Thursday, January 8, 2009

Children & PTSD, Part 2: What's the Best Treatment?

Today, Part 2 of my Children & PTSD interview with William Krill...

When should a parent consider getting treatment for a child who exhibits PTSD symptoms?

I think with children it is important to have a professional do an initial assessment and keep tabs on them for say, six months after a known traumatic event. I would educate the parent on what to watch for, and if symptoms reach the criteria for the diagnosis, begin to treat. But if a child does not develop Acute Stress signs within a few weeks after the trauma, it’s not too likely that full blown PTSD will develop. If the child clearly has Acute Stress, the sooner the treatment the better.

What treatments are available for children?

Most treatments for children are based on the treatment modalities for adults with PTSD. Early in my work with PTSD children, I tried using these methods, and tried to modify them the best I could to use them with children. I became quite frustrated because the methods were awkward when used with children, and with very young children, where insight and mature understandings of the trauma facts are used in adult treatment, children clearly did not have these capabilities.

In addition, one of the usual methods for adults, that of multiple detailed reviews of the trauma until the person becomes desensitized to the facts, was just far too brutal for a child. The ‘flooding’ method was developed for soldiers with PTSD…people who presumably had a very strong ego before their trauma. For a child who may have been abused his whole life and thus has a very damaged ego, repeating the details of the trauma over and over is just ridiculous.

I started to study PTSD in children and have been developing my own Gentling process for about twelve years. During the past six years or so, I have taught the method to many foster parents and other treatment professionals, and they have all had good success with it, where other approaches have not helped the child to make progress.

What I have developed with Gentling makes use of general cognitive-behavioral techniques, but with the addition of some very specific techniques and a loose structure course of treatment. Basically, Gentling 1) strives to help the child feel safe in all environments, 2) sensitizes him to his own symptoms (since he has lived with them his whole life, he does not recognize them as disordered), 3) educates him on how PTSD works in his body and mind, 4) teaches him how to interrupt his own stress episodes to be more comfortable, and finally, 5) helps him to become less reactive to cues and triggers. This is all done at the pace the child dictates, and all work is done with an exceedingly gentle approach.

How should a parent prepare to understand, treat and heal PTSD in her child?

Getting parents or foster parents on board the treatment plan is very important. I spend a great deal of time educating adults around the child (including teachers, extended family members, fellow professionals, even judges) in first fully understanding how PTSD works in children, and then in the Gentling techniques of healing.

One final question: Why do you choose to work with children?

I don’t fully understand my passion for helping abused children to heal, but it might be summed up by one little boy I treated. He had been beaten and thrown in a closet by his stepfather (who knew the boy was frightened of the dark), then the stepfather screwed the door shut. His mother found him hours later, when she came home from work. He was terrorized, and he had torn all of his fingernails off in trying to get the door open. After he related this story to me, he hugged me and said: “When I talk to you Mr. Bill, the hurt goes away.”

For more information on William Krill, or to view his really excellent resources, parenting articles and PTSD information, visit his site.

(photo: TiZi042)

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