Guest blog post from Jessica M., public health undergraduate intern with the Center for Pediatric Traumatic Stress
How many times have you been folding the laundry or washing the dishes and heard your teenage daughter sigh, “I can’t deal?” Or how many times have you found yourself scrolling through social media unable to “deal” with the nonsensical things people say and do? How often do you find yourself shopping for a well needed item and find that the item is way more expensive than you expected? You suddenly “just can’t deal” with these price. But some way, somehow, you always do deal with it.
Let’s put a slight spin on this scenario. Today you have to explain to Brenda, that her child has just been diagnosed with stage-two leukemia. You, as this child’s doctor, have to explained this to her in the most sensitive and sympathetic way you know how; but that will not stop the earth from moving under her feet. You look over at your four year old patient who immediately reads the look of anguish, disbelief and worry on his mother’s face. Brenda doesn’t utter the words, “I can’t deal.” She can hardly muster up the courage to look you in the face. But the reality is that, at that moment, she really can’t deal. She’s just not sure how. This wasn’t in the parenting books. No one told Brenda how to prepare for cancer. But some way, somehow, she will deal with it. And you will help.
In the world of pediatrics much of the attention and focus is placed on the ill patient, rightly so. Physicians want to treat any physical malaise or discomfort. However, often times the patient and his/her family’s emotional discomfort are overlooked. There are various signs of distress and inability to cope with stressful situations.
“To pity distress is but human; to relieve it is Godlike.”
These signs of distress liken unto the symptoms of Post-Traumatic Stress. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria include symptoms that appear in several different categories.
Psychological distress looks like:
• Distressing memories or dreams that one experience involuntarily, or signs of distress at trauma reminders
• Avoiding thoughts, feelings, people, and activities that are reminders of the trauma
• Dissociation; altered sense of reality of surroundings or oneself
• Sudden mood changes
• Persistent exaggerated negativity (detachment from others, negative expectations of self, others and/or world) expectations of self, others, or
• Changes in arousal (hypervigilance, exaggerated startle, sleep disturbance, or concentration difficulties)
• Refusing to talk about injury or illness
Research from the Journal of Child Psychiatry and Human Development concluded that the most effective way to lessen long-term distress is to recognize the signs early and address them. If you recognize these symptoms in your patient and/or the family, it is imperative that you take action. This requires the implementation of Trauma Informed Care, (TIC). Trauma informed care is an approach which consciously takes into account the fact that the child and his/her family are susceptible to have suffered psychological trauma. With this approach health providers must be mindful of the potential for trauma. Check out the Pediatric Psychosocial Preventative Health Model and equip yourself with proper knowledge of how to treat your patients and their families more effectively.
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