Trauma-Focused CBT for Traumatic Grief in Military Children

Although military children are typically as resilient as the general child population, the ongoing conflict has exposed military children to unusual stressors such as repeated deployment, severe injury, or the death of a parent or sibling. U.S. forces have experienced more than 5,600 casualties during Operation Iraqi Freedom and Operation Enduring Freedom, with growing numbers of suicides among Service members. These deaths have affected thousands of military children. Most bereaved military children experience adaptive grief characterized by deep sadness, longing for the deceased person, and being comforted by positive memories of the deceased. A smaller number of military children develop childhood traumatic grief, characterized by trauma symptoms that interfere with adaptive grieving. Children with traumatic grief get “stuck” on the traumatic aspects of the death such as picturing the imagined or real details of the death; imagining the pain their loved one experienced in the moments before dying; wishing for revenge; and becoming angry at those who do not understand or share the child’s thoughts and feelings about the death. These children avoid reminders of the deceased person. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for children with trauma symptoms including those with traumatic grief. TF-CBT may be particularly suitable for military families. This article describes the clinical application of TF-CBT for traumatic grief in military children.     

Book Review of Counseling Children and Adolescents Through Grief and Loss

Book reviewed in this article: Counseling Children and Adolescents Through Grief and Loss by Jody J. Fiorini & Jodi Ann Mullen, 2006     

The Effects of Psychological Trauma on Children and Adolescents

In this review the authors examine the cognitive, affective, behavioral, and somatic-physiological effects documented in the literature as sequelae of overwhelming life events in children and adolescents. Findings from the literature are compared with the current formulations of Post-traumatic Stress Disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R, American Psychiatric Association, 1987) as this diagnostic category applies to children. Responses likely to be observed in children and adolescents who have been exposed to traumatic events are discussed. Suggestions for future research and counseling practice are presented     

Disenfranchised Grief Following a Traumatic Birth

Following a “failed” birth plan, some women experience trauma. Because most of these women do end up with a healthy baby, their support system does not necessarily support the sadness felt at the loss of the dream birth experience, leading to disenfranchised grief. Comments on a Facebook post linked to an essay from the Scary Mommy website were examined. Thematic analysis revealed three overarching categories of comments: (a) grief is disenfranchised by others through nonlosses and one-upping; (b) other posters expressed camaraderie for the loss of a dream birth, expressing empathy; and, (c) conditional support.     

The Trauma and Complicated Grief of Ambiguous Loss

Ambiguous loss is a newly identified type of loss that occurs when a loved one is physically present, but psychologically absent. Dementia is just one example. Because the lost person is here, but not here, grief is frozen, life is put on hold, and people are traumatized. With no official verification of death, no possibility of closure, and no rituals for support, there is no resolution of grief (Boss 1999). Clergy, especially pastoral counselors, can witness and provide comfort for such uncanny loss because people rely on them for support, not just from the clear loss of death, but from the ambiguous losses, catastrophic and ordinary, that inevitably will occur across the life course.     

Health-Related Quality of Life in Children and Adolescents Following Traumatic Injury: A Review

This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18?years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18?years, with 12 studies considering children 5?years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11?years). Some improvement was seen 6?months to 2?years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.     

儿童创伤截肢

儿童意外伤害在国内外一直是受到普遍重视的问题,我国在这这方面的研究不多。严重肢体创伤的处理无论从专业理论还是在手术技巧上均要求很高,尤其对儿童肢体的毁损性创伤的治疗往往使临床医师常需在截肢与肢体挽救二者之间作出困难的选择。如何确定急诊截肢和保留肢体,国内外目前尚未有一个客观合理权威的标准。本文主要综述儿童截肢的标准和方法,以供参考。     

Exploring the Use of an Integrative and Ecological Framework When Treating Children with Trauma

ABSTRACT

Children’s clinical symptoms can often only be understood within their individual and family contexts. However, contemporary research has pointed to the importance of also working with children’s social identities and macrosystem environment when attempting to understand and treat clinical problems. The case of a 10-year-old Dominican-American girl who presented with a significant trauma history, oppositional behavior, and difficulties interacting with her peers is examined using a developmental ecological framework. Attachment theory, cognitive behavioral therapy, narrative therapy, and multicultural family systems therapy, with a focus on trauma responses, are integrated when exploring the case. Additionally, the benefits of exploring the influence of social identities (race, ethnicity, immigration status/perceived immigration status, and class) are explored via an approach that focus on transformation and healing from oppressive systems by integrating sociopolitical realities in therapy.     

Construct and Criterion Validity of the Comprehensive Trail Making Test in Children and Adolescents with Traumatic Brain Injury

The current study examined the construct and criterion validity of the Comprehensive Trail Making Test (CTMT) when used to evaluate children and adolescents with traumatic brain injury (TBI). Participants included 100 children and adolescents, 50 who had sustained TBI and 50 normal comparisons (NC). Analyses indicated that the CTMT factor scores were significantly correlated with tests of perceptual organizational ability, processing speed, and motor function and provided support for its construct validity. Additionally, correlations between the various CTMT scores suggested that a different pattern of associations was present in the TBI group compared to the NC group. Finally, the TBI group performed significantly worse (p < .001) on all of the CTMT scores, including each of the five CTMT trails as well as the factor and composite index scores. Results support the construct and criterion validity of the CTMT when used to assess children and adolescents with TBI.     

儿童功能性躯体化症状研究述评

功能性躯体化症状(Functional-somatic Symptoms, FSS)是指无法用医学知识解释, 或经医学治疗后无改善的躯体不适症状, 多发于儿童和青少年群体, 常伴随焦虑、抑郁等心理障碍共同发生。儿童FSS的发病受多方因素的影响, 包括社会文化、年龄、性别、家庭环境、生理易感性等。各个心理学流派从不同视角提出了儿童FSS的心理理论模型。心理干预, 尤其是认知行为疗法和放松–生物反馈疗法对治疗儿童FSS有较好的效果。     

Defense Mechanisms Development in Children,Adolescents, and Late Adolescents

To replicate and extend Cramer's (1987) original cross-sectional study concerning the development of defense mechanisms, the Thematic Apperception Test responses of 148 students in Grades 2, 5, 8, 11, and college freshmen were collected and scored for denial, projection, and identification using Cramer's Defense Mechanisms Manual (1991). Our results supported the notion that the relative use of denial and projection decreases and identification increases as a function of grade level. The findings provide additional support for the psychoanalytic view (Freud, 1966) of an ontogenetic developmental line of defense.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

Grief Counseling for Muslim Preschool and Elementary School Children

This article describes Sunni Muslims' view of death, mourning and burial rituals, and accepted healing practices. Interventions for addressing death with Muslim children, group counseling, play therapy, and community outreach are discussed. A case study of interventions for coping with a preschool Muslim boy's death is provided. Este artículo describe la perspectiva sobre la muerte, el luto y los rituales de enterramiento, así como las prácticas de curación aceptadas de los musulmanes suníes. Se discuten intervenciones para tratar de la muerte con niños musulmanes, consejería de grupo, terapia de juego y vinculación con la comunidad. Se incluye un estudio de caso de intervenciones para el afrontamiento de la muerte de un niño musulman en edad preescolar.     

A Review of the Use of Trauma Systems Therapy to Treat Refugee Children,Adolescents, and Families

ABSTRACT

Children and adolescents within refugee families face adverse childhood experiences emanating from multiple sources. These traumatic events can begin with persecution within their country of origin, during the migration process, and within their re-settled countries. More specifically, these children and their families are more prone to the four core stressors being: traumatic, acculturative, isolative and resettlement stress. Trauma Systems Therapy for Refugees (TST-R) is a promising treatment model to address child and adolescent mental health disparities revolving around direct and vicarious trauma. In TST-R, the treatment team systematically targets the needs of the child, while collaborating with cultural brokers from the refugee community, their school, and family unit. Researchers have used TST-R as an intervention for reducing trauma symptoms in Somali, Somali-Bantu, and Bhutanese children, adolescents, and their families. We review the strengths and limitations of this model. Further research is needed to determine its applicability to other communities within the United States and abroad.     

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.