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Abstract
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Sixty-four children and 66 adults were screened for post-traumatic stress disorder 6 to 14 months after a school shooting. Although there were no differences in overall frequencies of DSM-III-R diagnoses or cluster endorsements, there were developmental influences. Post-traumatic stress disorder was associated more with emotional states recalled from the disaster than with proximity. Emotional states mediated the formation of malignant memories leading to symptomatology, suggesting that postdisaster intervention be offered on the basis of degree of emotional reaction as well as proximity.
VioLit summary
OBJECTIVE:
The aim of this research by Schwarz and Kowalski was to compare diagnosis and symptomatology of post-traumatic stress disorder in children and in adults, to explore the developmental influences upon the manifestation of the disorder, and to examine the role of a number of factors in the expression of the disorder.
METHODOLOGY:
The authors employed a quasi-experimental cross-sectional design with a non-probability sample of 64 children and 66 adults, all of whom lived in a community that had been the setting for a fatal shooting spree in a local Chicago school. From the day of the shooting, staff at Evanston Hospital provided a variety of treatment services to the whole community, including clinical screening to assess incidence of post-traumatic stress response and other psychological responses to the event. Children and parents in the community were also screened 8 to 14 months after the incident. A structured interview of the children included questions about post-traumatic stress disorder (PTSD) symptoms, as well as other reactions to the incident (associated symptoms) and their experiences of the event (event variables). Parents completed questionnaires about their responses in these same categories. As well as children and parents, school personnel also completed questionnaires, 6 months after the event, about their responses to the shooting. In the initial clinical screenings, PTSD was assessed via use of the 20-item Reaction Index, based upon the Diagnostic and Statistical Manual, Third Edition (DSM-III). The Index had established validity. For the child interview, an expanded children's version of the Index was based upon DSM-III-Revised criteria, and was tailored to be specific to this particular incident. Adults completed a self-report version of the Reaction Index. A liberal threshold was set if a symptom was reported at least a little of the time; a moderate threshold was when a symptom was present at least some of the time; and a conservative threshold was considered when a symptom was reported at least much or most of the time. Analyses included Chi-Square, frequencies and correlations.
FINDINGS/DISCUSSION:
The authors found that 42% of children who were in the classroom on the day of the shooting, all eye witnesses and 21% of the total student population participated in the clinical screening. The majority of the subjects personally knew either the deceased, the injured or their families. Event variables were either emotional (e.g., worry, fear or anger) or sensory (e.g., seeing blood or hearing the gunshot). Most children reported emotional responses to the event, although a minority actually saw or heard the incident. Most adults experienced emotional responses, and whilst few actually saw or heard the incident, most did see media coverage or hear reports of witnesses. The authors examined the frequencies of reported experiences with PTSD symptoms, including overall PTSD diagnosis, and three symptom clusters - reexperiencing, avoidance and arousal. Children reported more symptoms across the clusters than did adults, and reported experiencing the event as an extreme stressor more often than did adults. There were no significant differences between children and adults in overall PTSD diagnosis - frequencies for liberal, moderate and conservative thresholds were 39%, 19% and 3% respectively for adults, and 50%, 27% and 8% respectively for children. Most children experienced the associated symptoms of anger and fear, with 40% experiencing some form of guilt. The authors suggested that the similarity of the children' and adults' experiences and their meeting of DSM-III-R criteria did not imply similarities in PTSD or in its treatment, as the presentation and course of the disorder might differ between the two groups. Results indicated that there were no direct relationships between proximity to the incident or sensory experiences and PTSD symptomatology, although there were significant associations found between recalled emotional states and PTSD symptoms and diagnosis.
AUTHORS' RECOMMENDATIONS:
The authors concluded by stressing the need to consider emotional experiences, and not just proximity, in the concept of exposure to traumatic events. They confirmed the validity of using the adult DSM-III-R diagnosis of PTSD in children, but suggested that further research be directed at empirically validating the need for modifications to reflect age-specific differences.
EVALUATION:
This piece of research provides an informative and insightful examination of the effects of post-traumatic stress upon children and adults. However, results should be considered with some caution. The small and self-selected nature of the sample precludes generalization, as only extreme cases might have been presented. The self-reporting of responses and recall from a considerable time after the event, might have distorted memories and therefore might have led to inaccurate reporting. The written self-reports of adults and the use of interviews for children might have led to differential sensitivity to detecting symptoms, and the one-time nature of the screening, without psychiatric interview, might have precluded the detection of more symptoms. Characteristics of the reporting community were not considered, and these might have affected the clinical picture. No control groups were available as a context for the study of symptom formation, and the group of children was taken as one whole, ranging in age from 5 to 14 years, without consideration of varying ages within the group. Also, the use of people within the community as the interviewers might have affected the results, as the interviewers themselves might have suffered from PTSD responses. Despite these methodological flaws, the study represents a valuable, well-written and thorough investigation of some of the stress responses found within a traumatized community. The finding of the importance of emotional states in PTSD has many implications for prevention and treatment planning, as well as for future research in the field. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
N1 - Call Number: F-97, AB-97
KW - Illinois
KW - Firearms Violence
KW - Exposure to Violence
KW - Adult Witness
KW - Juvenile Witness
KW - Child Witness
KW - Middle Childhood
KW - Late Childhood
KW - Late Adolescence
KW - Early Adolescence
KW - Post-Traumatic Stress Disorder
KW - Psychological Victimization Effects
KW - Witnessing School Violence
KW - Witnessing Violence Effects
KW - Adult Adjustment
KW - Child Adjustment
KW - Juvenile Adjustment
KW - Emotional Adjustment
KW - Witness Adjustment
KW - School Homicide
KW - School Shooting
KW - Firearms in School
Language: en |