HJNO Mar/Apr 2022

HEALTHCARE JOURNAL OF NEW ORLEANS  I  MAR / APR 2022 43 Julie B. Kaplow, PhD, ABPP Executive Director Trauma and Grief Center Children’s Hospital New Orleans high number of COVID-related losses that we’re seeing across the country. Many of these children have also experienced prior traumas and losses, making them even more vulnerable to developing PTSD. What is often confusing about PTSD in children is that it can look like other psy- chological or behavioral problems. For example, children with PTSD may look like they have Attention Deficit Hyperactivity Disorder (ADHD) because PTSD symp- toms such as hyperarousal (being jumpy) or hypervigilance (being on edge) resemble attention and hyperactivity problems. For this reason, our TAG Center’s trainings with teachers and school personnel focus on recognizing how PTSD can manifest in stu- dents of different ages, shifting their line of questioning from “what’s wrong with that child” to “what happened to that child?” Shifting this mindset is the first step to tru- ly understanding the impact of trauma on children’s behaviors and what that can look like in the classroom. What Symptoms of PTSD in Children Can Look Like • Reexperiencing the event, which can involve nightmares or feeling like the event is happening all over again, even during the day. • Avoidance — not wanting to talk about or think about the event. For example, children may walk out of the room if they hear people talking about a loved one who died. • Feeling numb. Sometimes children with PTSD report that they feel like they don’t have any feelings at all. This can often be confusing to parents, es- pecially if a child is not showing much emotion after someone has died. • Hypervigilance — appearing to be very jumpy or highly attuned to what’s happening in the environment at all times. • Negative beliefs about the world — children with PTSD may believe that the world is a dangerous and unpre- dictable place after experiencing a trauma. There are several factors that make it more likely that a child will experience PTSD after a traumatic event. Some of these include: proximity – the closer they were to the event, the more likely they are to develop PTSD (e.g., those who were clos- est to a school shooting are more likely to develop symptoms); history of prior trau- mas and losses; preexisting mental health issues (e.g., depression or anxiety); and lack of social support. Core Treatment Elements for PTSD There are a number of trauma-focused treatments for children that share some common elements. First, most trauma-fo- cused treatments include emotion regula- tion and cognitive coping. Emotion regu- lation skills are used to help children cope with their strong feelings related to the trauma. Cognitive coping skills help chil- dren to generate more “helpful” thoughts that can help them to feel better, such as “I know I’m safe now” or “I’m stronger than I thought I was.” Many trauma-focused treatments also include “trauma processing,” which in- volves helping children to talk about and make sense of the traumatic event itself. The more children are able to talk about and describe the trauma in a safe, sup- portive environment, the less powerful and scary those traumatic memories are. Finally, many trauma-focused treatments include a caregiver component, where chil- dren share the skills they’re learning with the caregiver. We find that if the caregivers can provide ongoing support, both in ther- apy and at home, the more effective the treatment is. This often requires that the caregiver receive his or her own therapy, especially if they have experienced their own traumas or losses, in order to be able to fully support their child. What Happens if PTSD Goes Untreated? Left untreated, PTSD can lead to long- term problematic outcomes, even into adulthood. These can include depression, suicide risk, substance abuse, relationship problems, or violent behavior. In fact, the majority of our society’s most significant problems, including sex trafficking, do- mestic violence and community violence, stem from unresolved childhood trauma. This speaks to the need to identify “at-risk” youth and intervene as early as possible to help them lead healthy, happy, and produc- tive lives. n Julie Kaplow,PhD,ABPP, is executive director ofThe Trauma and Grief Center (TAG) at Children’s Hospital NewOrleans and executive director ofTheTAGCen- ter atThe Hackett Center for Mental Health in Hous- ton,TX.The overarching mission of each of the TAG Centers is to raise the standard of care and increase access to best practice care among youth who have experienced trauma and bereavement. “What is often confusing about PTSD in children is that it can look like other psychological or behavioral problems.”