|
Introduction
During the past few years, trauma has become
a dominant issue in the forefront of professional
communication and debate. Trauma itself has
been known to manifest as an array of psychological
and physiological issues. While the repercussions
of specific traumas such as war, vehicular accidents,
robberies, hostile terrorist actions, and weather
related events have been clearly associated
with Posttraumatic Stress Disorder (PTSD), the
relationship of PTSD to a number of childhood
experiences has not been as clearly defined.
The controversy is intensified with the inability
to conduct research on children who are preverbal
or incapable of comprehending the traumatic
event. Research has indicated that children
have an inherent ability of being resilient,
thus this research intends on providing information
that clarifies why children have an inherent
ability to be resilient. It intends on clarifying
why some children are capable of rebounding,
while others are not faceted with the proper
tools to rebound. In order to be diagnosable,
according to the Diagnostic Statistical Manual
IV-TR, the criterion specifies that an individual
must have persistent impairment for at least
one month following a traumatic event and that
this must cause dysfunction of life and functioning.
This article will compare and contrast issues
central to trauma and the affect upon children.
The article intends on clarifying treatments
that are most effective and theories that are
most beneficial in treating PTSD.
Posttraumatic Stress Disorder
The causation of Posttraumatic Stress Disorder
(PTSD) is the exposure to a trauma or a set
of traumatic experiences. The etiological hypothesis
is that PTSD is caused by the trauma. The type
of trauma is not as significant as is the frequency,
intensity, severity, longevity, and the duration
with which the trauma is endured. The exposure
to a trauma may vary in intensity, severity,
longevity, and the frequency with which an individual
experiences the impact of the trauma. When an
individual has been exposed to a trauma and
the impact of the trauma persist, lasting an
extend period of time; then the probability
that the individual has the diagnosis of PTSD
is plausible. PTSD is based on one’s primal
fears and anxiety. The severity of the stress
associated with the trauma may be the stimulus
that perpetuates the PTSD. “There’s
a well-established dose-response relationship
between stress and its effects: the more severe
the stress, the more severe the symptoms.”
(Allen, 2005, p. 182) Furthermore, even if an
individual endures extreme stress, it does not
mean they will develop PTSD symptoms. However,
if an individual does endure an extremely stressful
event and/or an intensely stressful situation
they may be more prone to develop PTSD.
Research has discovered that childhood victimization
and its connection to PTSD coincides with adult
victimization. (Brown, 2008) “As has been
observed among adults, child clinicians and
researchers have discovered that the presentation
of PTSD in childhood can vary dramatically with
respect to the severity, chr onicity, and number
of symptoms expressed (Faust & Furdeall,
2002; Norman-Scott & Faust, 2002; Faust
& Katchen, 2004, p. 427). Characteristically,
children and adults who endure the hardships
of a trauma may have a vast array of symptoms
associated with the trauma. Symptomatologically,
a victim of PTSD may present with re-experiencing,
intrusions, distractibility, hyper-arousal,
avoidance and numbing, regression, sleep disorders,
difficulty concentrating, stimulus discrimination,
hypervigilance, outbursts of anger, social withdrawal,
altered perceptions, dissociation and somatization,
exaggerated startle responses, and the abuse
of drugs, alcohol, or others substances. For
younger children, it is much rarer that they
may present with issues of drugs, alcohol, and/or
other substance abuses, it is important that
clinicians take this into account. “Like
adults, traumatized infants (children) show
symptoms of sleep disturbance, nightmares, hyper-arousal,
intrusive memories, and personality changes.”
(Allen, 2005, p. 173) The symptomological difficulties
have been shown to affect the individual at
a variety of stages in life despite their age,
gender, intellectual quotient (IQ), temperament,
and socio-economic standing.
Children may develop a host of psychological
and psychiatric traits. They may develop fears
and anxieties associated with the trauma causing
the onset of dissociated emotions through disorganized
or agitated behaviors, numbness, re-experiencing,
anxiety, stress, avoidance or depression. Children
and adults who are affected by the trauma may
have difficulty trusting in another person;
relying upon others; or associating with others.
If a victim has to associate themselves in events
such as a court case, identifying their perpetrator,
and/or other legal proceedings, the association
may trigger a host of psychological difficulties,
even triggering memories associated with their
original traumatization. If they are forced
to involve themselves with their perpetrators
or associates of their perpetrators, it is important
that the individual is reassured that they are
protected and not to fear their perpetrator.
Victims who are forced to face their perpetrators,
it has been shown that they may become drawn
inwardly, even showing signs of dissociation
and depersonalization. Therefore, it is vitally
important that when children are forced to face
their perpetrators that “they” are
capable of feeling secure and reassured of their
safety. It is important to recognize that most
children’s perpetrators are commonly associated
with them (e.g. family, friends, friends of
family, religious leaders, etc.). When working
with younger children, it has been discovered
that play therapy, music therapy, and art therapy
are excellent venues for accessing information
concerning their perpetrators and their personal
victimization. Through such therapeutic orientations,
children may actively relive and act out events
expressing themes associated with the trauma.
Furthermore, not unlike adults, children have
been known to re-experience their victimization
through their dreams; therefore, it may be important
to monitor their dream states as well.
Frequently, victims of trauma who meet the
diagnosable criteria of PTSD may avoid people,
places, activities, or things. In conjunction
with their avoidance of people, places, or things,
they may sterilize themselves from affection
altogether. They may choose to limit the type
of affection, the amount of affection, the individuals
they show affection, and why they show affection.
They may have skewed ideological views on why
affection should be shown. They may also limit
or reject affection from others. PTSD victims
may be inclined to view the future as bleak
and without merit.
Children may present with an inability to be
manageable in educational and organizational
confines. They may prove hostile towards peers
and adult figureheads (e.g. teachers, religious
leaders, social leaders). Children may avoid
contact with peers, family, and other significant
role players in their life. Children may begin
avoid aspects of their life that they once loved,
admired, and provided them pleasure.
Diagnosing a child with PTSD may prove more
difficult than an adult. Although children and
adults can prove resilient when addressing trauma
and traumatic events, the difficulty becomes
apparent when diagnosing a child who has not
developed language or verbal skills, or the
cognitive ability to comprehend the discussion.
The obstacles facing the diagnosis of a child
will vary dependent upon a number factors such
as age, intellectual quotient (IQ), educational
level, developmental stages and environmental
factors. “It is important to note that
most adults and children are resilient in the
face of trauma and do not develop long-lasting
emotional disturbances” (Feeny, Treadwell,
Foa, & March, 2004, p. 466). The complexities
of diagnosing an individual with PTSD, much
less a child with PTSD, can prove further difficult
when trying to gather information. If an individual
has caused the child to be traumatized, it may
exaggerate the traumatic issues because a child
may resist discussing issues if the perpetrator
is a family member, friend or friend of the
family. Children may have greater complexities
due to recalling the trauma because of their
age, IQ, educational level, developmental stages,
and environmental factors. Therefore, the diagnostic
concerns may be overlooked and the depths of
the traumatic impact may go without recognition.
Thus, allowing for the traumatic issue to become
more pronounced in the life of the individual.
Unfortunately, a child presenting with PTSD
usually has a direct link to some form of childhood
abuse. Research has indicated that a vast number
of psychiatric patients present with issues
stemming from childhood abuse. “…50-60
percent of psychiatric inpatients and 40-60
percent of outpatients report childhood histories
of physical or sexual abuse or both… Thus
abuse in childhood appears to be one of the
main factors that lead a person to seek psychiatric
treatment as an adult” (Herman, 1997,
p. 122). It is unfortunate that children may
endure childhood abuse, but even greater an
issue is that the childhood abuse may go unchecked
or undiagnosed until they are adults.
A child’s environment is core to a child’s
sense of personal security. A child that is
incapable of feeling secure may experience fractures
within their sheltered existence. Being sheltered
is not to imply that parents are confining them
to a room, rather sheltering is synonymous with
protective factors (i.e. sheltering from abuse,
personal harm, or the perception of harm). While
childhood PTSD may be associated with a number
of issues, one of the prominent issues today
is associated with physiological health. A child’s
resiliency could be associated with longevity,
a superman type of existence, an invincibility,
and youthfulness. Children who become ill and
no longer fall under the misconception of their
invincibility become genuinely aware of their
own human frailty. This too is often witnessed
in victims of rape, incest, molestation and
kidnapping.
A child who has an opportunity to be raised
in a secure and safe environment may see their
world in a pluralistic fashion. A child who
is raised in a secure and safe environment with
the proper attachments may have a positive personal
perception and worldview. A child who has been
raised in an environment that is pluralistic
in its ideological perspectives, may foresee
a life of endless bliss and optimal possibilities.
If a child who has had a good familial environment
endures a trauma, they have been known to seemingly
thrive beyond those who have not had a good
familial environment. It is not to say that
a child in a good environment will thrive and
others will not, rather with the “proper”
familial support and affection, a child has
a greater chance of returning close to the “normal”
life that they once knew or understood. Whereas,
a child without familial support or improper
affection may not have the boundaries whereby
to gain the support much needed to thrive and
prove interpersonally resilient.
A child who endures a trauma will experience
a sudden change of their worldview and perception
of themselves. The change may be sudden or gradually
experienced. It is like the child has his or
her curtains drawn revealing that they are indeed
not invincible, becoming knowledgeable of the
magnitude of their human frailty. Such change
is rarely sought out and is often forced upon
the individual through some sudden traumatic
experience. Despite the trauma, children most
frequently remain as unconquerable survivors.
Moreover, unlike adults, a child is commonly
uncompromised and unblemished devoting themselves
to a childlike state. When the trauma occurs
and the most egregious event shatters their
childlike state, the child becomes fluently
aware of their own humanity. Children who suffer
from a wide range of health issues when the
onset is sudden may suffer from symptoms of
PTSD.
Cancer thrives on the human ability to survive.
It literally and figuratively devours the right
to human survival. Cancer is one of the most
common of childhood illnesses. While cancer
may seem as bleak as any illness, the survival
rate amongst childhood victims remains encouraging.
“The current overall 5-year survival rate
for childhood cancer is 75% (Ries et al., 1999),
with improved outcomes attributable to more
aggressive multimodal treatments” (Kazak,
Alderfer, Barakat, Streisand, Simms, Rourke,
Gallagher, & Cnaan, 2004, p. 493). When
a child is suddenly impacted by a health related
issue, the suddenness of this disease may leave
children in a state of brokenness and disrepair.
“Posttraumatic Stress Symptoms (PTSS)
(PTSS; Stuber, Kazak, Meeske, & Barakat,
1998) have emerged as one of the most important
psychological consequences of childhood cancer.
The diagnosis of cancer represents a life threat,
which is core to the concept of traumatic stress”
(Kazak, et. al. 2004).
The debate surrounding diagnosing PTSD and
other childhood illnesses stems from a similar
debate that permeates the issues of childhood
abuse. How can an individual suffer from PTSD
if they have not endured a true violent action
or life-threatening scenario? Conversely, how
can a child not be a victim of an illness or
abuse if their own life was securely attached
prior to their victimization?
Trauma does not have to occur directly or personally
to affect you vicariously. It is important to
recognize that trauma affects not only those
who have endured the trauma, but those who are
in the life of the victim. When a child endures
a trauma, the family will frequently reap the
impact of the trauma as well. Likewise, if a
child’s family endures a traumatic event,
he/she too may experience the trauma vicariously.
Therefore, the trauma rarely impacts just one
individual. When a family member that has been
considered an anchor endures a trauma, it will
frequently cause a rippling affect throughout
the family. Thus, when a child sees that individual
who has been a stable force in their family
traumatized, it may upheaval a variety of emotional
issues, including emotional distress, fears,
and anxieties.
All children are vulnerable to trauma and the
possibility of PTSD; however the physiological
and psychological makeup of the child may determine
their own risk. “A child’s risk
of developing PTSD is related to the seriousness
of the trauma, whether the trauma is repeated,
the child’s proximity to the trauma, and
his / her relationship to the victim(s)”
(AACAP, 1999, Online). Traumas that lead to
childhood PTSD are commonly associated with
prolonged and repeated traumatization. “Fortunately,
most persons who are exposed to potentially
traumatic events do not develop PTSD”
(Allen, 2005, p. 173). Therefore, if a trauma
is not endured in a prolonged spectrum the effect
of the trauma is lessened.
When a child has the proper support mechanisms
in place, they are less likely to incur the
full severity of the trauma. The familial structure
of a child’s home may account for variations
of cause-and-effect. If a child is raised in
a home based on a single parental figure, “…there
may be less child supervision, resulting in
greater exposure to community violence”
(Ng-Mak, Salzinger, Feldman, & Stueve, 2004,
p. 198). The probability that a child will be
affected by a trauma is increased when that
child does not have the proper support mechanisms
in place. Even if a child has inconsistencies
within the confines of their care, the rate
of their exposure to traumatic experiences increases.
The probability that traumas will be eradicated
is highly unlikely, thus it is prudent that
children and adults be provided with the proper
support and coping mechanisms.
The physical and psychological implications
of trauma can prove detrimental. If a group
of individuals were to face the same trauma,
with the same intensity, severity, longevity,
and frequency the responses of those individuals
would differ drastically. The responses of the
individuals would vary due to their own personal
makeup, ability to prove resilient, and the
protective parameters in place. In fact, the
manner with which they respond will vary dependent
upon how they have been raised to act and react.
You may see abroad array of responses in the
nature of their automatic response, the breathe
of the response, and longevity with which they
respond. As individuals, we are all equipped
differently to respond to a trauma or traumatic
events. Thus, each individual receives their
ability or inability to cope to a trauma through
two central dynamics: nature and nurture.
Children at all stages of life may develop
PTSD as a result of being exposed to violent
acts; they may develop it having endured an
injury; they may develop it having an association
with someone or something that threatens their
sense of safety; the prevalence of trauma may
be rooted in physical, emotional, verbal, or
sexual abuse; and they may develop PTSD as a
vicarious repercussion of hearing or witnessing
news and information about a traumatic event.
The traumatization of an individual may be the
causation of long-term internal struggles with
external and internal results.
When a trauma has been experienced vicariously,
the manifestations resulting from the trauma
can prove ghost-like. Unless it is recognized
that a child has endured a trauma first person,
it is less likely that parental caregivers will
assess the effects as being directly correlated
to the traumatic event. The old premise was
that unless there are dire physiological issues,
the assumption was that a child could not have
any major issues directly or indirectly correlated
to the trauma. Ironically, practitioners are
called to advocate for the victim and there
are “many professionals (who) may underestimate
the prevalence and impact of trauma and its
association with distress and mental disorders”
(Goldsmith, et al. 2004, p. 449). As a practitioner,
we should consider all possibilities including
the impact on an individual who might otherwise
be presumed to unaffected. The practitioner
should be fully attentive and alert to the possibilities
of vicarious issues, with a clearer understanding
and comprehension of the direct and indirect
effects of trauma. Children are the most vulnerable
to the repercussions of vicarious trauma, for
they are unaware how viewing traumatic events
can have a lasting detrimental effect upon their
own lives. It is worth noting that while all
events are relevant to our existence as members
of humanity, they are not all possibilities
for our lives. For instance, if an individual
resides in Florida the likelihood of being affected
by a Tsunami is increased. On the other hand,
if an individual lives in Denver, Colorado the
likelihood of enduring a Tsunami is scientifically
implausible. Children tend not to rationally
consider the distance between them and the physical
traumatic event, thus it is important that children
are capable of being debriefed following events
such as December 26, 2004 Tsunami.
The therapeutic relationship is about re-establishing
a sense of trust between the patient and their
ability to trust others. It is about developing
cohesion within the therapeutic relationship
between the therapist and patient. If a child
has been the victim of abuse or prolonged traumatization
developing a connection may be difficult. Since
children’s issues are primarily developed
from childhood abuse it is important to recognize
the effects. “The effects of physical
abuse…are particularly devastating. Children
under one year of age, who comprise of 44% of
all child fatalities from abuse and neglect,
represent the most at-risk segment of the population.
Children under age 6 account for 85% of children
killed by child abuse” (Osofsky, 2004,
p. 261). A child’s potential for recovery
is typically high. However if a child endures
traumatic experiences over an extended period
of time, the likelihood of recovery becomes
lessened with each act of violence.
Children are resilient by nature. Proper nurturing
harnesses the positive aspects of resiliency
and provides direction for children who have
been victimized. When facing obstacles whether
merely advancing developmentally learning to
walk, talk and expressing their emotions children
are resilient. Children have proved resilient
in the face of the gravest obstacles whether
they are recovering from an illness or they
have been abused or witness to a trauma. An
ability to prove resilient is central to one’s
ability to recover. “Recovery, therefore,
is based upon the empowerment of the survivor
and the creation of new connections. Recovery
can take place only within the context of relationships;
it cannot occur in isolation” (Herman,
1997, p. 133).
Children especially need to be capable of expressing
fears and anxieties associated and derived from
their trauma. Children are often prone to sealing
information prudent to their victimization in
order to protect their perpetrator or fears
associated to disclosing such information.
Children must be capable of expressing and
disclosing the nature of their victimization.
If a child is prevented from disclosing or expressing
the emotions around their victimization, the
consequence of the denial of expression and
disclosure is that they may be re-victimized.
Recent studies have indicated that children
who are denied the freedom to express and disclose
may further perpetuate issues central to their
victimization. Thus, children who have been
victims of religious, educational, familial
and community cover-ups are beginning to gain
prominent ground in their right to express and
disclose the extent of their victimization.
Moreover, the difficulty remains in gaining
the rapport of the victim so that they will
feel secure enough to disclose prudent information
related to their victimization. “Exposure
to childhood trauma and abuse is posited to
lead to substance abuse through various mechanisms,
including as a maladaptive coping strategy,
self-medication or self-destructive impulses
stemming from low self-esteem (Widom, et al.,
1999)” (Grella, Stein, & Greenwell,
2005, p. 44). A child’s disclosure and
expression of the effects of traumatic events
is necessary.
Therapeutically, the patient arrives with hesitation
and reservation about disclosing information
revolving around their victimization. The therapeutic
environment should be about instilling within
the life of the patient a sense of safety and
care. “The therapy relationship is unique
in several respects. First, its sole purpose
is to promote the recovery of the patient…Second,
the therapy relationship is unique because of
the contract between patient and therapist regarding
the use of power” (Herman, 1997, p. 134).
Third, it is about providing a place of unconditional
acceptance, safety and care. If the patient
feels threatened or feels as if the therapist
is casting a shadow of disapproval, the patient
will ultimately reject the therapist and never
disclose information prudent to their victimization.
Children, who have endured their victimization
through the hands of another, might be hesitant
to disclose information central to their traumatization
because of implied threats by the perpetrator
or the disbelief implied by others, or fears
and anxieties exacerbated by their victimization.
Treatment for children affected by PTSD and
trauma should be based on a multimodal approach.
Since the spectrum of effect is broad, the therapeutic
treatment plan must be inclusive of all aspects
involving the impact of the trauma. Principally,
“the foundation of treatment is safety
of the therapeutic relationship” (van
der Kolk, et al., 1996, p. 18). Victims of trauma
must feel as though they have entered a hall
of safety and security. “The organizing
principle of our work is the best interest of
the child; that is, the needs of these very
young traumatized children are first and foremost”
(Osofsky, 2004, p. 260).
Treatments and instruments that have been key
to recovery have been: Expressive Art Therapy
(which may “…include visual arts
(drawing, painting, sculpture, collages), movement
/ dance; music; language arts (storytelling,
essays, poetry); drama; and play / sand-tray
therapy),” (Schiraldi, 2000, p. 255),
Eye Movement Desensitization and Reprocessing
(EMDR), Cognitive Behavioral Therapy (CBT),
Subjective Units of Disturbance Scale (SUD),
Beck Depression Inventory (BDI), and Beck Anxiety
Inventory (BAI). Treatment objectives and instruments
are as vast as the needs plaguing patients.
Because trauma is faceted with a number of other
psychological and physiological manifestations,
it is important to rule-out other possibilities.
Therefore, using instruments such as the BDI
a practitioner can determine and distinguish
factors associated with the PTSD and other psychological
factors. In fact, the treatments for therapeutic
recovery are endless, but the key is retrieving
a treatment that will mesh with the needs of
the individual patient.
Play therapy can prove a productive resource
of treatment when addressing concerns of younger
children. Through the application of play therapy
a child is capable of exploring and providing
accounts relevant to their traumatization. “Play
can be a very useful part of treatment for both
adults and children” (Schiraldi, 2000,
p. 262). For example, when addressing a child
who has been the victim of sexual abuse, the
therapist may have the child discuss how they
might treat another through providing them with
a doll. The doll then becomes a representation
of how they have internalized the morals and
ethics provided unto them by their caregiver,
as well as an outlet to express their own victimization.
A therapist may have the child describe what
was done to them by their perpetrator, to what
extent the perpetrator violated them, and how
the victimization made the child feel.
Safety is pinnacle for a child to fully thrive
and recover. “The practitioner must take
into account real-world variables and those
previously identified in the literature that
have the propensity to complicate the trauma
reaction and render it less amenable to direct
treatment” (Faust & Katchen, 2004,
p. 430). Faust & Katchen (2004) discussed
a number of factors that are critical to recovery
they are: having the ability to live in a safe
environment and having traumatizing stimuli
garnished in order that they may survive; relocating
children to a place of safety; if children are
experiencing issues of grief and loss these
reactions must be dealt with prior to dealing
with issues of PTSD; and risk and protective
factors directly correlated to their trauma.
Children are most vulnerable to traumatic experiences
that are based in abuse. Faust & Katchen
(2004) discuss how a child under the age of
10 may develop graver concerns central to the
trauma because of the developmental processes.
“One can argue that this is the case because
children are attempting to master crucial and
fundamental cognitive and emotional developmental
attainments within these years” (Faust
& Katchen, 2004, p. 430).
In the life of a child, trauma may be a reality.
It is the protective factors around the child
that will create an element of resiliency helping
the child rebound from a traumatic event. Traumatic
experiences vary in the magnitude, extent, and
length with which they occur. The descriptive
nature of PTSD is how an individual may cope
following a traumatic event. Trauma is not a
singular diagnosis and the prognosis may vary
from patient-to-patient. Determining the degree
with which an individual receives treatment
may vary dependent upon a number of variables.
How a person manages and copes following a traumatic
event, may determine what measures the practitioner
takes in treatment. Environmental factors, conditioning,
socioeconomics, nurture and nature, may determine
which treatment procedures, techniques, and
theories are applied in therapy. While the therapeutic
approach of the practitioner might be chosen
by preference or style of the approach, the
patient will be the ultimate factor in deciding
what approaches are a fit for his or her life.
References
Allen, J. G. (2005) Coping with trauma, Hope
through understanding (2nd ed) Washington, DC:
American Psychiatric Publishing.
American Psychiatric Association (2000) Diagnostic
and statistical manual of mental disorders (4th
ed., text revision) Washington, DC: Author.
American Psychological Association (2002) The
American Psychological Association’s (APA’s)
Ethical Principles of Psychologists and Code
of Conduct. Retrieved March 23, 2005, from http://www.apa.org/ethics/code2002.html.
Faust, J. & Katchen, L. B. (2004) Treatment
of children with complicated posttraumatic stress
reactions. Psychotherapy: Theory, Research,
Practice, Training,. 41 (4), 426-437
Feeny, N. C., Treadwell, K. R. H., Foa, E.
B., & March, J. (2004) Posttraumatic stress
disorder in youth: A critical review of the
cognitive and behavioral treatment outcome literature.
Professional Psychology: Research and Practice,
35 (5), 466-476.
Goldsmith, R. E., Barlow, M. R., & Freyd,
J. J. (2004) Knowing and not knowing about trauma:
Implications for therapy. Psychotherapy: Theory,
Research, Practice, Training, 41 (4), 448-463
Grella, C. E., Stein, J. A., & Greenwell,
L. (2005) Associations among childhood trauma,
Adolescent problem behaviors, and Adverse adult
outcomes in substance-abusing women offenders.
Psychology of Addictive Behaviors, 19 (1), 43-53
Henry, D. B., Tolan, P. H., & Gorman-Smith,
D. (2004) Have there been lasting effects associated
with the September 11th, 2001, Terrorist attacks
among inner-city parents and children? Professional
Psychology: Research and Practice, 35 (5), 542-547
Herman, J. (1997) Trauma and recovery, The
aftermath of violence-from domestic abuse to
political terror. New York, NY: Perseus Books
Group
Kazak, A. E., Alderfer, M. A., Barakat, L.
P., Streisand, R. Simms, S. Rourke, M. T., Gallagher,
P., & Cnaan, A. (2004) Treatment of posttraumatic
stress symptoms in adolescent survivors of childhood
cancer and their families: A randomized clinical
trial. Journal of Family Psychology, 28 (18),
493-504
Ng-Mak, D. S., Salzinger, S., Feldman, R. S.,
& Stueve, C. A. (2004) Pathologic adaptation
to community violence among inner-city youth.
American Journal of Orthopsychiatry, 74 (2),
196-208
Oklahoma City National Memorial (n.d.) On American
soil, Oklahoma City National Memorial. Retrieved
March 26, 2005, from http://www.oklahomacitynationalmemorial.org
Osofsky, J. D., (Ed.) (2004) Young children
and trauma, Intervention and treatment. New
York, NY: The Guilford Press
Phillips, D., Prince, S., & Schiebelhut,
L. (2004) Elementary school children’s
responses 3 months after the September 11th
terrorist attacks: A study in Washington, DC.
American Journal of Orthopsychiatry, 74 (4),
509-528
Schiraldi, G. R. (2004) The posttraumatic stress
disorder sourcebook, A guide to healing, recovery,
and growth. Los Angeles, CA: Lowell House
van der Kolk, B. A., McFarlane, A. C., &
Weisaeth, L. (1996) Traumatic stress, The effects
of overwhelming experience on mind, body, and
society. New York, NY: The Guilford Press
|
