A considerable number of children are exposed to extreme stressors such as the sudden loss of a loved one, serious traffic accidents, violence, and disaster. In order to facilitate school psychologists' assistance of teachers working with traumatized children, this study aimed to explore elementary school teachers' perspectives. Using a qualitative design, the study explored the perspectives of a purposively varied sample of 21 elementary school teachers (ages 22-55 years; with 0.5-30 years of teaching experience; 5 men). The teachers participated in semistructured interviews, which were transcribed and analyzed in line with the method of "summative analysis" by F. Rapport. Even though some teachers expressed confidence in working with children after traumatic exposure and many referred to a supportive atmosphere within the school, the most prominent themes in the participants' narratives reflected uncertainty about, or a struggle with, providing optimal support to children. They searched for a clear role definition as well as a good balance in answering conflicting needs of the exposed children and classmates, wished for better knowledge and skills, and experienced difficulties related to the emotional burden of their work. The findings suggest a need for further research into this understudied topic. In addition, the identified themes can be used by school psychologists to systematically explore individual teachers' strengths and difficulties and to provide them with tailored advice and training.

/pdf/teachers-perspectives-on-providing-support-to-children-after-o4vdlcduvd.pdf

Teachers' perspectives on providing support to children after trauma: A qualitative study

The long-term consequences of exposure to firearm injury—including suicide, assault, and mass shootings—on children’s mental and physical health is unknown. Using PRISMA-ScR guidelines, we conducted a scoping review of four databases (PubMed, Scopus, PsychINFO, and CJ abstract) between January 1, 1985 and April 2, 2018 for articles describing long-term outcomes of child or adolescent firearm injury exposure (n = 3582). Among included studies (n = 31), most used retrospective cohorts or cross-sectional studies to describe the correlation between firearm injury and post-traumatic stress. A disproportionate number of studies examined the effect of mass shootings, although few of these studies were conducted in the United States and none described the impact of social media. Despite methodologic limitations, youth firearm injury exposure is clearly linked to high rates of post-traumatic stress symptoms and high rates of future injury. Evidence is lacking on best practices for prevention of mental health and behavioral sequelae among youth exposed to firearm injury. Future research should use rigorous methods to identify prevalence, correlates, and intervention strategies for these at-risk youth.

What are the long-term consequences of youth exposure to firearm injury, and how do we prevent them? A scoping review

In December 2012, 20 elementary school children fell victim to gun violence. Shortly after the killings occurred, national media outlets instantaneously and simultaneously began covering the tragedy with “calls to action” explicitly voiced by public officials and members of the general citizenry. Gun violence in African American communities has also left an indelible mark on the quality and quantity of life among the youngest members as well. Statistics released by federal law enforcement officials reveal that, collectively, more children of color die each year to gun violence. However, gun-related crimes involving low-income persons and racial and ethnic minorities are framed by the media as a convergence of cultural, environmental, and individual shortcomings and immorality. Consequently, structural and/or policy resolutions to address such crimes involving low-income persons and racial and ethnic minorities are overlooked or even omitted from the national and, more importantly, political discourse.

The Role of the Media in the Disparate Response to Gun Violence in America

We examine the historical development and use of the diagnosis of post-traumatic stress disorder that has been primarily applied to war veterans. We explore how study of this population and refinement of this diagnosis were influenced by changing paradigms and the emergence of new theory. From this context, we then explore similarities and differences between the symptoms, stressors, and social supports of war veterans with those of youth living in violent, impoverished communities. Based upon this analysis, we conclude with implications for researchers, education, mental health, and social service policy-makers and service providers.

/pdf/post-traumatic-stress-disorder-a-diagnosis-for-youth-from-19yzbtqa80.pdf

Post Traumatic Stress Disorder: A Diagnosis for Youth from Violent, Impoverished Communities

Exposure to potentially traumatic events is an unfortunately common experience for children and adolescents. Up to 66% of urban adolescents and 40% of suburban adolescents report being the victim of violence (Campbell & Schwarz, 1996; Singer, Anglin, Song, & Lunghofer, 1995). Each year in the United States, 20 million children suffer accidental injuries, resulting in 8.7 million emergency room visits; and 241,000 children are injured seriously enough to be hospitalized (Grossman, 2000). Other potentially traumatic events such as residential fires, natural disasters, and serious medical events affect tens of thousands of youth each year (Shannon, Lonigan, Finch, & Taylor, 1994). Accurate early assessment of children’s acute stress reactions, including acute stress disorder (ASD) symptoms, can help clinicians serve the immediate needs of distressed children and guide secondary prevention to reduce the severity of persistent distress, e.g. posttraumatic stress disorder (PTSD), after trauma exposure. Brief self-report measures can be used to efficiently triage children, identifying those with extreme acute distress as well as those at greater risk for long term mental health complications. Standardized interview measures can be used in research and clinical settings where more time and human resources are available. To date, prospective research investigations of child acute traumatic stress reactions have been scarce, and have not adequately included ethnically diverse populations, at least in part due to the lack of validated measures (Rabalais, Ruggiero, & Scotti, 2002).

Recent development of both checklist and interview measures of child acute stress promises to expand both clinical practice and research in this area. The first child self-report measure designed specifically to assess acute traumatic stress reactions, the Acute Stress Checklist for Children (ASC-Kids) was developed and validated in a sample of 176 English-speaking children with recent medical trauma, primarily injury (Kassam-Adams, 2006). The first standardized interview measure of child acute traumatic stress reactions, the Diagnostic Interview for Children and Adolescents – Acute Stress Disorder module (DICA-ASD) was developed and validated in a sample of 168 English-speaking children with acute burns or other injuries (Miller, Enlow, Reich, & Saxe, 2009). Recognizing the need for Spanish-language measures, our research team undertook a careful translation of the ASC-Kids into Spanish, creating the Cuestionario de Estres Agudo – Ninos (CEA-N). We then created a Spanish version of the DICA-ASD interview, the Entrevista Diagnostica para Ninos y Adolescentes – modulo de Trastorno de Estres Agudo (EDNA-TEA), with the permission and collaboration of the DICA-ASD developers.

There are few validated Spanish-language measures of posttraumatic stress for children. To our knowledge the measures assessed here are the only Spanish-language measures developed specifically to assess acute traumatic stress in children and adolescents. There is a critical need for validated Spanish-language measures for children in the US, with 1.8 million Latino children in the US who are not fluent in English (Pew Hispanic Center, 2012), and an estimated 43% of first generation Latino children who speak English “less than well” (Pew Hispanic Center, 2009). Their under-representation in child health research leads to substantial gaps in our knowledge about the mental health needs of Latino children (Flynn & Fuentes-Afflick, 2002). When English-language measures are translated for use in practice or research, time and resource constraints have often precluded independent validation of the new Spanish version, however, best practices (Gudmundsson, 2009; Hambleton, Merenda, & Spielberger, 2005) include utilizing a systematic and thoughtful process of translation and adaptation, piloting items and administration instructions with intended users in the new language, and collecting (and reporting) data that can form the basis for assessing reliability and validity of the newly translated measure.

The purpose of the current study was to examine psychometric properties (reliability and validity) of checklist and interview measures of acute traumatic stress in children, in both Spanish and English. This study expands upon prior validation studies for the English-language versions of both measures and is the first to examine the psychometric properties of each of the Spanish-language measures. We hypothesized that checklist and interview measures of acute stress would be strongly associated with each other, and that each acute stress measure would be associated with posttraumatic stress symptoms assessed 3 months later. Regarding convergent and discriminant validity, we hypothesized that each acute stress measure would show a low to moderate association with depression severity, but would be more strongly associated with general anxiety symptoms.

Development and psychometric evaluation of child acute stress measures in Spanish and English.

PROBLEM. The prevalence of acute stress disorder symptoms (ASDS) and other psychiatric comorbidities in youth with recent gunshot injuries.



METHODS. Children (n = 20) admitted to an urban hospital ER for gunshot injuries over a 4-year period were evaluated for ASDS, co-morbid DSM- III-R diagnoses, legal and gang involvement, and psychiatric history; medically hospitalized children (n = 36) similar in age, sex, race, and socioeconomic status served as a control group.



FINDINGS. Gunshot-injured youth reported a 75% rate of ASDS compared to a 14% rate in medically ill youth (OR 18.6; χ2= p < .0001). Parent ratings of ASDS closely corresponded with youth ratings. Youth rated reexperiencing the event as the most frequent distressing symptom. Gunshot injury was associated with legal problems, gang involvement, marijuana/alcohol dependence, conduct disorder, social phobia, and agoraphobia compared to youth with medical illness.



CONCLUSIONS. Compared to youth with medical illness, gunshot-injured youth were 18–6 times (p = .0001) more likely to show symptoms of ASDS. Further research, developmentally appropriate assessment, prevention, and treatment are needed in this area.

Acute stress disorder symptoms in gunshot-injured youth.

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Acute stress disorder symptoms in gunshot-injured youth.