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Introduction
Life is a continuous flow of events. Some of them are pleasant others are stressful. Everything that is happening around a child is leaving its imprints on the child psyche as their minds are very impressionable. It is like ponds filled with water where the ripples of events are breaking the peaceful surface of the water but the effect of it is very transient. They can cope with it easily as it is surrounded by its secure contours. Traumatic events are like storms in a little pond which can have a very lasting and disastrous impact on it. These events can grave consequences in the future and the reactions can seriously hamper the normal functioning of a childs life.
Any event whose magnitude is beyond the stress normally experienced by an individual is termed as trauma. It can be a natural calamity like an earthquake, flood cyclone or it can be an accident. Witnessing a bomb explosion, violence of any kind be it in-home or street and any kind of abuse either physical or sexual can produce a condition which the psychologists term posttraumatic stress disorder. The more chances that trauma has that it will be repeated the stronger the probability that it will lead the victim to develop this disorder. Almost 30% of the children who face trauma develop this disorder ( Pfefferbaum, 1997).
W.H.O defines this disorder as A delayed or a protracted response to a stressful event or situation (either short or long-lasting) of an exceptionally threatening or long-lasting nature, which is likely to cause pervasive in almost anyone (Gorman, 2003).
When a child is experiencing a calamity the brain on the neurophysiological level stimulates stress-mediating neural systems including the hypothalamic-pituitary-adrenal (HPA) axis, central nervous system (CNS) noradrenergic (NA), dopaminergic (DA) systems, and associated CNS and peripheral systems that provide the adaptive emotional, behavioral, cognitive and physiological changes necessary for survival (Perry et al, 1998). These changes which are cognitive emotional behavioral physiological are necessary for the survival of the individual. The tell-tale signs of this psycho-physiological condition may develop either immediately or later. Only 15%give a delayed response.
The magnitude and the occurrence of this disorder are dependent on many factors like the genetic makeup the closeness of the people who are killed or injured to the child. Sometimes he himself can be involved in physical or sexual abuse, repetition of the event, gender, age, and availability of support system are the contributing factors
The symptoms of this disorder are that the child may experience can be broadly categorized into four main types
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Re-experiencing the trauma. This can be in the form of nightmares, triggers can lead to an exaggerated response and reliving of the trauma
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The flight response where the person tries to avoid situations and people which remind him of the calamity.
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Emotional numbing is a phenomenon where a child is unable to respond to stimuli to avoid experiencing the painful feeling.
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Hyperarousal i.e a small incident or trigger results in an emotional outburst. There is trouble sleeping or concentrating. The victim is jumpy and is hyper-vigilant.
Statement of Problem
We will Study children who have post-traumatic stress disorder due to the tsunami. It will be the focus of this paper. On 26th December 2004 tsunami disaster struck the shores of Thailand Indonesia Sri Lanka and India It devastated more than 8 countries.
Tsunamis are giant waves after waves that are generated by the earthquake. The worst affected where the city of Aceh. According to UNICEF 100,000 people were killed and one-third of them were children (UNICEF, 2005). The highest causalities were that of women and children. Men were able to reach safer grounds as a result of their physical prowess. Hundreds of children were left homeless and orphaned in this disaster. A study was conducted on 1364 schoolchildren of Takuapa district, Phanga province. found that The prevalence of PTSD in the affected students were 57.3, 46.1, 40.6,10.4, and 7.6 percent at 6 weeks, 6 months, 1 year, 1 1/2 years, and 2 years respectively. The male: female was 1: 1.7. The peak age was 9-10 years old (Piyasil et al, 2006).
The percentage of children with Post-traumatic stress disorder was more in the case of those who had witnessed the disaster with their own eyes than those who were indirectly affected. In this sample study, 27.3% of children who were involved were suffering from PSTD. Only 3.1 % developed this disorder when they are indirectly affected by it. These kids who have posttraumatic stress disorder need continuous support treatment and therapy so that they can lead a normal life.
The exact number of children affected by post-traumatic stress syndrome is not available. Partly because infants and toddlers are unable to take child-specific structured interviews which are necessary to diagnose this disorder They cannot express what they are feeling This problem needs a holistic approach as these children are facing all sorts of problems.they have lost their home and family and have to struggle for food shelter and their vulnerability has left them open other kinds of exploitation. Ideally, the complete rehabilitation of these children would mean that there is an arrangement for foster homes where the caregivers are instructed on how to deal with these victims.
Some of these children can be highly irritable and aggressive therefore a lot of patience is required while dealing with them. The lack of attention, social withdrawal impulsiveness, anger, and regressive behavior like bed wetting and encopresis, and thumb sucking.PSTD hampers childrens development. The child is unable to socially integrate with his peers. They cannot achieve their developmental milestone.
The children with this disorder can have a learning disability like poor communication skills, slow language acquisition lowered I.Q. This cognitive development can lead to academic failures and social development. It might give them a sense of inferiority complex and maim their chances of becoming functional adults. As they reach their adolescence their self-awareness is going to give them a perspective that will be responsible for their understanding of life and its events
Literature Review
Posttraumatic stress disorder in children is a fairly under-researched topic. Whatever research has been conducted has been done in the area of limitation of DSM-IVTR criteria to diagnose children with PTSD. There is a vast field of how this disorder results in behavioral physiological and psychological complexities in adult life. The other options of study could deal with the effectiveness of various methods of treatment. Tanya Andersons PTSD in Children and Adolescents Deals with symptomatology among children and adolescents diagnosed with PTSD, issues in diagnosing PTSD in children and adolescents, and lastly, traumas impact on development. The last aspect of the study is just fleetingly referred to. The impact of trauma in children is a very important issue therefore more emphasis should have been given to it.
Expert Consensus Treatment Guidelines for Posttraumatic Disorder: A Guide for Patients and Families gives a holistic approach to treating adult patients of this disorder. It has very little material on how to treat children who are suffering from the same problem. The play-way method which would be effective in treating children is given a fleeting reference. As we have seen everywhere little attention is given to the psychiatric problems of kids These manuals are supposed to be read by parents, caregivers, and individuals suffering from this problem and there is very little information on nuances of this pathological condition on kids.
Psychosocial Care in Disaster Management Facilitation Manual for Trainers of Trainees in Natural Disasters by Dr. Sekar and his colleagues gives a comprehensive account of the disaster and its economic, social, and psychological impact of the tsunami. It has given a good insight into how to deal with children facing trauma (Sekar et al, 2005).
Conclusion
The ideal way to cater to an aftermath of a natural calamity is to gauge the number of victims of that tragedy than the psychological effects of it on the individuals.Some children will be mildly affected by post-traumatic stress disorder and the best method to deal with them would be the wait and watch method. These symptoms will resolve within the period of four weeks We need to provide a safe and secure environment for these kids. If the parents are alive then we dont have to create any kind of support system but if they are no more then a support system needs to be created. Sometimes time can be a great healer as in case of personal loss. In any case, a follow-up on these children is necessary as there is the possibility that this problem might get aggravated later on.
Some children were severely affected by this trauma and cognitive behavior therapy is highly recommended for them. eye movement desensitization and reprocessing [EMDR]) can also be conducted on children according to need and efficacy. For some, the CBR might work as a diary of significant events, and its associated emotions are maintained and the childs assumptions which are irrational are questioned. This is a way of making the child realize that his fears can be unreasonable.8to12 sessions are required to treat patients with serious onset of post-traumatic stress disorder. This method is cost-effective and can be provided on an outpatient basis.
Some victims of the tsunami catastrophe especially elder children had guilt feeling that they were unable to save their near and dear ones as they were fleeing for their lives. This could be easily combated by providing them evidence The therapy has to be based on the age, circumstances, and development of the child EMDR has been somewhat successful with individuals suffering from various psychological disorders like phobias anxiety paranoid schizophrenia, learning disabilities, eating disorders, substance abuse. The patients are asked to follow a moving stick of light with their eyes. Nobody knows how it works but its worth trying as there are no side effects. The use of this therapy is quite difficult with very young kids
Drugs like paroxetine or mirtazapine are used to treat adult patients but they cannot be used with kids because of adverse effects on the kids minds Children with a sleep disorder can be treated by hypnotizing them on a short term basis. Different kinds of therapy supportive therapy, non-directive therapy, hypnotherapy, psychodynamic therapy, or systemic psychotherapy
can be utilized to try and help children overcome this disorder However there is no evidence of how much these therapies are useful. Exposure therapy was utilized to treat a kid who had developed an extreme fear of the sea. The anxiety of the kids who had seen giant waves of the sea destroying their entire life is not unfounded. The kids were taken to the sea and made to realize that it is not always dangerous Repetition is a very important factor in this method of treatment Play therapy is usually useful in children suffering from this problem. They sometimes enact the entire sequence in trauma through play.
Play is an important method by which a child is able to convey his feelings of anger frustration bereavement. They can confront their fears and insecurity Once a problem is faced its intensity is lost. Different activities c like clay modeling, drawing puppetry, storytelling and games can be planned according to the age group of the children so that children can vent their feelings. In tsunami children started talking about their past by drawing broken boats, drowning people e.tc This has a cathartic effect. It signals a return to normalcy. Countries like India Srilanka are making use of this therapy to treat the victims of the tsunami.
Children from grades one to five are involved in activities during a two-week summer camp in the village school. Every day begins with spoken English practice, followed by fun activities such as songs and games. youth organization Nehru Yuva Kendra supplied more than 270 volunteers, among them O.K., to provide psychosocial support for out-of-school children affected by the tsunami, throughout the Indian state of Tamil Nadu.
These children who are suffering from these are sometimes very aggressive They have sleep problems, become reticent or socially withdrawn. These temper tantrums and regressive behavior are symptoms of disease, It is not a reflection of a childs inherent nature. These are the mechanisms which help a child cope with their altered realities. They think it is going to reduce their pain and anguish. Therefore the counseling of the family members and caregivers is very necessary Social organizations and community workers are an important factor in taking care of these children as tsunamis caused large-scale destruction and the entire families are wiped out leaving behind few survivors.
These community workers are members of the same community. Therefore they have close language and social ties with them. These community workers need to be trained to deal with the psychological problems faced by the members of the community talking with children can enable them to come to terms with their tragedy. Some children who had lost families are in most need of these caregivers as is the case of Ms. Marico. When she was only ten years old she used to be so scared that she never used to play with children of her own age.
The workers working with this child realized this and spent time with her in her own space by making her do some activities. They also spoke to the aunt of the child and said that the child needed to be talked with and reassured. She used to be with the aunty. At first, the child did not talk much. Later she started remembering and talking about the member she had lost in the tsunami. Then once, while talking she started crying and cried a lot. She was then motivated slowly to come down and be with the other children and she was also given support for continuing her studies (Sekar, 2005). The constant emotional and psychological support of the community workers is going to help these children recover from this disorder. They can considerably reduce the severity and number of cases of such disorder.
References
Davis, L. & Siegel, L. (2000). Posttraumatic Stress Disorder in Children and Adolescents: A review and analysis. Clinical Child and Family Psychology.
Gorman, Jane (2003) Understanding post traumatic stress disorder; for better mental health.
K. Sekar, Subhasis Bhadra,. Jayakumar (2005). Psychosocial Care In Disaster Management Facilitation Manual For Trainers Of Trainees In Natural Disasters.
Pfefferbaum, B. (1997) Posttraumatic stress disorder in children: A review of the past 10 years. J.Am.Acad.Child Adolesc.Psychiatry 36[11], 1503-1511.
Perry, B. D. and Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America 7[1], 33-51.
Piyasil, Vinadda; Ketuman, Panom; Prubrukarn, Ratanotai; Jotipanut, Vajiraporn; Tanprasert, Somsong; Aowjinda , Sumitra; Thaeramanophab, Somchit. (2006). Post-traumatic Stress Disorder in Children and Adolescent after Tsunami Disaster. Thai perdriatic Journal. Vol 13, no 3. 2006.
UNICEF (2005). India: Volunteers put smiles back on young faces; Tsunami disaster countries in crisis. Web.
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