Post-traumatic Stress Disorder is a severe anxiety disorder that can result after any exposure to a psychological trauma. The goal of this presentation is to help educators become more aware of the manifestations of this disorder in the classroom. By the end of the session, participants will be better positioned to differentiate normal reactions to trauma from abnormal reactions.

1. POSTTRAUMATIC STRESS DISORDER (PTSD)
Glendon Rayworth, Psy.D., C.Psych.
E-mail: glendonrayworth@live.ca

2. Presentation Outline
(A)PTSD Defined
(B)PTSD In Children
(C)Group Trends
(D)Technical Criteria
(E)Technical Case Study
(F)Practical Criteria
(G)Practical Case Study
(H)Odds and Ends

3. PTSD Defined
-PTSD is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. (Wikipedia, 2012)
-PTSD is a type of anxiety disorder. It can occur after you’ve seen or experienced a traumatic event that involved the threat of injury or death (U.S. National Library of Medicine).

4. PTSD In Children and Teens: An Overview
Who is at risk?
Anyone who has lived through en event that could have caused them or someone else to be killed or badly hurt.
What are some examples?
Violent crimes, car crashes, fires, war, natural disaster, a friend’s suicide.
What increases the risk?
-Severity of the trauma
-Parental reaction to the trauma
-Proximity to the trauma
Source: US National Center for PTSD

5. PTSD in the Schools: Group Trends
The Race Effect
Post-Traumatic Stress Disorder (PTSD) is found more frequently in inner-city African American and Latino youth than in European American youth. (Zyromski, 2007)
The Behavioural Effect
More violence exposure/PTSD= more behavior problems and less school achievement (Thompson and Massat,2005).
The Violence Effect
Students with PTSD and exposure to violence are more likely to use violence. (Gellman & Delucia-Waack, 2006).
The Alienation Effect
Student Alienation Syndrome (SAS) is posited as a theoretical syndrome describing the effect of trauma experienced in the school setting. Symptoms include hopelessness, oppositionality, and hypervigilance. (Hyman, Cohen, and Mahon, 2003)

6. PTSD: DSM-IV-TR Criteria
A.The person has been exposed to a traumatic event…
B.The traumatic event is persistently reexperienced…
C.Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)…
D.Persistent symptoms of increased arousal (not present before the trauma)…
E.Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

7. The Case of Little Albert (John B. Watson’s ‘Poster Boy’ For Classical Conditioning 1920)
US=Loud noise  UR=Fear/crying
CS=White rat  CR=Fear/crying
Little Albert generalized this fear to other furry objects, such as rabbits, dogs, and beards.
In PTSD language, the furry objects became the “cues” referenced in B-4 of the DSM-IV- TR.

8. Practical Diagnostic Criteria: An ABC Approach (Adapted from “After The Injury” , Children’s Hospital of Philadelphia)
(A) Re-experiencing
(B) Avoidance
(C) Hyperarousal
aftertheinjury.org

9. (A)Re-experiencing: Reliving what happened
Thinks a lot about what happened to him/her
Has bad dreams or nightmares
Gets upset or has physical symptoms (headache, stomachache, heart beating fast) at reminders of what happened

10. (B)Avoidance: Staying Away From Reminders
Doesn’t want to talk about what happened or tries to push it out of his/her mind
Wants to stay away from people, places, or things that are reminders of what happened
Afraid of something that s/he was not afraid of before (or a previous fear or worry seems to get worse)
Not interested in usual activities, since the injury
Not interested in being with people s/he usually likes, since the injury

11. (C)Hyper-arousal: Feeling Anxious or Jumpy
Worries a lot that something else bad will happen
Startles easily – for example, jumps if there is a sudden noise
Irritable or has angry outbursts, since the injury
Has trouble paying attention to things, since the injury
Has trouble falling or staying asleep, since the injury

12. Other Concerns
Pain or discomfort that does not get better
Trouble returning to school or other activities
Changes in your child’s usual behavior

13. Other Symptoms
Anger
Sadness
Feeling alone and apart from others
Feeling as if people are looking down on them
Low self-worth
Trust issues
Out of place sexual behaviour
Self-harm
Substance abuse
Weapon possession (protection)
Impulsive and aggressive behaviours
Day dreaming
Blank stares
Fatigue
Acting out/disruptive behaviour/clowning around

14. The Case of Jason
Age: 16
Grade: 11
Gender: Male
Race: Black
Religion: Christian
Parenting:Single mother/father absence
Siblings: Three younger siblings

15. Family History
Born outside of Canada
At age 4, Jason and his mother left country of birth, fleeing political persecution
Moved to Canada at age of 12, with mother facing deportation
Lived in homeless shelters before which time public housing became available

16. School History
Gifted programming before arriving to Canada
Mischievous/disruptive behaviour history
Five suspensions:drug possession, drug intoxication, pulling the tab on a fire extinguisher, physical assault, and trafficking in illegal drugs.
Two expulsions: (1) Robbery (2) Trafficking
Grade 8: 50s Grade 9: 70s Grade 10: 50s

17. Current Situation/Symptoms
Transfer
Pseudonym
Withdrawn/Strange
Suspicious
Uncharacteristically isolative/quiet at home
“I saw something happen”
Reluctant to talk about details
Trust issues
Drug intoxication
Work resistant
Acting out

18. Psychological Testing Results
Jason is a 16-year-old boy in Grade 11 whose profile of intellectual functioning indicates a generally Average level of performance, with weaknesses in visual-motor functioning and strengths in rote memorization. Assessment of academic functioning indicates generally adequate levels of achievement, with weaknesses in applied written expression and math computation, and strengths in listening comprehension. Jason’s overall level of academic achievement is generally commensurate with his level of intellectual functioning. Though Jason does exhibit a mild processing deficit in visual-motor functioning, which may limit his capacity to complete written work comfortably and efficiently, the extent of this deficit is not significant enough to warrant the diagnosis of a learning disability. Assessment of social, emotional, and behavioural functioning indicates solitary withdrawal, behavioural inhibition, depressed mood, and anxiety. Much of this is judged to be an adjustive reaction to recent stressful events in Jason’s social sphere, causing significant mistrust and fearfulness, which may border on defensive suspicion. More characteristically, Jason has exhibited a pattern of non-conforming, disinhibited, and disruptive behaviour, recently escalating to criminal proportions. Accordingly, while features of Conduct Disorder are evident, this diagnosis is deferred, in light of recent expressions of progress and reform. In order to sustain this reform however, carefully supervised transition and support will be required.

19. Accommodating PTSD in the Classroom
Establish a feeling of safety. Lead by example.
Avoid exposure to triggers.
Maintain a predictable and consistent routine. Preview changes.
Make sure classroom environment is user friendly (e.g. not too cluttered/ crowded/noisy).
 Validate their distress if they bring it up. E.g. “That sounds really stressful. How can we help you with that?” Don’t be dismissive or trivializing E.g. “Just try to block it out.”
Reassure them that their distress is a normal response to abnormal stress.
Program opportunities for self-soothing. E.g. Music, relaxation scripts, exercise, fidget toys, etc…
Clarify disciplinary protocol proactively.
Provide the student with a sense of control. E.g. Give them choices.
If acting out, address privately “It’s hard for you to focus today. How can I help you?”/“You don’t seem to be yourself today. What’s up?”

20. Resources
http://ptsdassociation.com/about-ptsd- association.php (London, ON)
http://www.aftertheinjury.org/quick-quiz (Philadelphia, PA)
http://www.camh.net/About_Addiction_Mental_Health/Mental_Health_Information/ptsd_refugees_brochure.html (For refugees and new immigrants)
http://www.ptsd.va.gov/public/pages/ptsd- children-adolescents.asp (USA)