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Mental Health PTSD Recovery

Treating PTSD in Children and Adolescents

Post-Traumatic Stress Disorder (PTSD) is not just for adults:Blossom©saritzrogers

it also occurs in children and adolescents. Children and teens that witness violence and have post-traumatic stress symptoms require psychological care, but studies are suggesting that while children may experience the full range of post-traumatic stress symptoms, the manifestation of symptoms can differ from that of an adult.

 

The Journal of Pediatric Psychology says, “in the DSM-IV, eight criteria require verbal descriptions of experiences and emotional states. The lack of developmental modifications may result in an under-diagnosis of PTSD. “(Pynoos, Steinberg, & Goenjian, 1996). Scheeringa et al. (1995) Additional  “evidence suggests that children may experience disabling PSS (post-traumatic stress symptoms) that warrant treatment, but not meet criteria for PTSD (Carrion, Weems, Ray, & Reiss, 2002).

 

What has become crucial in defining this diagnosis for adolescents is the way in which clinicians understand how PTSD presents in youth. There is still a debate within the field of pediatric psychology about whether or not distinct youth criteria should be established — thus far, post-traumatic stress symptoms have been assessed primarily using criteria outlined for adults.  When assessing youth for PTSD, the adaptation for youth includes the “simplification of language and concepts.” However, there continues to be discussion amongst clinicians about the need for separate qualifiers for youth.

 

Symptoms of PTSD might include classic stress responses such as nightmares, fear and a general response to distress, but according to the American Academy of Child and Adolescent Psychiatry, there may be some symptoms unique to children and adolescents like:

 

  • Reenactment of the event
  • Regressed behavior
  • Separation anxiety,
  • Specific forms of behavioral, academic, and somatic problems”

Did you know: Between 25 and 87% of youth report experiencing at least one traumatic event before age 20, with girls reporting more episodes (Elklit, 2002)

 

Noelle Rodriguez, Psy.D. and Visions Outpatient Psychological Assistant shared some of her experience working with teens who suffer from PTSD. She listed some of the manifestations she sees and how she helps treat them:

  • High levels of depression because PTSD is misdiagnosed
  • Inability to formulate trusting relationships
  • Drug use to attempt to access or regulate feelings

Noelle also finds teens with PTSD also present with some or all of the following:

  • Poor time management
  • A need to find a voice but feels silent inside
  • Loss of self, feeling fragmented
  • Somatic symptoms i.e., body pains, headaches, etc.
  • Disassociation
  • Sexual promiscuously–looking to feel connected
  • Paranoia
  • Lack of boundaries, which leads to more mistrust

Noelle takes her PTSD clients through a process of deep, insightful work that helps them strive toward shifting their paradigm to include:

  • Empowerment;
  • Sobriety (if applicable) on their own terms;
  • Replacing maladaptive behavior with healthy behaviors, for example:
  • Learning to ask for help, finding a support group, becoming able to  recognize and identify PTSD symptoms before they have a chance to fully manifest
  • Self-care
  • Learn how to identify danger vs. safety
  • Develop tools with which to to deal with blame, shame and doubt
  • Time management
  • Honesty in relationships
  • Finding their voice and learning how to speak up for themselves
  • Learning to get grounded when one is in emotional pain.

 

Peter A. Levine, Ph.D, originator and developer of Somatic Experiencing and the Director of the Somatic Experiencing Trauma Institute has transformed the way in which I personally view PTSD.  He says in his book In an Unspoken Voice, “I hope to convey a deeper appreciation that their lives are not dominated by a ‘disorder’ but by an injury that can be transformed and healed.” Like Noelle, he talks about the need for someone working with PTSD to learn to self-regulate. Levine says this self-regulation “allows us to handle our own states of arousal and our difficult emotions,” and that it is what fosters the ability to “evoke a sense of being safely ‘at home’ within ourselves, at home where goodness resides.” Trauma work is a deep process. It involves learning how to hold ourselves with a sense of compassion while we look at the darkness that has swaddled our hearts.

 

So whether or not the DSM catches up, knowing that we have clinicians who are well versed in trauma work and who are willing to guide our youth to recovery is profound. Triggers eventually become tools we work with instead of against. And ultimately, with deep, consistent work, we develop the skills to change our relationship to our trauma and to heal.

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Recovery

Aleksandra Petrovic, LMSW — Trauma Specialist

Aleksandra Petrovic, LMSW, is a trauma specialist, coming to Visions via New York where she worked with underprivileged children and their families. Aleksandra’s work led her to a hospital outpatient program for dual-diagnosed adolescents, which used DBT (Dialectical Behavioral Therapy) as their primary modality of treatment. Continuing to help underprivileged youth, Aleksandra went on to work at a state-run adolescent recovery center with children ages 5-16 who had been shuffled through the foster care system until they could no longer be placed due to their behavior. Aleksandra earned her B.A at Columbia University, double majoring in psychology and French literature, with a minor in neuroscience. She went on to earn her masters degree in social work at Hunter’s School of Social Work in NYC.

Aleksandra has completed her training in EMDR at the EMDR Institute under its founder Francine Shapiro. She uses EMDR (Eye Movement Desensitation and Reprocessing) and TF-CBT (Trauma Focused Cognitive Behavioral Therapy) regularly when working with clients and their trauma(s).

EMDR is a

“one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning. (via SAMSHA)

TF-CBT is a

“psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement.” (via SAMHSA)

Aleksandra will use TF-CBT by having a client paint or write their story several times until there is a full range of emotions expressed. The repetition of reading and writing eventually desensitizes the severity of the impact of one’s memories. Aleksandra also uses Internal Family Systems (IFS) to help her clients safely access their trauma, helping them “go back” into the traumatic scene and “save” their younger selves. Processes such as these require a commitment to doing difficult work, but they are worth the efforts.   Deep trauma work employed in the modalities Aleksandra uses is extremely beneficial for treating trauma in adolescents and helping them process their trauma in a safe, therapeutic way.

Aleksandra uses the treatment modality most beneficial to her client’s needs whether it’s EMDR, TF-CBT, IFS, writing, movement, or art. Her approach and style are right in line with the Visions’ holistic, client-based approach to adolescent treatment. Her work with the kids at Visions is very individualized–Aleksandra first focuses on building a rapport with the kids, and creating a trusting, safe environment for them to express themselves. When she treats trauma, she assesses where the client is emotionally, whether their trauma was chronic or an isolated event, their awareness surrounding their trauma, if it is repressed or glaringly present, and whether or not there are any psychological issues like mood disorders, depression, or mania present resulting in a dual diagnosis.

Aleksandra has taken her own trauma recovery and transformed it into a path of being of service to adolescents struggling with their own deep traumas. She believes that treating trauma is a crucial step in working on one’s recovery from addiction, eating disorders and other mental health issues. Aleksandra recognizes the influence of major and minor traumas as often being the underlying cause of substance abuse and self-harming behaviors.  We are so fortunate to have such a compassionate, caring trauma specialist as part of our clinical team at Visions Our clients now have access to trauma treatment in both our residential and outpatient programs, as we recognize the deep impact unresolved trauma has on one’s recovery.

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Addiction Anxiety Depression Mental Health Obsessive-Compulsive Disorder (OCD) PTSD Recovery Therapy Treatment

MDMA: Is This Psychotropic Drug Helpful, Harmful, or Both?

Image via Wikipedia

Last time I wrote about ecstasy, it was about the rise in ER visits and the inherent dangers of using a drug that inevitably depletes one’s levels of serotonin and has the potentiality of long-term brain damage. So, when I came across an article talking about using MDMA (ecstasy) to treat post-traumatic stress syndrome (PTSD), my curiosity was sparked. Psychedelic drugs have been used to treat mental illness before, and with some success: In the 50s and 60s, psychology was in a Freudian phase, viewing psychological issues as conflicts between the conscious and unconscious minds. At that time, psychedelics were used to allow patients to face their unconscious minds while awake, which purportedly eliminated the variables of memory retrieval. Still, these methods of treatment weren’t without controversy.  With the influx of street use, and folks like Timothy Leary telling people to “”Turn on, tune in and drop out,” the use of psychedelia to treat mental illness was met with great discernment and fell to the wayside.

Currently, interest in using MDMA and other psychedelics to treat depression, obsessive-compulsive disorder (OCD) and PTSD is gaining traction. MAPS is doing extended research on this subject, and states that MDMA isn’t the street drug we call ecstasy, noting that while ecstasy contains MDMA, it also may contain ketamine, caffeine, BZP, and other narcotics and stimulants. According the MAPS site they are “undertakinga 10-year, $10 million plan to make MDMA into an FDA-approved prescription medicine.” They are also “currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. Companies also cannot profit from MDMA because it is only administered a limited number of times, unlike most medications for mental illnesses which are taken on a daily basis.”

The use of this drug has leaned so far from its psychotherapeutic roots, proving to be one of the most popular, highly sought-after street drugs around. Because of this, the useful aspect of this drug may easily be overlooked, forcing us to question how we can take something that has morphed into a social enigma and call it useful. I’m curious, will sufficient research place this drug at the discerning hands of medical professionals once again? And how do we, as a recovery community accept this when we have kids coming in suffering from the long-term, negative effects caused by this very drug?

Related articles:

MDMA May Help Relieve Posttraumatic Stress Disorder(time.com)

Ecstasy As Treatment for PTSD from Sexual Trauma and War? New Research Shows Very Promising Results (alternet.org)

Clinical Study of MDMA Confirms Benefits Noted by Therapists Before It Was Banned (reason.com)

Neuroscience for Kids

Ecstasy Associated With Chronic Change in Brain Function