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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. - 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 • • • • • 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. • • • • • 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. • 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