Did You Know?

A condition known as Complex Posttraumatic Stress Disorder has been recognized by the World Health Organization, in its International Classification of Diseases, 11th revision. Calls to recognize complex PTSD as a distinct disorder arose from concerns that the PTSD diagnosis may not adequately capture the experiences of those exposed to repeated traumas.

Complex PTSD is recognized as typically developing after prolonged exposure to extremely threatening or horrific events such as repeated sexual or physical abuse that the child cannot escape from. Complex PTSD includes all the PTSD criteria — coupled with severe and persistent difficulties in regulating emotions, along with experiencing guilt or shame related to the trauma and challenges in sustaining relationships. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

At any given time, approximately one in a thousand children develop posttraumatic stress disorder (PTSD) after being exposed to serious adversities. In British Columbia, as many as 700 children may have PTSD at any given time. According to the 5^th edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, to receive a PTSD diagnosis, children must meet the following criteria:

• Being exposed to actual or threatened death or serious injury or sexual violence — through directly experiencing or witnessing or learning of such events
• Experiencing clinically significant problems related to the trauma that continue for a month or more and that impair the child’s functioning, including:
  • intrusive, recurrent and distressing memories or dreams or flashbacks, or intense
    psychological distress or physiological reactions
  • avoidance of associated situations, such as specific places or people
  • negative thoughts and emotions such as fear, horror, anger, guilt or shame
  • hyper-reactivity, including anger outbursts and sleep difficulties.

There are separate diagnostic criteria for children aged six years and younger — given that symptoms may differ when compared with those of older children (and adults). For example, for young children, intrusive symptoms may involve re-enacting trauma during play. For more information, see Vol. 15, No. 2 of the Children’s Mental Health Research Quarterly.

World Autism Awareness Day will be observed with a virtual event on April 2, from 7 a.m. to 10 am Pacific.

Organized in collaboration with autistic people, the event will feature people from around the world discussing how respect for neurodiversity can help overcome barriers and improve the lives of people with autism. It will also address the contributions that autistic people make – and can make – to society, and to the achievement of the United Nation’s sustainable development goals.

The event is organized by the UN, in collaboration with the Swiss-based Institute of Neurodiversity, an organization established and run by neurodivergent people for neurodivergent people and their allies.

Autism spectrum disorder refers to a group of complex neurodevelopment disorders. They are characterized by repetitive patterns of behaviour and difficulties with social communication and interaction. The symptoms are present from early childhood.

The event will be streamed on the UN’s YouTube and Twitter channels.

The International Day for the Elimination of Racial Discrimination — marked this year on March 21 — is observed annually on the day the police in Sharpeville, South Africa, opened fire and killed 69 people at a peaceful demonstration against apartheid “pass laws” in 1960.

Since then, the apartheid system in South Africa has been dismantled. But many people continue to suffer from the injustice and stigma brings — even in countries like Canada. This point is brought home by the annual day, which was instituted by the General Assembly of the United Nations in 1979

In the vol 15 no 3 issue of the Children’s Mental Health Research Quarterly we examine racism. We discuss the impact it has on children and we evaluate interventions designed to reduce it.

Even one child being exposed to serious avoidable adversities is one too many. This is particularly true given that there are effective approaches that can reduce children’s exposure to these adversities. Yet when traumatic events have occurred, there are still many ways to help children. The Children’s Health Policy Centre makes four recommendations to help children better cope with trauma:

1. Intervene before mental health symptoms develop. Even after children have experienced a serious adversity such as maltreatment, it is possible to prevent mental health symptoms from developing — and adding further to their distress and burdens. The program Fostering Healthy Futures prevented emotional problems and reduced the need for future mental health interventions for children in foster care. Multisystemic Therapy reduced mental health concerns for children involved with protective services but still living with their parents. And the program It’s My Turn Now helped children who had been exposed to intimate partner violence. Helping parents develop new skills to support their children was a component of these latter two programs.
2. Consider other effective interventions for preventing behaviour problems and substance use. Among the four interventions included in our systematic review, none showed evidence of success in preventing common difficulties associated with childhood trauma, such as problematic behaviour or substance use. But both these challenges can be prevented by using other proven psychosocial interventions, including parent training programs to prevent behaviour problems and Preventure to prevent problematic substance use.
3. Implement prevention programs before maltreatment occurs. The ideal approach is to
   prevent exposure to avoidable serious adverse experiences such as child maltreatment. Prevention also recognizes children’s rights — to safety and to having their basic needs met. Yet Canadian data from 2008 identified more than 236,000 child maltreatment investigations, with approximately 36% of these cases being substantiated. Practitioners can play an important role in prevention by delivering effective parenting programs, including programs that can reduce child injuries.
4. Enact policies to reduce socio-economic disparities. The link between a major
   form of trauma — child maltreatment — and socio-economic disadvantage is well
   So successful prevention also likely involves addressing this larger
   societal issue. Other countries have made progress. For example, Denmark, Finland,
   Iceland and Norway have successfully reduced socio-economic disparities through
   long-standing social programs that redistribute income. Canada can follow suit by enacting similar programs, as the federal government and some provinces and territories have done in recent years. For more information, see Vol. 15, No. 1 of the Children’s Mental Health Research Quarterly.

Critical incident debriefing (or simply debriefing) typically involves a single-session intervention where participants describe their experiences very soon after witnessing or being a victim of a traumatic event and then discuss strategies for coping. While debriefing was initially designed for adults, its use with children has increased. However, the limited number of studies conducted on debriefing with children found limited or no benefit.

As well, cautions about debriefing have also emerged from adult studies. This includes some studies finding adverse events, such as increased long-term distress. Given almost no evidence of benefits, coupled with the potential for harm, debriefing should not be used with children unless better studies emerge showing positive results.  For more information, see Vol. 15, No. 1 of the Children’s Mental Health Research Quarterly.

The last Wednesday in February — this year, Feb. 22 — signifies a national stand against bullying. Helping children learn to self-regulate — by paying attention and inhibiting impulsivity — is an important step in reducing bullying. Parents can promote this skill by responding to their children’s needs, providing positive feedback during challenging tasks, and supporting older children and teens to be more autonomous. For more information, see Vol. 15, No. 4 of the Children’s Mental Health Research Quarterly. Titled Childhood bullying: Time to stop, the issue describes the basics of bullying and provides a review of eight bullying interventions, including five that produced some positive effects.

Indigenous communities in Canada have long displayed strength and resilience in the face of multiple adversities associated with colonialism and its legacies. These legacies have included the forced removal of children into residential schools, the multi-generational aftermath of these policies, continuing overrepresentation of Indigenous children in the child protection and youth justice systems, and ongoing exposure to individual and systemic racism.

To redress these legacies, in 2015 the Truth and Reconciliation Commission issued 94 calls to action. In particular, these calls to action address the deep social and health disparities Indigenous children and families experience in Canada — which are preventable forms of serious adversity. Reducing these adversities is essential to enable all Indigenous children to flourish.

All Canadians can support this flourishing by engaging in reconciliation. For example, we can express support for the Commission’s calls to action and call on federal and provincial or territorial governments to enact them. As well, Canadians can become aware of resources that promote wellness for Indigenous young people, such as those provided by BC’s First Nations Health Authority. For more information, see Vol. 15, No. 1 of the Children’s Mental Health Research Quarterly.

Research has emerged on factors that help young people cope with having experienced serious trauma such as the death of a loved one or witnessing a violent event. A meta-analysis that combined findings from more than 100 studies identified various factors that buffered the negative effects of experiencing or witnessing trauma. These buffers include family, peer and school support. Family support includes having a warm and accepting parent as well as a cohesive family. Peer support refers to receiving emotional and social encouragement and being satisfied with one’s friendships. School support involves having teachers and other school staff to help children and young people feel valued and safe. For more information, see Vol. 15, No. 1 of the Children’s Mental Health Research Quarterly.

A study of 2,000 Welsh and English youth at age 18, showed that young people who had faced trauma were at much higher risk of specific mental disorders. These included:

• substance use disorder (other than alcohol or cannabis) — 3.5 times higher odds
• conduct disorder — 2.3 times higher odds
• cannabis use disorder — 2.3 times higher odds
• generalized anxiety disorder — 2.2 times higher odds
• depression — 2.2 times higher odds
• attention-deficit/hyperactivity disorder — 1.9 times higher odds
• alcohol use disorder — 1.5 times higher odds.
• self-harm —3.5 times higher odds.
• attempting suicide — 5 times higher odds
• committing a violent offense — 1.5 times higher odds.

In a similar study with US youth, all traumatic exposures assessed were associated with up to double the risk for developing a substance use disorder. As well, exposure to interpersonal violence more than doubled the risk for girls developing conduct disorder. For more information, see Vol. 15, No. 1   of the Children’s Mental Health Research Quarterly.