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A Behavioural Exceptionality in the
Classroom
Workshop by Lauren Pike
What is PTSD?
•PTSD stands for Post-Traumatic
Stress Disorder
• a type of anxiety disorder
• long term psychological distress
experienced after a
terrifying event
• chronic, long term effect on individual
• often misdiagnosed, shares
symptoms with other anxiety disorders
and exceptionalities such as ADHD
Causes of PTSD
• any event that can be interpreted as traumatic or
life-threatening by an individual.
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Examples of Traumatic Experiences That
May Lead to PTSD:
Violent personal attack or assault
Sexual assault or abuse
Torture
Kidnap
Causes of PTSD
Burglary, Robbery, Home
Invasion, or Mugging.
House Fire or Freak Accident.
Death of a loved one.
Car accident.
Living in a war zone.
Symptoms of PTSD
• Flashbacks of the earlier
trauma (re-experiencing
the event)
• Increased sleep
disturbances
• Continual thought pattern
interruptions
• Persistent and intrusive
thoughts about the
trauma
Symptoms of PTSD
•
•
•
•
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Inattention
Violent outbursts
Detachment from reality, passive or avolition
Can lead to drug use, reckless behaviour, or suicide
Freezing
What does it look like in the
classroom?
• PTSD can present itself in many ways, which contributes to
the difficulty of properly diagnosing it.
A student with PTSD may:
-appear disengaged and unmotivated
-adopt a sleep-like posture in class
-seem lazy or careless
-be unable to concentrate
-lash out verbally or physically
Recognizing and Diagnosing
PTSD
If you have a student who you think may have PTSD:
• Notify administration
• Contact the child’s parents
• The student should meet with a psychologist for
proper diagnosis
Recognizing and Diagnosing
PTSD
• A psychologist will diagnose PTSD using criteria set
out in the DSM-IV
• (1) the person experienced, witnessed, or was confronted with
an event or events that involved actual or threatened death or
serious injury, or a threat to the physical integrity of self or
others
• (2) efforts to avoid thoughts, feelings, or conversations
associated with the trauma
• (3) efforts to avoid activities, places, or people that arouse
recollections of the trauma
• (4) inability to recall an important aspect of the trauma
Recognizing and Diagnosing
PTSD
• The following accommodations can be used for
students who are diagnosed with PTSD and
those who may present similar symptoms but
do not fully meet the criteria for a diagnosis.
Establishing Empowerment and
Control
• Life events that contribute to PTSD usually involve a
person to experience a loss of control, causing them to
be interpreted as traumatic.
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Low self-esteem
Low self-efficacy
Learned helplessness
Lack of choice
Loss of control
Strategies to Empower
Gaining Control over the Body:
• Breathing exercises and relaxation games
-Ex., taking a break during class to take a few deep breaths to relax
the body and learn from biofeedback cues.
Providing Choice:
• Provide several assignment deadlines. This provides the student
with control and he or she can decide when to hand in an
assignment. Also, relieves stress in those who lead chaotic lives at
home
-Ex., a student might have choice between two different types of
assignments, or can hand it in on a Friday or Monday.
Meeting Basic Needs
Maslow’s Hierachy of Needs
How to Meet Basic Needs
Ensuring Classroom Safety (Psychological Need)
-knowing safety routines can allow the student to
focus on academic material
For example:
-teaching students how to follow instructions
-how to dial 911
-the differences between ‘good touches’ and ‘bad touches’
-how to alert others for help
-how to avoid strangers
-lockdown procedures and fire drills
How to Meet Basic Needs
Students with PTSD will be scanning the classroom looking
for cues that deem the room as being safe or unsafe.
Work with the student’s caregivers and therapist to identify
stressful ‘trigger cues’ that can be removed from the
classroom.
Examples of stressful cues:
-scary or violent drawings by other students or on the wall
-closing the classroom door
-locking doors or cupboards
-touching the student
Accommodating for Hypervigilance
Strategies to accommodate a
student with hypervigilance:
-warn the student when any
foreseeable loud noises will occur
-ask permission to touch the child’s
hand
-identify trigger cues and remove or
minimize them
-approach the student from the
front, so they can see you
-avoid yelling or calling the student
when his or her back is to you
Group Think
Brainstorm accommodation strategies for each individual with PTSD.
GROUP 1: When Abby was 5 years old, her mother was killed in a house fire.
Thankfully, Abby was rescued from the house by firefighters, but still has
flashbacks of the event. She can’t concentrate on her school work and
startles easily.
GROUP 2: Jacob was sexually abused by his uncle when he was 7 years old.
In class, he lashes out physically and verbally if stressed out or startled.
Other times he appears to be asleep at his desk and appears unmotivated
to complete schoolwork.
GROUP 3: Two years ago, Ira was involved in a car accident with his
grandparents where the driver of the other car was killed and ejected
through the car windshield. Ira saw the other driver’s lifeless body and has
since been diagnosed with PTSD. Ira can never concentrate at school and
never finishes his schoolwork.
GROUP 1: When Abby was 5 years old, her mother was
killed in a house fire. Thankfully, Abby was rescued
from the house by firefighters, but still has flashbacks of
the event. She can’t concentrate on her school work
and startles easily.
Help Abby by:
-reviewing fire drill procedures
-teaching fire detection skills, allowing her to meet a
firefighter
-reassuring her that the room is safe
-showing her how to use fire detectors and dial 911
-warning her ahead of time with loud noises are about to
occur
-using breathing exercises and empowerment activities
GROUP 2: Jacob was sexually abused by his uncle when he
was 7 years old. In class, he lashes out physically and
verbally if stressed out or startled. Other times he appears
to be asleep at his desk and appears unmotivated to
complete schoolwork.
Help Jacob by:
-reducing trigger cues within the room, such as loud noises
or locking doors
-ensuring all basic needs are met
-asking permission to touch his hand if he needs assistance
-approaching him from the front
-providing choice in assignment and due dates to help
foster self-efficacy and improve self-esteem
GROUP 3: Two years ago, Ira was involved in a car accident with
his grandparents where the driver of the other car was killed and
ejected through the car windshield. Ira saw the other driver’s
lifeless body and has since been diagnosed with PTSD. Ira can
never concentrate at school and never finishes his schoolwork.
Help Ira by:
-find out Ira’s specific triggers and stresses
-he may not be completing schoolwork because he is worrying
about the car ride home from school
-practice breathing exercises to promote self-control
-discuss alternate methods of transportation with his parents.
Perhaps, Ira would rather walk home from school with a friend
instead of driving.
-teach survival skills, road safety skills
-warn Ira of loud noises and sounds, reduce sounds of street
traffic from the outside environment.
Conclusions
•
PTSD is a chronic anxiety disorder that is often misdiagnosed.
•
The etiology and presentation of PTSD is unique for each individual and
depends on the traumatic event that caused the disorder.
•
Strategies to accommodate for PTSD can be used for other anxiety
disorders as well.
•
Allow the student to establish a sense of control and personal
empowerment.
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Make sure that the students basic needs are met, to reduce preventable life
stresses.
•
Identify specific symptoms and find a strategy to reduce triggers within the
classroom.
References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of
Mental Disorders, (4th ed.). Washington, DC: Author, 35-41.
American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition, Text Revision. Washington, DC,
American Psychiatric Association, 2000.
Askov, E.N., & Wolpow, R. (1998). Strong in the broken places: Literacy
instruction for survivors of pervasive trauma. Journal of Adolescent & Adult
Literacy, 42(1), 50-57.
Byers, E.S., DeLamater, J.D., & Shibley Hyde, J. (2009). Understanding
Human Sexuality: Fourth Edition. United States: McGraw-Hill Ryerson.
Collins Sitler, H. (2009). Teaching with awareness: The hidden effects of
trauma on learning. Clearing House, 82(3), 119-124.
References Continued
Demaree, M.A. (1994, March). Responding to violence in their lives:
Creating nurturing environments for children with post-traumatic stress
disorder. Paper presented at the Annual Conference of the Association
for Supervision and Curriculum Development, Chicago, IL.
Grosse, S.J. (2001). Children and post traumatic stress disorder: What
classroom teachers should know. Retrieved from the Educational
Resources Information Center:
http://www.hawaii.edu/hivandaids/Children%20and%20PTSD%20%20
%20What%20Classroom%20Teachers%20Need%20to%20Know.pdf
Perry, B.D. (2002). Stress, trauma and post-traumatic stress disorders in
children: An introduction. Retrieved from
http://www.childtrauma.org/CTAMATERIALS/PTSDfn_03_v2.pdf