|
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
|
