"Symptoms include extreme anxiety that can be triggered by sounds, sights, or smells."
One of the lesser known conditions is Post-Traumatic Stress Disorder (PTSD). This is a condition most of us attribute to soldiers returning from war. In recent years the experiences of war veterans has been widely documented and given us insight, recognition and understanding of this debilitating condition. Did you know that PTSD can happen to any of us at any time? PTSD can, and does, affect children and young people. You might be wondering ‘how’?
PTSD is a real illness with very real symptoms. The NHS describe it is “an anxiety disorder caused by very stressful, frightening or distressing events”. Symptoms include extreme anxiety that can be triggered by sounds, sights, or smells. Interestingly, symptoms can occur weeks, months or years after an event. Whomever the victim, the likelihood is that there will be an impact on the whole / wider family, relationships and friendships. PTSD can affect behaviour or delay a child’s development if they are young, particularly motor skills and language acquisition. PTSD will almost certainly affect academic achievement. Sufferers need a ‘safe place’ they can retreat to and will need sustained support from those around them. Recovery and healing are possible with the help of trained professionals and intensive support programmes such as Cognitive Behaviour Therapy (CBT). Bear in mind that there is no ‘quick’ fix. Recovery can take a very long time.
Post-Traumatic Stress Disorder may occur when a child or young person witnesses others go through a traumatic event, or if they themselves / others close to them have a life-threatening illness. PTSD can also occur in children and young people who live through a traumatic event such as sexual / physical abuse or other violent acts where their safety is threatened.
Disasters such as floods, car crashes, fires, domestic violence and deaths (including suicides of a friend or relative) are all mitigating incidents. Rape and assault are most likely to cause PTSD than other forms of trauma. It stands to reason that the most severe traumas result in the highest levels of PTSD symptoms. However, how trauma affects one person may not necessarily be how it affects another. Some children and young people are far more resilient and deal with trauma better than others.
Victims of PTSD often feel they can’t talk about the cause for fear of increasing feelings of anxiety, panic attacks or other physical symptoms. They might also believe that others will not understand. Sufferers may be withdrawn, tearful, irritable, feel threatened, lonely, detached or isolated. They may also feel guilty and suffer from nightmares or hallucinations. PTSD is emotionally and mentally exhausting. Victims can also suffer from claustrophobia or agoraphobia, and will often experience flashbacks triggered, as aforementioned, by the senses, experience insomnia, have difficulty concentrating and short-term memory loss. PTSD will certainly have a significant impact on day-to-day life and an individual’s ability to cope.
Physical symptoms are also very real for sufferers. Symptoms can include sudden outbursts of tears, panic attacks, pain, headaches, stomach pain, diarrhoea, tightness of chest, shortness of breath, muscle cramp, feeling dizzy or sick, sweating, racing heart and trembling. Victims may experience any of these symptoms at any time.
In addition to seeking professional help there are positive ways that schools can help victims to cope better.
Create an environment that is consistent, relaxing and restful where the pupil feels safe – this helps to relieve stress. This is more easily achieved in Primary schools where pupils are less likely to move around the school building. Consider setting up a nurture group. In Secondary schools, provide a quiet room / space where students can retreat too. A ‘time-out’ card would help a student to take control of a situation and alleviate stress. High levels of noise and the hustle and bustle of large numbers of students moving around at break times or between changes of lessons may cause distress however silence might also be a trigger. It’s important, if at all possible, to be aware of triggers. Ensure that there are procedures in place should the pupil take ‘flight’ and that key members of staff are aware of what to do and who to contact. Offer time with your school counsellor if you have one… if the student wants to talk to them, don’t push if they don’t want to or if they feel they are receiving the support they need from other services.
Keep clear channels of communication with parents and carers, and also with other professionals who are involved. Lack of communication can be as damaging as misinformation. Siblings of PTSD sufferers may also be suffering. They will have witnessed and been affected by their sibling’s distress. They might also be very confused about their own feelings and be experiencing high levels of anxiety. Siblings can sometimes be overloaded with feelings of responsibility if they are frequently being asked how their brother or sister is, or being messenger, or having the responsibility of taking work home.
Some activities may also cause distress. Again, it is important to find out what a trigger may be. It might a textual thing. This might mean that a pupil has difficulty participating in Art, Food Technology or DT activities. If smells are the trigger there could be a whole host of elements within the school building.
Encourage a pupil to participate in exercise if you can. Exercise can help to relieve tension. Although if a student didn’t enjoy sporting activities before their trauma, they are unlikely to enjoy it afterwards. Consider offering paired or small group activities – art, crafts and music can be very therapeutic (if they’re not a trigger!). For specialist support there might be somebody within the local authority who can offer therapeutic writing.
"Lack of communication can be as damaging as misinformation."
A victim of PTSD may need to have a reduced timetable and / or a delayed start or finish to the school day. Offer a phased return to school with support if possible. To start short sessions are best. For students in year groups where national statutory exams are due to be taken, you might need to think about reducing the number of subjects an individual would previously been expected to take. Adding pressure to an already anxious student will only increase their levels of anxiety and make the recovery longer.
Teachers and support staff can play an important role in recognising the symptoms of PTSD. Be mindful that victims will need a period of adjustment. If a pupil wants to talk about a traumatic event, be prepared to listen. It can be challenging and requires patience. If a student threatens self-harm or suicide seek help immediately. Seek advice for yourself if you need to. It’s important to talk and you can do this whilst maintaining confidentiality.
Have you worked with PTSD-suffering pupils? Share your stories below.