BOOK
Disaster and Trauma, An Issue of Child and Adolescent Psychiatric Clinics of North America, E-Book
(2014)
Additional Information
Book Details
Abstract
An overview of childhood traumatic exposures and their impact for health care providers - child and adolescent psychiatrists, general psychiatrists, other pediatric behavioral health providers and primary care clinicians - is presented. Most clinicians are unaware that children in the United States are exposed to trauma frequently, either as a single occurrence, or through repeated events. These exposures result in neurobiological, developmental and clinical sequelae that can undermine children's health and well-being. This issue describes the multiple types of traumatic exposures and their sequelae, methods of screening and assessment, and principles of effective prevention and clinical treatment. The volume highlights areas of particular relevance to children, such as natural disasters, war, domestic violence, school and community violence, sexual victimization, and complex trauma. Each is differentiated as a unique trauma, requiring trauma-informed systems of care to effectively meet the needs of the exposed population. Since traumatic exposure results in added risk to child well-being, the third section of the volume describes strategies for primary prevention (e.g. violence prevention) and risk mitigation (e.g. skill and resilience building strategies), as well as reviews evidence based treatments for trauma-induced clinical disorders.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Disaster and Trauma | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Child And Adolescent\rPsychiatric Clinics\r | xi | ||
| Preface\r | xiii | ||
| Epidemiology of Traumatic Experiences in Childhood | 167 | ||
| Key points | 167 | ||
| Introduction | 167 | ||
| Traumatic event characteristics | 169 | ||
| Inadequate surveillance efforts | 169 | ||
| Conceptual and methodological differences | 170 | ||
| Definitions | 170 | ||
| Sampling Approach | 171 | ||
| Respondent | 171 | ||
| Screening Method | 172 | ||
| Review of important literature | 173 | ||
| Sexual Victimization | 173 | ||
| Physical Abuse and Assault | 175 | ||
| Witnessed Violence | 176 | ||
| Traumatic Death of a Loved One | 176 | ||
| Internet-Assisted Victimization | 176 | ||
| Other Potentially Traumatic Events | 177 | ||
| Disaster | 177 | ||
| Motor vehicle accidents | 177 | ||
| Other accidents and animal attacks | 177 | ||
| Polyvictimization | 178 | ||
| Application in clinical practice | 178 | ||
| Knowing High-Risk Populations | 178 | ||
| Need for Screening | 178 | ||
| Screening Techniques | 179 | ||
| Case Formulation | 179 | ||
| Tools for practice | 179 | ||
| Future directions | 179 | ||
| Summary | 180 | ||
| References | 180 | ||
| The Biological Effects of Childhood Trauma | 185 | ||
| Key points | 185 | ||
| Introduction | 185 | ||
| Review of the pertinent literature: the neurobiology of biological stress systems | 188 | ||
| Limbic-Hypothalamic-Pituitary-Adrenal Axis | 188 | ||
| The LHPA Axis and Childhood Trauma | 189 | ||
| Permanent changes occur as a result of childhood trauma onset | 190 | ||
| Childhood trauma re-regulates biological stress systems | 190 | ||
| Priming also called sensitization occurs as a result of childhood trauma | 190 | ||
| Trauma timing and duration influence biological stress systems | 192 | ||
| Individual differences in response to childhood trauma are associated with different types of biological stress system regu ... | 193 | ||
| Early trauma type and trauma severity influence biological stress systems | 193 | ||
| Genetic factors influence biological stress system responses to childhood trauma | 193 | ||
| Epigenetic factors influence biological stress system responses to childhood trauma | 194 | ||
| Gender differences influence the effects of childhood trauma on biological stress systems | 196 | ||
| Social support buffers biological stress system dysregulation and its associated negative behavioral and emotional outcomes | 196 | ||
| Individual biological stress systems dysregulation in response to childhood trauma and the genes associated with the function of these systems influence other\rbiological systems during development to contribute to psychopathology\r | 196 | ||
| Childhood trauma adversely influences development | 197 | ||
| The Locus Coeruleus–Norepinephrine/Sympathetic Nervous System/Catecholamine System and Childhood Trauma | 197 | ||
| The Serotonin System and Childhood Trauma | 198 | ||
| The Oxytocin System and Childhood Trauma | 200 | ||
| The Immune System and Childhood Trauma | 200 | ||
| The Effect of Childhood Trauma on Neuropsychological Functioning and Cognitive Development | 201 | ||
| The Effect of Childhood Trauma on Brain Development | 202 | ||
| Clinical practice application | 206 | ||
| Important tools for practice | 206 | ||
| Future directions | 207 | ||
| Summary | 208 | ||
| References | 208 | ||
| Assessing the Effects of Trauma in Children and Adolescents in Practice Settings | 223 | ||
| Key points | 223 | ||
| Review of literature on child/adolescent trauma assessment | 223 | ||
| Rationale and Benefits of Trauma Assessment | 224 | ||
| Key Domains to Assess | 225 | ||
| Trauma exposure/developmental history | 226 | ||
| Posttraumatic stress disorder diagnosis/symptoms | 226 | ||
| Other trauma-related symptoms/complex trauma responses | 226 | ||
| Emotional/behavioral manifestations (including risk behaviors) | 226 | ||
| Functional difficulties | 226 | ||
| Caregiver and family functioning | 226 | ||
| Strengths (child, caregiver, community) | 226 | ||
| Review of assessment instruments for use in practice settings | 227 | ||
| Child Report | 227 | ||
| Caregiver Report | 228 | ||
| Provider Report | 228 | ||
| Using a Range of Assessment Approaches and Techniques | 228 | ||
| Making Sense of Discrepant Information | 229 | ||
| Considerations for selecting and implementing assessment measures | 232 | ||
| Factors for Consideration Across Contexts and Settings | 233 | ||
| Developmental and Cultural Considerations | 234 | ||
| Practical Considerations for Staff | 234 | ||
| Application of trauma assessment information in clinical practice | 235 | ||
| Challenges | 236 | ||
| Resources | 237 | ||
| Future directions and conclusions | 237 | ||
| Summary | 238 | ||
| References | 239 | ||
| Outcomes of Traumatic Exposure | 243 | ||
| Key points | 243 | ||
| Introduction | 243 | ||
| Definitions | 244 | ||
| Literature review | 244 | ||
| Clinical impact of trauma in children | 245 | ||
| Longitudinal responses to trauma | 245 | ||
| Outcomes of psychological and mental trauma | 245 | ||
| Outcomes research in traumatized children | 246 | ||
| Prevalence of Psychological Trauma and Stress | 246 | ||
| What constitutes child and adolescent trauma? | 246 | ||
| Susceptibility, coping, adaptation, and resilience | 247 | ||
| Treatment planning | 247 | ||
| Screening for posttrauma mental effects | 248 | ||
| Physical examination and psychiatric assessment for posttrauma mental effects | 248 | ||
| Family and systems issues | 249 | ||
| Self care of those caring for traumatized children | 249 | ||
| Ethical considerations in the treatment of traumatized children | 249 | ||
| Advocacy and public policy initiatives | 249 | ||
| Important Tools for Practice | 249 | ||
| Future directions in child and adolescent trauma | 250 | ||
| Summary | 250 | ||
| References | 250 | ||
| Recommended readings | 254 | ||
| Mass Trauma | 257 | ||
| Key points | 257 | ||
| Introduction | 258 | ||
| Vulnerable pediatric populations | 259 | ||
| Disaster | 259 | ||
| War and Terrorism | 259 | ||
| Review | 260 | ||
| Epidemiology | 260 | ||
| Disasters | 260 | ||
| War | 261 | ||
| Terrorism | 262 | ||
| Phenomenology | 263 | ||
| Clinical Outcomes | 263 | ||
| Disaster | 264 | ||
| War and Terrorism | 264 | ||
| Family Issues | 268 | ||
| Systems Issues | 269 | ||
| Community Response Strategies | 270 | ||
| Challenges | 271 | ||
| Important tools for practice | 272 | ||
| Skills for Psychological Recovery | 273 | ||
| Future directions | 273 | ||
| Summary | 274 | ||
| References | 275 | ||
| School Intervention Related to School and Community Violence | 281 | ||
| Key points | 281 | ||
| Introduction | 281 | ||
| Clinical practice applications | 282 | ||
| Phenomenology | 282 | ||
| The unique role of schools | 282 | ||
| Clinical outcomes in school-based interventions | 284 | ||
| Family issues | 284 | ||
| The History of School Preparedness and Crisis Intervention Strategies/Educational Policy and Funding in the National Context | 284 | ||
| Impact of Trauma on Educators as a Workforce Issue | 286 | ||
| Therapeutic Strategies | 287 | ||
| Early interventions | 287 | ||
| Strategies for long-term recovery | 288 | ||
| Challenges | 289 | ||
| Future directions | 289 | ||
| Summary | 290 | ||
| References | 290 | ||
| Children’s Exposure to Intimate Partner Violence | 295 | ||
| Key points | 295 | ||
| Definition | 296 | ||
| Epidemiology | 296 | ||
| Prevalence | 296 | ||
| Risk and Protective Factors | 297 | ||
| Impairment | 299 | ||
| Strategies for identifying and addressing IPV in the clinical setting | 300 | ||
| Identification and Assessment | 300 | ||
| Prevention | 302 | ||
| Treatment | 302 | ||
| Systems issues | 303 | ||
| Future directions | 304 | ||
| Summary | 305 | ||
| References | 305 | ||
| Child Physical Abuse and Neglect | 309 | ||
| Key points | 309 | ||
| Introduction | 309 | ||
| Epidemiology | 310 | ||
| Risk factors | 310 | ||
| Definitions | 311 | ||
| Physical Abuse | 311 | ||
| Neglect | 312 | ||
| Clinical outcomes | 312 | ||
| Therapeutic strategies | 312 | ||
| Health care provider mandates for reporting | 313 | ||
| Challenges | 313 | ||
| Early Identification | 313 | ||
| Addressing Mental Health Needs of Maltreated Children | 314 | ||
| Interdisciplinary Collaboration | 314 | ||
| Important tools for practice | 314 | ||
| Future directions | 315 | ||
| Summary | 315 | ||
| References | 316 | ||
| Child Sexual Abuse | 321 | ||
| Key points | 321 | ||
| Phenomenology and definitions | 322 | ||
| Epidemiology | 323 | ||
| Risk factors | 324 | ||
| Factors influencing disclosure | 324 | ||
| Course and outcomes | 326 | ||
| Systems involvement | 326 | ||
| Therapeutic strategies | 327 | ||
| Challenges | 328 | ||
| Dissemination and Implementation | 328 | ||
| Intrafamilial Sexual Abuse | 329 | ||
| Cultural Considerations in CSA Populations | 330 | ||
| Summary | 330 | ||
| References | 331 | ||
| Complex Trauma | 339 | ||
| Key points | 339 | ||
| Introduction | 339 | ||
| Complex Trauma Prevalence | 340 | ||
| Prevalence of complex traumatic events | 340 | ||
| Prevalence of complex trauma outcomes | 341 | ||
| Causes of Complex Trauma Exposure | 341 | ||
| Causes of Complex Trauma Outcomes | 341 | ||
| Complex trauma and disrupted brain development | 342 | ||
| Complex trauma and disrupted attachment | 343 | ||
| Phenomenology | 343 | ||
| Dysregulation of Affect and Behavior | 344 | ||
| Disturbances of Attention/Consciousness, Cognition, and Information Processing | 344 | ||
| Interpersonal Difficulties | 345 | ||
| Distortions in Attributions | 345 | ||
| Biology | 345 | ||
| Predicting clinical outcomes for complex trauma exposure | 346 | ||
| Family Issues | 346 | ||
| Offending caregiver dynamics | 346 | ||
| Resilience/Coping | 347 | ||
| Systemic Issues | 348 | ||
| Implications for children in care | 348 | ||
| Juvenile justice | 348 | ||
| Clinical Assessment of Complex Trauma | 349 | ||
| The Challenge of Diagnosing Youth Exposed to Complex Trauma | 351 | ||
| Treatment of Youth Exposed to Complex Trauma | 352 | ||
| Attachment, self-regulation, and competency | 352 | ||
| Child-parent psychotherapy | 352 | ||
| Dialectical behavior therapy | 353 | ||
| Eye movement desensitization and reprocessing | 353 | ||
| Integrative treatment of complex trauma | 353 | ||
| Parent-child interaction therapy | 353 | ||
| Real-life heroes | 353 | ||
| Seeking safety | 353 | ||
| Structured psychotherapy for adolescents responding to chronic stress | 353 | ||
| Trauma affect regulation: guide for education and therapy | 353 | ||
| Trauma-focused cognitive behavior therapy | 353 | ||
| Trauma systems therapy | 353 | ||
| Summary | 353 | ||
| References | 354 | ||
| Universal Preventive Interventions for Children in the Context of Disasters and Terrorism | 363 | ||
| Key points | 364 | ||
| Introduction | 364 | ||
| Literature search and review | 364 | ||
| Practice applications: organization and structure of disaster mental health services | 365 | ||
| Timing of Intervention Delivery | 368 | ||
| Delivery Sites | 370 | ||
| Providers | 371 | ||
| Conditions Addressed and Outcomes | 371 | ||
| Important tools for practice: screening and intervention approaches | 375 | ||
| Screening and Case Finding | 375 | ||
| Intervention Approaches and Components | 376 | ||
| Future directions | 378 | ||
| Summary | 379 | ||
| References | 379 | ||
| Indicated and Selective Preventive Interventions | 383 | ||
| Key points | 383 | ||
| Introduction | 383 | ||
| Review of the pertinent literature | 384 | ||
| Prevalence of PTE Exposure and PTSS in Children | 384 | ||
| Risk and Protective Factors in PTSS Development | 386 | ||
| Preventive Interventions | 387 | ||
| Intervention Outcomes | 387 | ||
| Psychoeducation | 387 | ||
| Debriefing | 388 | ||
| Psychological first aid | 388 | ||
| Intervention for residual symptoms post disaster | 389 | ||
| Intervention for at-risk military families | 389 | ||
| Stepped preventive care models | 389 | ||
| Pharmacologic interventions | 390 | ||
| Challenges to Effective Implementation Strategies for Early Preventive Interventions | 391 | ||
| Benefits of Early Preventive Interventions for Children, Families, and Health Care | 392 | ||
| Clinical Practice Application | 392 | ||
| Summary | 392 | ||
| References | 392 | ||
| Psychological and Pharmacologic Treatment of Youth with Posttraumatic Stress Disorder | 399 | ||
| Key points | 399 | ||
| Evidence for psychotherapeutic treatment of youth with PTSD | 399 | ||
| Cognitive behavior therapy–based therapies | 401 | ||
| Trauma-focused Cognitive Behavior Therapy | 401 | ||
| Several Cognitive Behavior Therapies Have at Least One Randomized Controlled Trial Showing Efficacy with Traumatized Youth | 402 | ||
| Non-CBT therapies | 402 | ||
| Child-Parent Psychotherapy | 402 | ||
| School-based/group therapies | 403 | ||
| Psychopharmacologic treatments | 403 | ||
| Antidepressants | 404 | ||
| Tricyclic Antidepressants | 404 | ||
| SSRIs | 404 | ||
| Antiadrenergic agents | 404 | ||
| Guanfacine and Clonidine | 404 | ||
| Prazosin | 405 | ||
| Propranolol | 405 | ||
| Second-generation antipsychotics | 405 | ||
| Risperidone | 405 | ||
| Quetiapine | 405 | ||
| Mood stabilizers and other medications | 406 | ||
| Clinical practice application | 406 | ||
| Timing of Trauma | 406 | ||
| Single Versus Repeated/Multiple Traumas | 406 | ||
| Comorbid Symptoms | 407 | ||
| Age of the Child | 407 | ||
| Safety Concerns | 407 | ||
| Future directions | 408 | ||
| Summary | 408 | ||
| References | 408 | ||
| Index | 413 |