Article

Alleviating posttraumatic stress in children following Hurricane Andrew

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Abstract

Sixty grade-school children who showed classroom behavior problems following Hurricane Andrew were given massage therapy on 8 days 1 month after the hurricane. Scores on the PTSD Reaction Index suggest that the children were experiencing severe posttraumatic stress. As compared to a video attention control group, the children who received massage therapy reported being happier and less anxious and had lower salivary cortisol levels after the therapy. In addition, the massage therapy group showed more sustained changes as manifested by lower scores on the Children's Manifest Anxiety Scale, The Center for Epidemiological Studies Depression Scale, and self-drawings, and were observed to be more relaxed. These positive effects were promising given the persistence of PTSD symptoms noted for children who have not received intervention following disasters such as hurricanes.

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... While the methods used for randomly assigning participants to experimental groups bore minimal risk of bias, 10 trials used cluster randomization Gelkopf and Berger 2009;Jordans et al. 2010;Ooi et al. 2016;Qouta et al. 2012;Slone and Shoshani 2008;Slone et al. 2013;Tol et al. 2008Tol et al. , 2012Tol et al. , 2014 indicating that the randomization was performed before the formal recruitment and inclusion of individual participants in the trial. The lack of sufficient information prevented assessing the risk of bias associated with deviation from the intended intervention in nine trials (Chen et al. 2014 (2 trials); Field et al. 1996;Jordans et al. 2010;Ooi et al. 2016;Shen 2002;Slone and Shoshani 2008;Tol et al. 2012Tol et al. , 2014 and with blinding of outcome assessor in eight trials (Chemtob et al. 2002;Chen et al. 2014 (2 trials); Field et al. 1996;Ooi et al. 2016;Qouta et al. 2012;Shen 2002;Tol et al. 2012) (see Fig. 4). ...
... While the methods used for randomly assigning participants to experimental groups bore minimal risk of bias, 10 trials used cluster randomization Gelkopf and Berger 2009;Jordans et al. 2010;Ooi et al. 2016;Qouta et al. 2012;Slone and Shoshani 2008;Slone et al. 2013;Tol et al. 2008Tol et al. , 2012Tol et al. , 2014 indicating that the randomization was performed before the formal recruitment and inclusion of individual participants in the trial. The lack of sufficient information prevented assessing the risk of bias associated with deviation from the intended intervention in nine trials (Chen et al. 2014 (2 trials); Field et al. 1996;Jordans et al. 2010;Ooi et al. 2016;Shen 2002;Slone and Shoshani 2008;Tol et al. 2012Tol et al. , 2014 and with blinding of outcome assessor in eight trials (Chemtob et al. 2002;Chen et al. 2014 (2 trials); Field et al. 1996;Ooi et al. 2016;Qouta et al. 2012;Shen 2002;Tol et al. 2012) (see Fig. 4). ...
... Among the 18 studies, 5 were related to the Israel-Palestine conflict(Barron et al. 2016;Gelkopf and Berger 2009;Qouta et al. 2012;Slone and Shoshani 2008;Slone et al. 2013) and 2 were related to war in northern Uganda(Bolton et al. 2007;Ertl et al. 2011). The other contexts of mass trauma were Hurricane Andrew(Field et al. 1996); Hurricane Iniki(Chemtob et al. 2002); the 1999 Jiji earthquake in Taiwan(Shen 2002); the 2004 South Asia tsunami); the 2008 Sichuan earthquake(Chen et al. 2014); political violence in Indonesia(Tol et al. 2008); civil wars in Nepal(Jordans et al. 2010), Sri Lanka(Tol et al. 2012), and Burundi(Tol et al. 2014); genocide in Rwanda(Unterhitzenberger and Rosner 2014); and adolescent war refugees relocated to Australia(Ooi et al. 2016). Three studies each investigated the effect of two interventions(Bolton et al. 2007;Chen et al. 2014;Ertl et al. 2011) for a total of 21 interventions included in this meta-analysis. ...
Article
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Background Meta-analyses of youth mass trauma intervention studies have focused primarily on posttraumatic stress even though depression and anxiety are common maladaptive outcomes that require intervention. Objective This meta-analysis examined youth mass trauma intervention effects on depression and anxiety relative to natural recovery and characteristics of the event, context, population, intervention, and intervention delivery that may have moderated these effects. Method A literature search identified 21 studies investigating the effectiveness of 24 randomized controlled trials with inactive controls (21 trials examined depression and 8 examined anxiety; 5 examined both). Intervention effects were computed as Hedge’s g estimates and combined using random effects models. Moderator analysis computed intervention effect sizes across selected covariates. Results The summary intervention effect was not significant for either depression or anxiety. There were statistically significant effects for depression with interventions delivered following a natural disaster (g = 0.40; p = 0.0192) or in a high income country (g = 0.30; p = 0.0253) and with non-trauma-focused interventions (g = 0.29; p = 0.0155) and those delivered in more than eight sessions (g = 0.23; p = 0.0416). The effect for anxiety symptoms was significant only with non-trauma-focused interventions (g = 0.83; p = 0.0428). Conclusions Given the prevalence of depression and anxiety post event, greater attention is warranted to develop and maximize the benefit of interventions for these outcomes. The findings suggest that trauma-focused interventions may need to be augmented with specific components directed at depression and/or anxiety.
... Of the 48 papers which were read in full, 8 met inclusion criteria (Fernandez 2007;Field et al. 1996;Giannopoulou et al. 2006;Lesmana et al. 2009;Martin et al. 2015;Tang et al. 2015;Yule 1992;Yule and Udwin 1991). Review of the reference sections of these papers revealed no additional publications but four other papers known to the authors were included in the analysis (Catani et al. 2009;Leor et al. 2013;Ronan and Johnston 1999;Vila et al. 1999). ...
... Two studies did not specify the delivery site. Interventions were delivered by mental health professionals except for the narrative exposure and meditation relaxation interventions studied by Catani et al. (2009), which were delivered by teachers trained as counselors, and the intervention delivered by massage therapists (Field et al. 1996). See Table 1. ...
... Six interventions out of eight studies using pre-/post-assessments of depression were effective with a statistically significant decrease in depression scores. CBT (Leor et al. 2013) and massage (Field et al. 1996) were superior to no intervention and to a placebo control, respectively, and EMDR in combination with psychoeducation was superior to psychoeducation only (Tang et al. 2015) in addressing depression. Tang et al. (2015) reported no change in depression in their psychoeducation control group after four to six weekly sessions, and Yule and Udwin (1991) reported a worsening of depression after one debriefing session. ...
Article
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Background The need to establish an evidence base for early child disaster interventions has been long recognized. Objective This paper presents a descriptive analysis of the empirical research on early disaster mental health interventions delivered to children within the first 3 months post event. Methods Characteristics and findings of the included studies were summarized in frequency tables. The long-term effect of the interventions was evaluated using the findings at follow-up assessments. ResultsEleven empirical studies examining 16 interventions delivered to children within 3 months post disaster were identified for review. The studies included only four randomized controlled trials. The studies examined a range of intervention types (e.g., cognitive behavioral therapy, narrative exposure, meditation relaxation, debriefing, eye movement desensitization and reprocessing) and reported positive effects for various outcomes including posttraumatic stress disorder caseness and posttraumatic stress symptoms, depression, anxiety, and functioning. Conclusions Reflecting the difficulty mounting services and conducting research in the early post-disaster phase, this descriptive analysis of the research on early child disaster mental health interventions revealed a dearth of studies but also the successful implementation of a number of interventions.
... These reactions are consistent with other research (Field et al., 1996;Flynn & Nelson, 1998;Osofsky et. al., 2009) that found preadolescents and adolescents may exhibit symptoms after disasters such as withdrawal, isolation, numbing, depression, sadness, refusal to do chores, antisocial behavior, decreased school performance, sleep disturbances, loss of interest in hobbies, increased risk-taking behavior, conduct problems and substance abuse. ...
... The available literature on disasters and their impact on children and adolescents indicated that this population reacts to trauma in a similar manner to adults (Field et al., 1996;Shaw et al., 1996;Warheit et al., 1996). Some studies (Cohen et al., 1996;Kirk & Madden, 2003) revealed that a large proportion of children and adolescents experience serious psychological distress after major natural disasters such as hurricanes. ...
... This is consistent with other research (Baggerly & Exum, 2009, Field et al., 1996Flynn & Nelson,1998) reporting that after natural disasters pre-adolescents and adolescents may exhibit symptoms such as withdrawal, isolation, numbing, depression, sadness, refusal to do chores, antisocial behavior, decreased school performance, sleep disturbance, loss of interest in hobbies, increasing risk taking behavior, conduct problems and substance abuse. ...
Article
Hurricane Katrina ripped through Louisiana and the Gulf Coast in late August 2005. This devastating storm left thousands of people homeless and forever changed the lives of those who lived in these areas. Adolescents in the storm-impacted areas continue to be affected by life events brought about by this natural catastrophe. Many adolescents moved to another parish or state and started a new school, and many students reported attending multiple schools. Adolescents lost possessions and friends, and many continue to experience grief and loss issues related to Hurricane Katrina. Family job loss and associated financial hardship added to the already complex lives of adolescents who were navigating their way through high school and dealing with day-to-day teenager stress. This paper reviews the research on natural disasters and the impact of Hurricane Katrina on adolescent psychological adjustment and adaptation. The results from this study indicate there is a statistically significant correlation between hurricane impact and mental health. The data shows that the students who experienced the most mental health issues such as Generalized Anxiety Disorders, post traumatic stress disorder, major depression, and eating disorder were in the evacuation group who returned to St. Tammany parish within 30 days after the hurricane. The data indicates that students relied primarily on parents and friends to help them adapt and adjust after the hurricane. This dissertation will help those who work with adolescents to better understand how they adapt and adjust after a major natural disaster.
... 49,50 Anxiety and depression State anxiety was significantly reduced following MT compared to a control group. 40,42,43,47,51 These studies examined participants who were either in labour, undergoing a bone marrow transplant, depressed adolescent mothers, depressed pregnant women, or elderly institutionalised patients. Hattan et al. 44 compared foot massage with relaxation following cardiac surgery, and this was the only study that did not include MT of the back and neck. ...
Pain above the injury level is predominantly musculoskeletal in origin and involves the structures of the upper extremity that must assume increased mobility and weight-bearing stresses in performance of transfers and wheelchair propulsion. This article discusses the recognition, diagnosis, and management of painful issues of the shoulder, elbow, wrist, and hand. A brief discussion is presented on pain entities that are familiar to pain treatment centers but possibly not to other health care workers, namely chronic fatigue syndrome and facet syndrome.
... Many child disaster interventions that have been studied use multimodal, modular, and manual-guided approaches with components using social support, psychoeducation, construction of a trauma narrative, cognitive-behavioral techniques, coping skills enhancement, and problem-solving skills. These interventions have been delivered to individual children, [84][85][86][87][88][89][90][91][92] to children in small groups, 78,79,83,[93][94][95][96][97][98][99][100][101][102][103][104] or in some combination of individual and group sessions. 105,106 Two studies in which children were randomized to individual or group administration of the same intervention showed no difference in outcomes, 86,107 although in 1 study, children assigned to the group approach were more likely to complete the intervention. ...
Article
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This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
... Other interventions were administered and studied with less frequency, as the treatment or control condition in clinical trials. These included psychodynamic therapy (e.g., Gilboa-Schechtman et al. 2010), play therapy (e.g., Shen 2002), hypnosis (e.g., Lesmana et al. 2009), massage (e.g., Field et al. 1996), and novel techniques (e.g., Sadeh et al. 2008). ...
Article
Objective: The purpose of this review is to describe interventions used with children who are exposed to disasters and terrorism and to present information about the potential benefits of these interventions. Methods: A literature search conducted in January 2013 using relevant databases and literature known to the authors that was not generated by the search yielded a total of 85 studies appropriate for review. Results: Intervention approaches used with children exposed to disasters and terrorism included preparedness interventions, psychological first aid, psychological debriefing, psychoeducation, cognitive behavioral techniques, exposure and narrative techniques, eye movement desensitization and reprocessing, and traumatic grief interventions. The investigation of these interventions is complex, and studies varied in methodological rigor (e.g., sample size, the use of control groups, outcomes measured). Conclusions: Given the limitations in the currently available empirical information, this review integrates the literature, draws tentative conclusions about the current state of knowledge, and suggests future directions for study.
... It has been shown that these techniques may be helpful in managing clients with mood disorders. 10,18,44 Further, a systematic review by N. H. Williams et al. 45 has shown that spinal manipulation improved psychological outcomes compared with verbal instruction alone. ...
... Although research has linked mental health to affectionate communication in general (Floyd, 2002;Floyd et al., 2005), evidence for a direct link between mental health and touch is again best extrapolated from the research on massage therapy. Experimental research has demonstrated that receiving massage improves the symptoms of depression (Field, Grizzle, Scafidi, & Schanberg, 1996), posttraumatic stress disorder (Field, Seligman, Scafidi, & Schanberg, 1996), and eating disorders (Hart et al., 2001). ...
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This article articulates the construct of affection deprivation, the condition of wanting more tactile affectionate communication than one receives. Individual- and group-level variance on the construct is investigated and its social and health correlates are identified in a survey of 509 adults from all 50 U.S. states, the District of Columbia, Puerto Rico, and 16 foreign countries. Affection deprivation shows no correlation with age and no relationship with ethnicity, but men report significantly higher average affection deprivation than women. Moreover, as affection exchange theory predicts, affection deprivation shows positive linear associations with loneliness, depression, stress, alexithymia, preoccupied and fearful avoidant attachment styles, and numbers of personality disorders, mood and anxiety disorders, and secondary immune disorders. Affection deprivation shows negative linear associations with general health, happiness, social support, relationship satisfaction, and attachment security. These findings support the claims of affection exchange theory that the provision and receipt of affection contribute to health and wellness in both mental and physical ways.
... Crianças autistas aumentaram na sua sensibilidade ao toque e atenção aos estímulos sonoros 25 . Crianças com perturbação pós-traumática de stress diminuíram os níveis de cortisol e de ansiedade, assim como a sintomatologia depressiva 26 . ...
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Resumo: Apresenta-se uma revisão da investigação desenvolvida no âmbito da massagem e da estimulação táctil-cinestésica ao bebé. Descrevem-se os estudos empíricos conduzidos no sentido de avaliar os efeitos no desenvolvimento, no bem-estar e em problemas específicos do bebé de termo e prematuro. Conclui-se a respeito do impacto positivo da massagem sobre a criança, os pais e na interacção entre ambos; nomeadamente porque beneficia dois objectivos primordiais dos cuidados de saúde do bebé prematuro: o ganho de peso e a redução dos dias de internamento em unidade de cuidados intensivos neonatais.
... 44 In some instances, the decision to administer individual intervention may be influenced by the techniques used. Certain intervention techniques, such as massage therapy, 20 necessitate individual delivery. Additionally, EMDR was typi- cally delivered in individual sessions. ...
Article
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This review summarizes current knowledge on the timing of child disaster mental health intervention delivery, the settings for intervention delivery, the expertise of providers, and therapeutic approaches. Studies have been conducted on interventions delivered during all phases of disaster management from pre event through many months post event. Many interventions were administered in schools which offer access to large numbers of children. Providers included mental health professionals and school personnel. Studies described individual and group interventions, some with parent involvement. The next generation of interventions and studies should be based on an empirical analysis of a number of key areas.
... Various forms of art and massage therapies have been employed separately or in combination with other types of interventions with acutely traumatized children. Field, Seligman, Scafidi, and Schanberg (1996) compared 8 sessions of massage therapy to a video-attention control condition provided to 60 grade school-age children within the first month after being exposed to a hurricane. Children in the massage condition experienced greater reduction in anxiety, depression, and cortisol levels, and an increase in positive feelings relative to children in the video-attention control condition. ...
Article
This chapter provides a review of basic concepts essential to understanding the nature and role of factors that may mediate or moderate the relationship between traumatic stress and a broad range of outcomes. Such intervening factors, including risk, vulnerability, protective, and resilience factors, can be conveniently accommodated within the categories of child intrinsic factors, family factors, and community ecology factors. Community-level and individual/family early interventions for children and adolescents after trauma are critically reviewed. Although many of these early interventions hold promise, a good deal more methodologically sound research using standardized measures is needed. Increase knowledge of risk, vulnerability, and resilience factors can facilitate the development of enhanced evidence-based early and intermediate interventions, clinical treatments, public policy, and trauma-informed services for traumatized children and their families across stages of recovery.
... 49,50 Anxiety and depression State anxiety was significantly reduced following MT compared to a control group. 40,42,43,47,51 These studies examined participants who were either in labour, undergoing a bone marrow transplant, depressed adolescent mothers, depressed pregnant women, or elderly institutionalised patients. Hattan et al. 44 compared foot massage with relaxation following cardiac surgery, and this was the only study that did not include MT of the back and neck. ...
This chapter aims to provide a summary of three important areas of research on pain after SCI: methodological concerns, risk factors associated with the development of pain after SCI, and the impact of pain across quality of life domains. In addition, an overview of cost-effectiveness analysis is provided. Given the increasing utilization costs associated with pain treatment, there will be an emerging interest nationally in cost-effectiveness studies as an important area of future SCI pain research.
... While effectiveness has been shown, there are no studies examining the technique alone with children in natural disasters. Finally, individual studies report efficacy of alternative treatments involving touch, such as massage (Field et al., 1996) and interaction with dolphins (Faye, 2004). While these techniques require substantial additional study, their efforts to address the physiological components of PTSD in children with alternatives to relaxation treatment deserve further attention. ...
Article
Worldwide children are impacted by natural disasters, including hurricanes, floods, tornadoes, earthquakes, wildfires, landslides and sandstorms, winter and severe storms, heat waves, volcanoes and tsunamis. School psychologists should understand natural disaster effects, such as economic loss, relocation and health concerns and mental health issues. While most children are able to cope, a significant minority develops severe symptoms and Post Traumatic Stress Disorder (PTSD). School psychologists should gain trauma mental health training through the American Psychological Association, the National Association of School Psychologists, and the International School Psychology Association. They can also be involved in school and community prevention, mitigation and educational programming. This article presents an overview for school psychologists of the literature on children in natural disasters.
... 49,50 Anxiety and depression State anxiety was significantly reduced following MT compared to a control group. 40,42,43,47,51 These studies examined participants who were either in labour, undergoing a bone marrow transplant, depressed adolescent mothers, depressed pregnant women, or elderly institutionalised patients. Hattan et al. 44 compared foot massage with relaxation following cardiac surgery, and this was the only study that did not include MT of the back and neck. ...
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Spinal cord injury results in global damage which has broad health and psychosocialramifications. Living with this injury is known to be associated with chronic secondaryconditions such as chronic pain, elevated levels of anxiety, increased prevalence offatigue, high risks of infections, and elevated risks of mood disorder. This chapter willdiscuss the efficacy of relaxation strategies such as massage, progressive musclerelaxation and hypnosis for managing these secondary conditions. Implications for futuretrends in rehabilitation are discussed.
... Stress management strategies used in child disaster interventions include meditation [24,52], massage [53], hypnosis [54], traditional relaxation and breathing techniques [24,27,55,56], other exercises to enhance children's awareness of their bodies [24,26,27,55,56], and other culturally informed approaches [57,58]. For example, a recent controlled trial found an intervention composed of five mind-body techniques reflecting local practices and customs beneficial in reducing PTSD reactions relative to a non-treatment control in junior high school students in Indonesia exposed to a volcanic eruption [58]. ...
Article
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Opinion statement The field of child disaster mental health has seen remarkable growth over the last several decades, and awareness of the needs of children in the context of disasters has translated into the creation and evaluation of multiple interventions. The sheer volume of intervention studies and the systematic attention to examining the evidence base are impressive. Many different types of interventions have been used with children and adolescents including preparedness interventions, psychological first aid, debriefing, psychoeducation, cognitive behavioral interventions, exposure and trauma narratives, eye movement desensitization and reprocessing (EMDR), stress management, traumatic grief interventions, and medication management. Other approaches warrant attention especially those that incorporate culturally informed practices. The evidence suggests that intervention is superior to no intervention with the strongest support for cognitive behavioral interventions. Until additional comparative studies are conducted, however, it is premature to declare one intervention approach superior to others. The evidence supports preparedness interventions for resiliency building and enhancing safety response, but studies are needed to assess the effect of these interventions on self-protection activities during an event. In the acute post-disaster phase, psychological first aid is currently endorsed albeit based on minimal evidence suggesting the need for documentation of outcomes and additional study. Over the course of recovery, decisions about what interventions to use should consider and reflect the time since the event, the exposure and experiences of the children being served, the venue for service delivery, and the training of providers. Studies have not dismantled interventions to determine which components and/or common factors are responsible for benefit. Given the need to augment the evidence base, rigorous evaluation is recommended for all interventions.
... As with premature infants, massage is the form of nurturing touch most commonly studied. This has been found to decrease anxiety, stress hormone secretion and improve the well-being of traumatised children (Field, et al., 1996). For these reasons it is used in some treatment protocols for maltreated children (Perry, 2006). ...
Article
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It is advantageous for children in foster care to have caregivers who are strongly attached to them. However, foster parents may have difficulty attaching to the children placed in their care because they fear the grief that they will feel if a child is removed. The parents of premature babies are another group who may face difficulty attaching to their children owing to the fear of loss. Research has found that parent–premature infant attachment can be assisted via the promotion of close proximity and nurturing touch, aiding parents to interpret their child’s cues and understand their needs, and through providing caregiving. These findings may be applied to foster parenting and provide guidance in the methods by which foster parent-to-child attachment can be promoted. While foster parents who attach to their foster children will grieve if children leave their care, the careful facilitation of moves, providing feedback on children’s well-being and offering support through the grieving process will assist them to retain an ability to attach to subsequent foster children and to continue fostering.
... Nylig er det påvist at barn opplever en klar nedgang i fysisk kontakt fra foreldrenes side må en familie rammes av en traumatisk hendelse (Field, Seligman & Scafidi, 1996 Man kan også som Field og medarbeidere (1996) foreslår, la laerere instruere elever til å gi slik massasje til hverandre. I tillegg kan foreldre oppfordres til å gi mer fysisk kontakt til sine traumatiserte barn, f.eks. ...
Article
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Traumatized children struggle with intrusive images and thoughts, avoidance reactions and hyperarousal. Different practical guidelines and tools for helping children with these problems,are outlines. Several methods,are described such
... Although there are few studies about how to achieve the psychological ''calming'' of people in acute situations, it is well known clinically that the presence of caring helpers or members of the social network (family and friends), and adequate provision of information, has this effect. Physical contact also has a calming effect, although the beneficial impact of this largely has been demonstrated during the follow-up period for children (Field, 2006;Field, Seligman, Scafidi, & Schanberg, 1996). The following clinical example may illustrate the benefit of physical contact: ...
Article
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It is has been argued that early interventions for individuals, groups or others affected by traumatic events should not be routinely offered as there is the danger of causing more harm. The notion of “watchful waiting” has been espoused in clinical guidelines for the assessment and treatment of posttraumatic stress disorder (PTSD). Instead, a more proactive early intervention is suggested for potentially traumatic events that have the potential to lead to high psychic distress, PTSD, or complicated grief reactions for a significant number of those affected. This involves providing strategies tailored to the needs of these individuals and families and not providing conventional individual therapeutic interventions. Early intervention is wise as recent research has demonstrated that early misconceptions and negative appraisals about one's own reactions to a trauma can be significant in the development and maintenance of posttraumatic reactions and early intervention may help in forming adequate appraisals, thus counteracting misunderstandings and misperceptions. Adopting a “watchful waiting” approach with individuals and families has the potential to hinder and impede their longer-term coping responses. Recent advances, especially in the field of memory research, have implications for early interventions. We present recent findings, which make the case for early interventions following exposure to traumatic events.
... 49,50 Anxiety and depression State anxiety was significantly reduced following MT compared to a control group. 40,42,43,47,51 These studies examined participants who were either in labour, undergoing a bone marrow transplant, depressed adolescent mothers, depressed pregnant women, or elderly institutionalised patients. Hattan et al. 44 compared foot massage with relaxation following cardiac surgery, and this was the only study that did not include MT of the back and neck. ...
The US Congress faces a host of health issues that demand immediate attention. Many of these issues are of considerable importance to those persons with spinal cord injury (SCI), including the rising cost of health care and health insurance, the current budget shortfalls facing state governments, and the need for a Medicare prescription drug program. Persons with disabilities are becoming increasingly dependent on public forms of insurance, like Medicare and Medicaid, and are bearing a disproportionate share of service curtailment. Other issues relevant to persons with disabilities and health care providers are prospective payment reimbursement implementation for rehabilitation, the reauthorization of the Rehabilitation Act, and the New Freedom Initiative. Considering the political climate and the importance of such issues, the need for advocacy among professionals and consumers is greater than ever.
... Following Hurricane Andrew, children who had experienced the eye of the hurricane showed posttraumatic stress disorder symptoms [36]. Following one month of daily massages, they had fewer PTSD symptoms including less depression, anxiety, and sleep disturbance. ...
Article
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This narrative review on pediatric massage literature from the last decade suggests that massage therapy has positive effects on several pediatric conditions. These include preterm infant growth, psychological problems including aggression, gastrointestinal problems including constipation and diarrhea, painful conditions including burns and sickle cell, muscle tone disorders including cerebral palsy and Down syndrome, and chronic illnesses including diabetes, asthma cancer, and HIV. Potential underlying mechanisms for the massage therapy effects include increased vagal activity and decreased stress hormones. Limitations of the literature include the need for more randomized controlled trials, longitudinal studies, and underlying mechanism studies.
... (10) In a recent survey of US veterans returning from deployment in Iraq and Afghanistan, over 40% reported using CAM in the last 12 months, with massage therapy as the most common CAM treatment modality at 21%. (11) Studies suggest massage therapy (MT) may be able to reduce some symptoms of PTSD such as irritability, anxiety, depression, and tension. (12,13) Massage therapy for sleep symptoms related to PTSD have not been studied in this population. (14) While the mechanism for these effects is not clear, MT has been linked to changes in neurotransmitter levels, such as cortisol, serotonin, and dopamine, which control psychological arousal. ...
Article
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Background: Post-traumatic stress disorder (PTSD) is a common mental health diagnosis in Canada with prevalence estimated at about 2.4% in the general population. Previous studies have suggested massage therapy may be able to reduce the symptoms of PTSD. One of the symptoms commonly experienced is difficulty falling or staying asleep. No previously published massage therapy research has specifically assessed sleep symptoms of PTSD. Objectives: The research question was, "For individuals who have PTSD as a result of experiencing traumatic events, does MT have an effect on sleep quality?" Methods: A prospective series of case reports describing 10-week MT treatment plans provided by Registered Massage Therapists at Sutherland-Chan Clinic's Belleville location. Three individuals with PTSD were recruited using promotional posters in the community. Treatment focused on improving sleep quality and followed a pragmatic treatment protocol using light to moderate pressure. Outcomes were measured using a sleep diary, Pittsburgh Sleep Quality Index, and the Leeds Sleep Evaluation Questionnaire. Results: Data collected at baseline and throughout the series showed inconsistent improvement and worsening of symptoms amongst participants. Treatment was well tolerated and attended. No harmful incidents were noted. Conclusion: For these participants, MT did not predictably impact sleep quality. It is possible, as the underlying cause of poor sleep quality was unlikely resolved, the participants did not have a significant change in their sleep quality. This differs from findings of previous studies in which MT improved sleep for patients with poor sleep quality due to exposure to traumatic events. There is need for further understanding of how MT affects sleep.
... For example, in an intervention study for the children who were referred to school counselors due to behavior problems in school after Hurricane Andrew, the children who received massage therapy showed significant reduction in their level of anxiety, depression, and stress compared to the video attention control group. 1 According to the review of the massage therapy research, the effect of massage therapy is promoting growth, decreasing depression and aggression, enhancing attentiveness, reducing pain, and improving immune function. 2 Another leading researcher of massage/touching, Kerstin Moberg 3 listed the following effects of touch: lowering blood pressure, pulse rate, and level of stress hormones, promoting health, making children calmer, socially more mature, and less aggressive, and having less physical complaints. ...
... Additionally, even though prior research shows the very strong benefits of touch on stress disorders (Field, Seligman, Scafidi, & Schanberg, 1996), Lukoff and Strozzi-Heckler (2017) argue that helping veterans, in particular, to obtain the healing benefits of human touch is especially difficult because of problems of distrust from traumatic military experiences, and so it's especially important to find gentle introductions to touch. Touch may seem antithetical to military culture; however, 14% of active military report using massage therapy compared to 8.3% of civilians (Goertz, et al., 2013). ...
Article
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Prior research has shown that there are several symptoms of Post-Traumatic Stress Disorder (PTSD) that are persistently hard to treat and critically important for full recovery. Community reintegration can be an especially challenging aspect of returning home from combat duty. The purpose of this study was to test the effects of a community dance program on some of these psychological symptoms. Community dance has been shown to strengthen cognitive plasticity which is often a problem for veterans with PTSD. This program also includes predictable gentle touch and family involvement, two elements that can predict stress reduction and successful community reintegration in those with PTSD. Before and after each ten-week community dance program, seventeen veterans and accompanying family members were measured on connectedness using the Interpersonal Needs Questionnaire, Revised (INQ-R) (Van Orden, Witte, Gordon, Bender, & Joiner, 2008), experience avoidance using the Acceptance and Action Questionnaire, Version 2 (AAQ-II) (Bond, et al., 2011), and hope and optimism using a modified Life Orientation Test, Revised questionnaire (LOT-r) Scheier, Carver, & Bridges, 1994), combined into a wellness score. Each ten-week program consisted of weekly, 90-minute community dances with live music and a nationally recognized dance caller. We found improvements in wellness scores for all participants, regardless of PTSD status, partial h 2 =0.52. We think this program, and programs like it, show great promise in treating some of the most persistent symptoms of PTSD in veterans and in their families.
... 49,50 Anxiety and depression State anxiety was significantly reduced following MT compared to a control group. 40,42,43,47,51 These studies examined participants who were either in labour, undergoing a bone marrow transplant, depressed adolescent mothers, depressed pregnant women, or elderly institutionalised patients. Hattan et al. 44 compared foot massage with relaxation following cardiac surgery, and this was the only study that did not include MT of the back and neck. ...
Secondary conditions following spinal cord injury have been well described in the literature and have a documented impact on morbidity and mortality. Many of these conditions are potentially preventable and/or amenable to treatment, with the best outcome in the latter case when treatment is applied early. An epidemiologic approach to secondary conditions attempts to identify factors that can be used to develop risk models for their development, which in turn can be useful to clinicians for monitoring, early identification, and treatment. In this article, we review the literature describing risk factors for five major secondary conditions (chronic pain, respiratory complications, urinary tract infections, pressure sores, and depression) and offer suggestions for clinical monitoring and research.
... One of the few published studies to explicitly examine the effects of massage therapy on alleviating posttraumatic stress was conducted by Field and colleagues [10]. Sixty children (aged 6 to 11) with classroom behavior problems after Hurricane Andrew in the USA were randomly assigned either to a massage group or to a control group. ...
... Massage therapy has found to be an effective intervention; however, further studies are needed to determine if the positive effects last once massage therapy has concluded. 138 Play therapy has been found to be effective in reducing traumatic symptoms in children after a hurricane. 139 ...
... Seven articles focused on accidents or sudden loss of a loved one were excluded [16][17][18][19][20][21][22]. Finally, 19 were excluded due to a lack of outcome data on PTSD, missing appropriate numerical outcome data required to calculate effect sizes for analysis (i.e., means, standard deviations), and/or if consisted of treatment description only [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41], thus yielding 25 studies. Finally, one study was excluded as an outlier (Cohen's d>3.5) [42]. ...
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Although many post-disaster interventions for children and adolescent survivors of disaster and terrorism have been created, little is known about the effectiveness of such interventions. Therefore, this meta-analysis assessed PTSD outcomes among children and adolescent survivors of natural and man-made disasters receiving psychological interventions. Aggregating results from 24 studies (total N = 2630) indicates that children and adolescents receiving psychological intervention fared significantly better than those in control or waitlist groups with respect to PTSD symptoms. Moderator effects were also observed for intervention package, treatment modality (group vs. individual), providers' level of training, intervention setting, parental involvement, participant age, length of treatment, intervention delivery timing, and methodological rigor. Findings are discussed in detail with suggestions for practice and future research.
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This article reviews and summarizes existing research that has examined treatment outcome with traumatized children. Methodological challenges in this line of research are addressed. Additionally, there is a review of types of treatment study designs as well as the kinds of treatment that have been used with traumatized children. Treatment studies for children exposed to specific stressors—including disaster situations, school and community violence, severe medical conditions, war, sexual and physical abuse, and domestic violence—are summarized and critiqued. Major findings are that (a) no single treatment approach will likely be applicable for all traumatized children as this population presents with a diversity of emotional and behavioral difficulties, (b) research on abused children has accumulated the greatest amount of empirical treatment outcome data for traumatized children, and (c) cognitive-behavioral therapy has been demonstrated in several recent empirically sound studies to be effective in treating traumatized children. Implications from these findings for clinical practice, research, and public policy are addressed.
Article
This article reviews the four major components of trauma-focused cognitive behavioral therapy (CBT) for children and adolescents: exposure, cognitive processing and reframing, stress management, and parental treatment. For each component, background, description, and the current empirical support for including each of these components in the treatment of traumatized children is presented. Although there is growing empirical support for the efficacy of traumafocused CBT in decreasing psychological symptomatology, there are inadequate data to indicate the relative contribution of the individual CBT components. Suggestions for future clinical and research directions are also discussed.
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Thirteen adolescents with Attention Deficit Hyperactivity Disorder (ADHD) participated in Tai Chi classes twice a week for 5 weeks. Teachers rated the children's behaviour on the Conners Scale during the baseline period, after the 5 week Tai Chi session period and 2 weeks later. After the 10 Tai Chi sessions the adolescents displayed less anxiety, improved conduct, less daydreaming behaviours, less inappropriate emotions, and less hyperactivity. These improved scores persisted over the 2-week follow up (no Tai Chi period).
Article
This review of child disaster mental health intervention studies describes the techniques used in the interventions and the outcomes addressed, and it provides a preliminary evaluation of the field. The interventions reviewed here used a variety of strategies such as cognitive behavioral approaches, exposure and narrative techniques, relaxation, coping skill development, social support, psychoeducation, eye movement desensitization and reprocessing, and debriefing. A diagnosis of posttraumatic stress disorder (PTSD) and/or posttraumatic stress reactions were the most commonly addressed outcomes although other reactions such as depression, anxiety, behavior problems, fear, and/or traumatic grief also were examined. Recommendations for future research are outlined.
Article
In this review empirical data are presented on the use of touch therapy, specifically massage therapy for improving the clinical course of several conditions including growth and development of pre-term infants, reducing pain, increasing attentiveness, diminishing depression, and enhancing immune function. Potential underlying mechanisms for the massage therapy effects are proposed for each of these conditions. The general effect appears to derive from the stimulation of pressure receptors and the ensuing increase in vagal activity and slowing physiology which in turn facilitates a more relaxed behavioural state, effects a decrease in stress hormones, most particularly cortisol, and an increase in immune function, particularly natural killer cells.
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Health psychology represents a context within which massage therapy research, education, and practice can be positioned for the mutual benefit of both. Furthermore, complementary and alternative medicine (CAM) more often than not plays a mediating role in relating massage therapy to health psychology. On occasion, though, the linkage between health psychology and massage therapy can be quite direct without the mediating influence of CAM. This paper, accordingly, advances a conceptual model via both flowchart and Venn diagram displays for viewing the health psychology context for massage therapy with the possibility of CAM as a mediating factor. Attention is also given to the broad range of issues constituting contemporary health psychology as well as its correspondence to an equally diverse array of client populations and health conditions addressed in massage therapy research. Future directions in the areas of health psychology, CAM, and massage therapy are proposed with a view toward a mutual and reciprocal benefit accruing to these behavioral and health science arenas.
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Durch zwischenmenschliche Berührungen u. a. in Form von Massagen können verschiedenste physiologische Prozesse in Gang gesetzt werden. Zum Beispiel können Entspannungsmassagen Depression, Angst und Fatigue reduzieren, Schlaf verbessern, Stress abbauen, Blutzucker und Blutdruck senken und das Immunsystem regulieren. Die Befunde sind im Einklang mit Erkenntnissen der Psychoneuroimmunologie und Psychoneuroendokrinologie. Aus diesen Fachgebieten ist bekannt, dass Psyche und Nervensystem sowohl mit dem Immunsystem als auch dem Hormonsystem in Wechselwirkung stehen. Kurz gesagt bedeutet das, dass Veränderungen in einem der Systeme, Veränderungen in allen anderen Systemen nach sich ziehen. Daraus ergeben sich vielfältige Einsatzmöglichkeiten von zwischenmenschlichen Berührungen und Massagen als unterstützende Therapiemethode im Krankheitsfall. Außerdem in diesem Kapitel: Gewichtsdecken/ Sandwesten; Kontraindikationen und Nebenwirkungen von Massagen
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This Practice Parameter reviews the evidence from research and clinical experience and highlights significant advances in the assessment and treatment of posttraumatic stress disorder since the previous Parameter was published in 1998. It highlights the importance of early identification of posttraumatic stress disorder, the importance of gathering information from parents and children, and the assessment and treatment of comorbid disorders. It presents evidence to support trauma-focused psychotherapy, medications, and a combination of interventions in a multimodal approach.
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Increasing numbers of patients use complementary and alternative medical therapies. Use is particularly common in those with chronic diseases such as asthma and cystic fibrosis. Patients and families typically seek such therapies to relieve symptoms and to know they have explored all reasonable, safe options. Abandoning conventional therapies is rare when physicians support families' values and goals. At the Children's Hospital in Boston, massage and acupuncture have become standard treatments for patients admitted to hospital with cystic fibrosis. Our experience and clinical studies support the use of both massage and acupuncture to help decrease pain, anxiety, and dyspnea and to improve sleep in patients with chronic lung disease. Awareness of existing data may enhance availability and provision of acupuncture and massage services for appropriate patients. Additional research is needed to determine the optimal type, timing, duration, and frequency of these services in combination with standard therapies for patients with chronic pul-monary conditions. A sthma is the most common chronic pulmonary disease affecting both adults and children, causing considerable morbidity. The prevalence of asthma appears to be increasing worldwide at a rate of approximately 50% per decade. Nearly 80% of patients report disease onset prior to 6 years of age. 1 Cystic fibrosis (CF) is the major cause of severe chronic lung disease in children, occurring in 1 of 400 births in Brittany to 1 of 90,000 Asian infants in Hawaii. 1–3 The focus of this review is the use of massage and acupuncture to treat patients with chronic pulmonary disease, especially pediatric asthma and CF. It does not cover other therapies such as herbs, dietary supplements, biofeedback and relaxation therapies, breathing exercises, chiropractic, or homeopathy which have been reviewed elsewhere. 4 –10
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Touch is one of the most essential elements of human development, a profound method of communication, a critical component of the health and growth of infants, and a powerful healing force (Bowlby, 1952; Harlow, 1971, 1986). Ample research has demonstrated that tactile stimulation is extremely important for development and maintenance of physiological and psychological regulation in infants, children and adults (Field, 1998, 2003; Montagu, 1971, 1986). Touch has been an essential part of ancient healing practices. Touch has roots in shamanic and religious practices, and is reported to have been an integral part of health care practices and medicine since their emergence from the realms of religion and magic (Levitan & Johnson, 1986; Smith, Clance & Imes, 1998).
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INTRODUCTION Disasters affect many lives and reshape environments for years to come. This chapter aims to provide closing remarks about the evidence provided in this book, on what is known and not known about the impact of disasters on mental and physical health, the differential risk of certain populations and communities, and the determinants of vulnerability and resilience. We also look at lessons learned to date about intervention strategies that mitigate the mental health consequences of these events. Finally, we provide clear recommendations about critical gaps in knowledge and ways to address them going forward. EXPOSURE The mental health impact of disasters is strongly related to the scope of the disaster itself. In this book, Norris and Wind (Chapter 3) systematically review a host of factors that typically comprise exposure in disasters and categorize them into three groups: (1) traumatic stressors, such as loss of life, threats to life, injury, witnessing and horror; (2) loss of property, finances, or other resources, which may often follow floods, hurricanes, and fire; and (3) ongoing adversities, from lack of housing, displacement, and relocation to chronic stress. These potentially are involved in the development and persistence of mental and physical health outcomes, as well as in resilience and recovery processes (see Part Two and Three). Importantly, a large body of research has documented the effects of indirect exposure to disasters, challenging previous definitions of exposure and leading to scientific debate about the accuracy of such findings and their meaning.
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In this volume, Kathleen Nader has compiled an articulate and comprehensive guide to the complex process of assessment in youth and adolescent trauma. There are many issues that are important to evaluating children and adolescents, and it is increasingly clear that reliance on just one type of assessment does not provide the most accurate results. From history to recent advances, this book covers a wide range of methods and measures for assessing trauma, including case examples to illustrate the integration of these different facets. Altogether, the broad scope and inclusive depth of this work make it an essential addition to the field of trauma assessment.
Article
These practice parameters review the current state of knowledge about posttraumatic stress disorder (PTSD) in children and adolescents. The parameters were written to aid clinicians in the assessment and treatment of children and adolescents with PTSD symptoms. A literature search and extensive review were conducted in order to evaluate the existing empirical and clinical information in this regard. Expert consultation was also solicited. The main findings of this process were that a wide variety of stressors can lead to the development of PTSD symptoms in this population; that the specific PTSD symptoms manifested may vary according to the developmental stage of the child and the nature of the stressor, and for this reason, the diagnostic criteria for PTSD in adults may not adequately describe this disorder in children and adolescents; that several factors seem to mediate the development of childhood PTSD following a severe stressor; and that most of the therapeutic interventions recommended for children with PTSD are trauma-focused and include some degree of direct discussion of the trauma. Controversies and unresolved issues regarding PTSD in children are also addressed.
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Complementary and alternative medicine (CAM) is now a highly visible feature of contemporary health care. No longer restricted to the lay sector and the medical fringe, CAM practices can be found in conventional care settings. They are widely and increasingly being subject to research and there is now good evidence that at least some techniques are potentially effective. In the United States, as in other countries of the developed world, many millions of patients spend billions of dollars each year on CAM.
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Możliwości zastosowania technik tkanek miękkich w zmniejszaniu poziomu lęku a poziom optymizmu Streszczenie Optymiści mają bardziej pozytywną reakcję na interwencje medyczne oraz za-chowania promujące zdrowie, a jeżeli dochodzi do choroby, to bardziej wytrwa-le stosują się do rad lekarzy, realizując wzory behawioralne służące poprawie zdrowia. Celem eksperymentu było zbadanie, czy u pacjentów o optymistycz-nym stylu wyjaśniania w większym stopniu obniży się lęk po zastosowaniu za-biegów: masażu ogólnoustrojowego (eksperyment I) oraz masażu miejscowe-go (eksperyment II). Przeprowadzono łącznie dwa niezależne eksperymenty, w których wzięło udział 57 osób z dolegliwościami bólowymi w wyniku zaburzeń czynnościowych narządu ruchu. W eksperymencie I wzięło udział 30 pacjentów w przedziale wiekowym 35–65 lat (M= 54,6; SD=8,94). W eksperymencie II na-tomiast 27 pacjentów w przedziale wiekowym 23–69 lat (M=42,65;SD=13,4). W badaniu wykorzystano dwa kwestionariusze: Kwestionariusz Stylu Atry-bucyjnego (ASQ) oraz Kwestionariusz STAI. W przeprowadzonych badaniach wykazano, iż poziom lęku jako stanu u optymistów obniża się zarówno po za-stosowaniu masażu ogólnoustrojowego, jak i po zastosowaniu jednorazowej terapii docelowej. Stwierdzono także, że optymizm zależny jest od płci i wieku respondentów. Badania pokazują, że docelowo warto skupić się na psychotera-pii pozytywnej zmieniającej osoby z pesymistów w optymistów. Jednocześnie autorzy pracy zastrzegają, że skuteczność psychoterapii musi zostać zweryfiko-wana przez obiektywne badania kliniczne. Słowa kluczowe: optymizm, lęk, masaż ogólnoustrojowy, masaż miejscowy Abstract Optimists have a more positive response to medical interventions and health-promoting behaviors. Especially in difficult situations like suffering from disease. The aim of the experiment was to investigate if patients with opti-139
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This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior.
Article
The purpose of this study was to evaluate the benefits of peer massage for primary school children. A short peer massage routine was taught to pupils in five schools and evaluation was carried out to assess the impact that the process had on the pupils’ well-being, empathy, social skills and confidence. The impact of the intervention was measured by analysis of self-reported data from the pupils using a specifically designed evaluation tool. These results were compared to results from control groups in the same schools who were not involved in the daily massage. Class teachers evaluated the impact that the process had on the pupils and commented on the relationship between massage and subsequent behaviour and performance at school. In the area of well-being, the results for the massage group showed that they felt calmer and less worried than the control group. In the area of confidence, the children receiving massage clearly felt more confident in talking to children they did not know. These changes were supported by the teachers’ evaluations and comments; improved concentration in class was also noted. A less conclusive picture emerged in the social skills and empathy sections. This may suggest that the biggest impact of the programme was the way in which the process was internalised by the children. Feeling calmer, less worried and having more confidence can have a huge impact on the ability to develop lifelong coping strategies for managing the stresses and difficulties that life can bring and maintaining good mental health.
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Objective Trauma exposure is common in preschool children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO: CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children. Method Literature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age less than 6.5 years, and PTSD was assessed using standardised interviews at least one-month post-trauma. Information on sample characteristics, trauma-exposure, PTSD measurement and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis. Results Eighteen studies were included (N=1941). Pooled PTSD prevalence was 21.5% (95% CI 13.8 – 30.4%) when using the most developmentally appropriate diagnostic algorithm that was available. When focusing on the subset of studies that reported both standard adult criteria and age appropriate criteria (k=12), a pooled estimate of 4.9% (95% CI 2.5 – 8.0%) was obtained for standard adult criteria (DSM-IV), and 19.9% (95% CI 12.1 – 29.0%) was obtained for age appropriate criteria (PTSD-AA). Prevalence was three-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were utilised. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms. Conclusion Preschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show similar prevalence trends to older youth and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure appropriate identification and early support is provided.
Article
Preschool children received 20‐minute massages twice a week for five weeks. The massaged children as compared to children in the wait‐list control group had better behavior ratings on state, vocalization, activity and cooperation after the massage sessions on the first and last days of the study. Their behavior was also rated more optimally by their teachers by the end of the study. Also, at the end of the 5 week period parents of the massaged children rated their children as having less touch aversion and being more extraverted. Finally, the massaged children had a shorter latency to naptime sleep by the end of the study.
Article
• One hundred fifty-nine children (14.5% of the student body) were sampled after a fatal sniper attack on their elementary school playground. Systematic self-reports of posttraumatic stress disorder (PTSD) symptoms were obtained by use of a child PTSD Reaction Index. Analysis of variance revealed significant differences by exposure but not by sex, ethnicity, or age. Additional analyses were conducted of individual item response, overall severity of PTSD reaction, symptom grouping, and previous life events. The results provide strong evidence that acute PTSD symptoms occur in school-age children with a notable correlation between proximity to the violence and type and number of PTSD symptoms. Sampling at approximately one month after the trauma provided adequate delineation among exposure groups. The symptom profile of highly exposed children lends validity to the diagnosis of acute PTSD in childhood.
Article
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Article
Most of the 224 children who were survivor-plaintiffs of the Buffalo Creek disaster were emotionally impaired by their experiences. The major factors contributing to this impairment were the child's developmental level at the time of the flood, his perceptions of the reactions of his family, and his direct exposures to the disaster. The responses of children under 12 to fantasy-eliciting techniques are described and their observed behavior after the flood compared with developmental norms for their age and reports of their previous behavior. These children share a modified sense of reality, increased vulnerability to future stresses, altered senses of the power of the self, and early awareness of fragmentation and death. It is pointed out that these factors could lead to "after-trauma" in later life if they cannot make the necessary adaptations and/or do not receive special help to deal with the traumas. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Self-report data for 5,687 children ranging in age from 9 to 19 years were collected approximately three months after Hurricane Hugo devastated the rural community where the children lived. Information about the children's perceptions of hurricane severity, degree of home damage suffered as a result of the hurricane, and hurricane-related parental job loss was used to categorize children into four levels of hurricane exposure. Reports of anxiety were obtained via the Revised Children's Manifest Anxiety Scale (RCMAS) and reports of posttraumatic stress disorder (PTSD) symptoms were obtained via the Reaction Index (RI). Significantly higher anxiety scores and significantly more PTSD symptomatology was found for children experiencing more or more severe exposure to the hurricane. Girls reported more anxiety and PTSD symptoms than boys, and black children were more likely than the white children to report PTSD symptomatology. Additionally, girls were more severely affected by increasing levels of hurricane exposure as indicated by their RI scores. These results indicate that, similar to adult and child victims of crime and adult victims of disaster, the development of PTSD symptoms in children exposed to a natural disaster is a function of the degree of exposure to the traumatic event. The results also suggest that children's trait negative affectivity may moderate the effects of exposure on the development of PTSD symptoms.
Approximately 300 Italian elementary school children who were victims of a devastating earthquake were surveyed in an epidemiological study. The measure used was the Rutter Behavioral Questionnaire for Completion by Teachers. In one village a treatment program was developed and implemented. A frequency count of the expressed earthquake-related fears and anxieties was taken during every treatment session. Treatment consisted of a gradual series of steps that led to a replaying of the earthquake. It was hypothesized that the number of children shown to be at risk for developing neurotic or antisocial problems would be positively correlated with the amount of destruction in a village. This was not verified. It was also hypothesized that treatment would reduce earthquake fears and the number of children at risk. This was verified. The village where treatment was carried out for 1 academic year showed a significant drop in the at-risk scores. Conclusions were that treatment alleviates symptoms but that the number of children at risk seems to be more related to the length of time needed for the community to reorganize after the disaster.
Article
334 of over 400 children who survived the sinking of the cruise ship, Jupiter, in Athens harbour in October 1988 completed a battery of questionnaires 5-9 months later. Compared with age- and sex-matched controls, they show significantly higher scores on depression and anxiety. They also report more fears, particularly of stimuli related to the trauma. Overall, their scores on the Impact of Events Scale are as high as those reported by adults in other disasters. Follow-up studies a year after the accident reveal that nearly half the children meet the DSM-III-R criteria for PTSD. The usefulness of this screening battery is discussed. Some evidence for the effects of early intervention in schools is presented.
Article
A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. Compared with a control group who viewed relaxing videotapes, the massaged subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.
Article
This article reports highlights from over 200 parents' observations of their preschoolers' play and verbalizations in the year following Hurricane Hugo. Commonly reported activities included reenactment and discussion of the event in multiple mediums, personification of "Hugo", and expression of fears related to storms. Precocious concern for others, insight, and vocabulary were also noted. In these intact, relatively high functioning families, parents seemed able to facilitate their youngsters' adjustment without outside intervention.
Article
Psychiatric reports of 179 children aged 2 to 15 who were exposed to the Buffalo Creek dam collapse in 1972 were rated for post-traumatic stress disorder (PTSD) symptoms 2 years after the disaster. Age and gender effects and the impact of the level of exposure and parental functioning were examined according to a conceptual model addressing factors contributing to adaptation to a traumatic event. Results showed fewer PTSD symptoms in the youngest age group and higher symptom levels for girls than boys. Approximately 37% of the children were given a "probable" diagnosis of PTSD. Multiple regression analysis showed that life threat, gender, parental psychopathology, and an irritable and/or depressed family atmosphere all contributed to the prediction of PTSD symptomatology in the children.
Article
Fourteen months after a sniper attack at an elementary school, level of exposure to that event remained the primary predictor of ongoing posttraumatic stress reactions in 100 schoolchildren who were followed up. Guilt feelings and knowing the child who was killed were associated with a greater number of symptoms. Grief reactions occurred independent of degree of exposure to the event. The authors discuss the public health implications of these longitudinal findings.
Article
This longitudinal study examined the prevalence of posttraumatic phenomena and how they relate to symptomatic and behavioral disorders in a population of schoolchildren exposed to an Australian bushfire disaster. The prevalence of these phenomena did not change over an 18-month period, suggesting that they were markers of significant developmental trauma. The mothers' responses to the disaster were better predictors of the presence of posttraumatic phenomena in children than the children's direct exposure to the disaster. Both the experience of intrusive memories by the mothers and a changed pattern of parenting seemed to account for this relationship.
Article
The State-Trait Anxiety Inventory for Children (STAICj and the Children's Manifest Anxiety Scale (CMAS) were administered to 60 emotionally disturbed children and 60 normal children matched on mental age. Emotionally disturbed children obtained significantly higher scores on the A-State and A-Trait portions of the STAIC and the anxiety portion of the CMAS, while normal children obtained significantly higher scores on the Lie scale of the CMAS. Cutoff scores which maximized the discrimination between normal and emotionally disturbed children were established. Results are interpreted as demonstrating the potential usefulness of these measures for screening.
This paper describes the various traumatic components of the child abuse syndrome and explores their impact on the psychopathology, cognitive impairment, and developmental sequelae observed in abused children. The child abuse syndrome consists of two broad categories of trauma: the acute physical and psychological assault confronting the child with the threat of annihilation is superimposed upon the long-term traumatic components resulting from chronic abnormal parenting such as harsh, punitive child rearing, scapegoating, and maternal deprivation. Central nervous system impairment, which is frequently associated with child abuse, may be regarded as an additional source of trauma which potentiates the pathological impact of the acute and long-term components of the abusive environment. Most abused children exhibit the characteristic symptoms of the Post Traumatic Stress Disorder described in DSM-III.
Article
Preschool children's behavioral and physiological responses to separation were monitored before, during, and after their mothers' hospitalization for the birth of a sibling. During these 3 periods, play sessions were videotaped simultaneous with activity level and heart rate monitoring, nighttime sleep was time-lapse videotaped, and the parents were administered questionnaires on changes in their child's behaviors. Increases in fantasy play across these periods were interpreted as active coping both with the stress of separation and the altered interactions following the arrival of a new sibling. Increases in negative affect, activity level, heart rate, night wakings, and crying characterized the hospital period as one of agitation. Longer periods of deep sleep at this stage were interpreted as conservation withdrawal. Following the mother's return, decreases were noted in positive affect, activity level, heart rate, and active sleep suggestive of depression. These changes are discussed in the context of parallel data on agitation/depression during young primate separations.
Article
The Mount St Helens's ashfall provided a natural setting for the study of stress reactions to catastrophic events. Pre- and postdisaster data were collected from formal records and reports of 12 local agencies to examine the effects of disaster-related stress on mental illness and social behavior. Postdisaster data indicated a substantial increase in illness, alcohol abuse, family stress, violence, and aggression, with related adjustment problems. Data suggest that a postdisaster stress reaction, which is relatively nontransient, can occur following a catastrophe. (68 ref)
Article
Five months after a severe winter storm, a survey of children whose behavior had been assessed by means of a parent rating scale during a Head Start program 6 months before the disaster showed that some problem-behavior scores had increased significantly. The subgroups of children at higher risk were boys, whose Anxiety scale scores increased, and children accepted for Head Start only because their parents said they had special needs, whose Aggressive Conduct scale scores increased. For the entire group of children, school behavior improved. The findings support previous impressions that parents deny their children's problems after a natural disaster.
Children traumatized by witnessing acts of personal violence: Homicide, rape, and suicide behavior
  • Pynoos