With another recent incidence of school violence, Dan Nelson, MD of Cincinnati Children’s Hospital Medical Center Division of Child and Adolescent Psychiatry presentation was timely. Nelson is with the National Center for School Crisis and Bereavement and addressed the impact of natural disasters, domestic violence, abuse, neglect and post-traumatic stress disorder in children and adolescents at the Cincinnati Children’s Pediatric 2015 Mental Health Conference. His examples included several types of disaster and response scenarios- natural disasters, kidnappings, Oklahoma City bombing, school shootings, 9/11 (and beyond).
Nelson presented normal reactions to trauma in the acute phase. These are ‘not suggestive of future problems’ and include: “profound emotional response-crying, anger, numbness, sleep disturbance/nightmares (that don’t persist), problems with eating/appetite, reoccurring images of event, survival guilt, increased irritability, and poor concentration.” An acute stress response can include more intense symptoms that persist for more than 2 days and affect functioning. An acute stress response may include dissociative symptoms, avoidance, anxiety, hyperarousal and fears. He moved on to discuss post-traumatic stress disorder and biological research- which can include hormonal effects, blood pressure, heart rate, cellular and brain impact.
The National Center for School Crisis & Bereavement suggests that schools have a key role to play as a social support system supplemented by professional education and community groups. A school-based intervention might include consultation, education, teacher guidance, small group sessions, parent assistance, volunteers, and techniques. There might be anticipatory interventions, primary, secondary and tertiary measures and reintegration support. Two slides stood out: a map of the United States with school shootings and stabbings 1996-2006 [a lot]; and a graph with # of victims killed or injured. The health risk of having a gun in the home shows “children age 5-14 are 11x more likely to die of accidental gunshot wound; –14 are 13x more likely to die of gunshot wound murder; and 15-24 are 43x more likely to die, which led to the American Academy of Pediatrics issuing a policy statement urging parents to remove all guns from the home in 2000.”
Nelson addressed the role of adults as a buffer to trauma, treatment through-out the healing process, and adjustment over time. In one example of ‘contained traumatic response’ Nelson showed a slide of a tornado which hit a lodge in Tulsa, Oklahoma in 1991. The Girl Scouts were in the basement singing Girl Scout songs and “left together in a bus after dark” to rejoin their families. Their exposure to the damage was limited at the time and they were enveloped in calm and caring response. In contrast, “96% of preschoolers experiencing 9/11 who lived near the Twin Towers evidenced one PTSD symptom and 35% met DSM-IV criteria for PTSD.” There are several ways to handle crisis, and better ways –such as keeping media/press isolated from families and providing appropriate therapeutic support (before), during and after an event.
[photo credit is from the NSSL, National Severe Storms Laboratory, NOA OAR/ERL via Wikimedia Commons- Oklahoma]