe that many of us making a small contribution could make a real difference. My posts over the next few months will give suggestions as to how. I will start with outlining the situations in which children do learn to read.
     Volumes have been written about methods of teaching children to read, and hundreds of hours have been spent researching how children learn, but how a person actually learns to read is still a mystery. Methods go in and out of fashion, and one set of research contradicts the findings of another. But one observation remains constant— a child learns best in an atmosphere free of stress, in the company of a supportive and caring individual. Badgering and harassing a child, or otherwise communicating anxiety will result in the child having an adverse emotional attitude towards learning.
     There are many pre-reading activities in which a child can be involved which increase the child’s experience, foster the growth of language and encourage awareness and concentration, all of which set the stage for learning to read. These include Art, Crafts, Music, Movement and Imaginative Play, which a child can do at home or at Basic School. Some examples are

• Listening to and telling stories, rhymes, jingles, poetry.    

• Giving and following instructions.                                                 

• Dressing up and role playing, pretend and real use of telephone.

• Taking part in desk games.

• Sorting and matching by colour, size and shape in various materials.

• Drawing with pencils, crayons or markers. Painting with a brush (I have beaten the ends of hibiscus twigs to make brushes for 3-year-old children who tend to destroy conventional brushes.) Drawing with fingers in sand (not necessarily at the beach).



Children painting at my school in Lucea. 1983

      Some people think that ‘just playing’ has nothing to do with learning, when in fact it is an important pre-reading activity.
     Children will probably have no difficulty learning to read if they have had plenty of pre-reading activities, and if the following apply: The child

• Is in good health, can see and hear properly, is free from speech defects and is not seriously retarded in intelligence.

• Is not suffering from stress or post-traumatic stress disorder.

• Asks questions and wants to know what’s going on.

• Understands oral instructions and is able to carry them out.

• Listens satisfactorily to a story and can retell a simple story.

• Can see similarities and differences in simple drawings.

• Draw in a representational form.

• Is generally self-reliant and able to work on his/her own for short periods.

• Co-operates with others.

• Can match word with word.

• Shows signs of wanting to learn to read.

(Adapted from Key Words to Literacy by J. McNally and W. Murray The Teacher Pub. Co.)

     By the time they are five or six years old, children who have been exposed to books will also know how to turn the pages, and be aware that sentences run horizontally, from left to right. They will probably be more proficient than me with computers, tablets and smart phones! They will most likely know the letters of the alphabet and be able to write them. Teaching of reading and writing go hand in hand.

What next?


Examples of flash cards

      That depends on the teaching method employed. In the ‘look and say’ method, the child learns to recognize whole words by their shape, in sentences in a reading book or on flash cards. Whole sentences help the child to anticipate meaning. Flash cards can have a picture on one side and word on another, and a child can use them as a prompt. They have a variety of other uses, including the playing of games.

Some teachers use phonics from the beginning and use series such as Jolly Phonics. Children learn to associate letters with the speech sounds they represent, rather than learning to recognize the whole word as a unit. Knowing the letter sounds, the child must learn to blend e.g. ku-a-t into ‘cat’. I often wondered why so much emphasis is placed on spelling in Jamaican schools, but I had to ask myself
     “Is it easier to decode using phonics or by having learnt a spelling?”
      Part of the difficulty associated with phonics results from the way in which Jamaicans pronounce their words. (This difficulty is not unique to Jamaica as there are variations in pronunciation wherever the English language is spoken). Whether through spelling or phonics, the child only becomes a competent reader when he has ‘read’ the word enough times to be able to recognize it instantly. Some children need much more practice than others.

     All children need to read every day, and in addition to their ‘reading’ book, as they grow in confidence, they need a variety of reading material, including colourful and interesting books from the book corner or library. Let’s not forget to keep reading to our children—wonderful stories which children love to hear may have too many unfamiliar words or too small a print for the beginning reader.

        In my next blogs I will consider what happens to children who do not fit into the ‘best-case scenario’ and how we can help them.