Adolescence

The chosen population for this report is the formal operational adolescence stage from ages 12 and up according to Piaget’s Cognitive Development Theory (Hugar et al., 2017).  During this stage students begin to think in abstract terms, having abstract reasoning and are beginning to be able to use deductive logic.

Post Traumatic Stress Disorder

The diagnosis of PTSD has been extended to children and adolescents since 1987 (referred to as youth) (Hawkins & Radcliffe, 2006).  The symptoms of PTSD are variable because the extent of damage differs depending on developmental stage. The most common symptoms of PTSD include nightmares, fear, and general distress reactions. However, symptoms can extend to re-enactment of the event, regressed behaviour, separation anxiety, and specific forms of behaviour, academic, and somatic problems (Hawkins & Radcliffe, 2006).

Youth have been found to experience PTSD from many types of events where the severity of condition is related to the level of exposure and number of exposures to the experience.  There is also a clear association between childhood medical illness such as cancer or trauma due to an accident and post-traumatic stress symptoms in both children and parents.  Between 25 and 87% of youth report experiencing at least one traumatic event before age 20, with girls reporting more episodes (Hawkins & Radcliffe 2006).

Evidence of Symptoms 

PTSD is detected through youth and parent interviews and youth self-report PTSD/PSS measures exist (Hawkins & Radcliffe 2006). The Impact of Events Scale–Revised may be useful as a self-report measure to assess intrusive and avoidant reactions associated with a particular event (Hawkins & Radcliffe, 2006) and could highlight triggers. Another possible instrument is the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) which is often used as a self-report measure (Hawkins & Radcliffe, 2006) and would highlight levels of distress.  A very useful instrument for Guidance Officers is the Trauma Symptom Checklist for Children (TSCC) which is a self-report measure that can assess a range of symptoms in children (Hawkins & Radcliffe, 2006) and could be used to check whether PTSD is a possibility before investigating more thoroughly.

Impact on the Individual and Interactions

Children’s brains naturally respond to environmental signals to satisfy needs and develop strategies over time.  For example, if a child is malnourished, the child will develop strategies to ensure that a meal can be found and the child can survive (Libertin, 2019).  However, if a child faces repetitive starvation, their brain develops strategies to remain alert and reactive and other parts of the brain controlling logic and thinking do not develop.  For example, researchers have found that PTSD in early childhood abuse cases is associated with deficits in verbal declarative memory which suggests changes to the hippocampus (Caffo et al., 2005).  Eventually researchers have found that the teen’s brain develops neural pathways for fear as coping mechanisms to survive trauma that are triggered by emotions that are uncontrollable and unexpected.

PTSD triggers are certain smells, sights, situations and feelings that activate a strong emotional response from a person.  Reactions to triggers are uncontrollable by the individual once they escalate past a certain point.

Suggested Interventions

Overall, interventions to PTSD outbursts must be carefully and creatively built to build connected relationships.  Research by Libertin (2019) warns adults to steer clear of punishments that involve confiscation of digital devices and time-outs as these only exacerbate the problem.  Instead, interventions can be family or group activities such as social sport, bushwalks or other group activities that give the teen a chance to connect and share.  If connection is enabled, some teens experience post-traumatic growth where teens experience inflated perception of self, better interpersonal relationships, and positive changes to life priorities (Caffo et al., 2005).

The main treatment approaches used in the interventions for PTSD are Cognitive Behavioural Therapy (CBT), Play/Art, Eye Movement Desensitization and Reprocessing and Mind-Body Skills and multiple forms of treatment utilised in several studies (Rolfsnes & Idsoe, 2011).  In the first instance, researchers agree that trauma-focused CBT should be used in all children over seven years (Caffo et al., 2005; Brent et al., 2022).  For children who do not respond to trauma-focused CBT there may be trauma reoccurring or triggers causing relapse.  Research suggests that in these cases trauma reminders should be minimised or avoided (Brent et al., 2022).  Medication may also be considered (Brent et al., 2022).

Another possible scientifically backed intervention for PTSD in adolescents is the Brief Relaxation, Education and Trauma Healing (BREATHE) intervention.  Although developed for primary care hospital settings, the intervention has been shown to be feasible and sustainable (Srivastava et al., 2022).  Predominantly made up of breathing techniques and mind-body relaxation skills, BREATHE have scientifically been shown to increase a sense of control and decrease anxiety (Kobayashi-Suzuki, 2014).  Research suggests that BREATHE suits older children better than younger children although there is no research to suggest age-appropriate modification of the BREATHE approach.