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| Sunday, 6 February 2005 |
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Features |  |
| News Business Features Editorial
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Stress in the classroom
Q. How does trauma resulting from the tsunami affect children? A. The trauma of tsunami occurs along all sensory channels, (visual, auditory, olfactory, and tactile). Hence therapeutic modalities should be exposure based intervention that will utilize all of the child's sensory modalities sight, smell, tactile, balance, and hearing, that were a prelude to trauma. Q. How can you identify a child with PTSD in the classroom? A. Children who had experienced directly, witnessed, or heard about the tsunami, those, involved with actual or threatened death, or sustained serious physical injury to self or loved ones; children with parents missing, hurt, or dead, seen dead and maimed bodies; lost their homes, clothes, schoolbooks and all personal belongings, those with survivor's guilt, children who were at risk in addition to Tsunami stress-those with learning problems, mental disorder, previous loss, history of sexual abuse, other traumatic experience, early separation from parents, or with medical problems, and lack of social network; those with traumatic stress, who may show symptoms of fear, anger, increase alertness, anxiety, depression, extreme agitation, leading to a state of shock. Q. What are the symptoms of PTSD in children? A. Re-experiencing what happened; arousal, avoidance, other behaviors. Q. How will a child with PTSD re-experience the traumatic event of tsunami? A. 'Traumatic play' is a form of re-experiencing, seen in PTSD children in a form of repetitive acting out of trauma, or trauma related themes. * They will experience frequent memories of the event, and the event is replayed over and over again in their minds. Flash backs; * Having frightening upsetting, scary dreams, nightmares, sleep walking; * They will feel or act as if the experience is happening again; * Developing repeated emotional or physical symptoms like headaches, nausea, stomach pains, loss of appetite, diarrhoea, when the child is reminded of the event. Arousal: Anger, irritability, sudden angry outbursts, temper tantrums, sudden and extreme emotional reactions, to be nervous about the surroundings, sea, over alertness, jumping on hearing sounds, disorganised, agitated behaviour. Worrying about dying at an early age, helplessness, hopelessness. Hyper arousal with panic attacks, with extreme agitation anxiety, survivor's guilt, compulsions and obsession and depression. Avoidance: Avoiding the flow of memory, suppression, emotional numbing, unable to feel emotion and feel empty, Dissociation; like in a dream, day dreaming, feeling unreal, or outside yourself, also having blank periods that they loose interest in the surroundings, classroom work, refusal to go to schools, trying to avoid the thoughts, feelings or places and the sea that remind the child of the tsunami. Children become cold and preoccupied, so that the parents, teachers, friends and carers, will feel rebuffed. Other behaviors: Bedwetting, clinging, acting younger than their age (thumb sucking), isolation from family and friends; Delinquency, social with drawl, detachment from others. Difficulty in concentration, sleeping disturbance falling asleep or staying awake, fear of sleeping alone, sleep walking. Eating disorders, Substance abuse and alcohol, Sexual acting out, Social instability. Q. What are the risk factors? A. Age, less than 11 years are more likely to develop PTSD. Socio-economic status, negative life events, inherent coping mechanisms. Q. Is there a timeframe during which the symptoms of PTSD develop? A. Yes, generally to diagnose PTSD, the symptoms should last for more than a month, and cause impairment in a child's personal, family, academic and social life. Q. How is PTSD assessed? A. By combining findings from; observations, structured interviews, questionnaire and physical assessment (health carers). Q. How long does it take to recover from PTSD? A. The symptoms of PTSD may last from several months to many years. Some recover in six months. Some take a longer time. Once the trauma has occurred, however, early intervention is essential. Q. What factors will determine early recovery from PTSD? A. The child's inner magnitude of the trauma. This depends on: proximity of the child to tsunami, degree of emotional suffering of the child at the time of trauma and afterwards child's coping capacity which is the inherent coping mechanism "Wired" to respond to stress. Q. What is meant by a 'Resilient' Child? A. It is the ability of the child to 'spring back' from adversity. Resilience is a phenomenon that arises from the ordinary human adaptive processes. It is not necessary to possess special qualities to develop resilience. But to possess ordinary normal human resources in the mind, brain, body of children, in their families, relations, and the communities. Q. How can you identify a resilient child in the classroom? A. Child will be persistent; goal orientated; willing to interact with others; high self esteem; optimistic; intelligent; good social skills; Family support. Q. What is the course of PTSD? A. There can be periods of increased symptoms, following remissions. Q. Are there brain abnormalities seen in PTSD? A. Brain imaging studies show altered metabolites, blood flow and anatomical changes in the brain. Q. What are the Guidelines to teachers of PTSD children? A. The classroom should be a place of care for PTSD children; Identify the children at risk; Accept the children's regressed behaviours. Find time to be with the PTSD children while other children are doing independent work; provide reassurance to children, and additional emotional support. Encourage and support them to return to age appropriate routine behaviour with flexibility; encourage verbalising their emotions, and examining their reaction to the witnessed tsunami events: Allow children to tell the story in words, play or by drawing pictures. Art therapy for sad and guilty feelings; Provide opportunities and props for traumatic related play. Talk to the child about feelings, and understanding it. Acknowledge their experience, and try to normalise it. Gently discourage reliance on avoidance. Be honest with the children about what happened. Provide accurate information. But make sure it is, appropriate to the age and development. Q. How can the parents and professionals help the PTSD children? A. Early intervention; Strong physical presence, Exposure based intervention by utilising sensory based therapeutic modalities- eg; to overcome fear; use 'special imitating faces, voices, portrait make-up activities, animated cartoons which will help in systematic desensitisation. Use aroma therapy, and relaxation methods, breathing exercises, grief, anger and guilt management. Stress management therapy, meditation, meditation. Allow teachers and staff to discuss their feelings and show their emotions, and experience. Chronic infection and heart disease There appears to be a cause and effect relationship associated with persistent low grade infection and heart disease. Recent research has shown that certain micro-organisms can cause or at least are involved in the development of arterial plaque which leads to heart disease (CHD). Dr. D. P. Atukorale offers a simple inexpensive solution - use coconut oil in your daily diet. A large number of studies have reported an association between heart disease and chronic bacterial and viral infections. In 1980, scientists reported certain associations between atherosclerosis and heart disease in humans infected with a number of bacteria (e.g. Helicobacter pylori and Chlamydia Prneumoniae) and certain herpes viruses particularly cytomegalo virus. In one study Petra Saiku and colleagues at the University of Helsinki in Finland found that 27 out of 40 patients who've suffered heart attacks and 15 out of 30 men with heart disease carried antibodies released to Chlamydia which is more commonly known to cause gum disease and lung infections. Out of the subjects free of heart disease only 7 out of 41 had such antibodies. More evidence supporting the link between infections and C.H.D. showed up in early 1990 when researchers found fragments of bacteria in arterial plagues. At least one out of every two adults in developed countries have antibodies of Helicobacter pylori; Clamydia pneumonia or cytomegalovirus (CMV). The presence of antibodies does not necessarily indicate an active infections, or the presence of atherosclerosis, and this shows that infection has occurred at some time, and it is common for the above infections to persist indefinitely. The effectiveness of the immune system determines the degree of trouble the virus may cause. The weaker the immune system, the more likely an infection will hang on, and cause problems, and when those microorganisms enter the blood stream they can attack the artery wall causing low grade infection that lack any noticeable symptoms. As microorganisms colonise in artery wall, they cause damage to arterial cells. In an effort to heal the injury, blood platelets, cholesterol and protein combine in the artery wall setting the stage for plaque formation and atherosclerosis. Infection can both initiate and promote the growth of atherosclerosis in arteries which in turn leads to heart disease. The findings mentioned above suggest that at least in some cases heart disease may be treated with antibiotics. Antibiotics use is limited because they are only good against bacteria and are not useful against viruses. However, there is something that will destroy both the bacteria (Helicobacter Pylori and Chlamydia) and viruses (CMV) that are most commonly associated with atherosclerosis. The medium chain fatty acids (MCFA) in coconut oil which are known to kill three of the major types of atherogenic organisms are quite useful in the prevention of atherosclerosis. MCFA are known to kill dozens of disease causing organisms. Not only can coconut oil help protect you from the germs that cause ulcers, lung infections, herpes etc, but also heart disease and stroke. If you want to avoid dying from heart disease, you should be eating coconut oil. It appears that by simply using coconut oil in your daily diet in place of other oils, you can achieve a remarkable degree of protection from heart disease and stroke. Bone marrow cells for damaged hearts Bone marrow cells infused to the heart through tiny incisions helped several severe heart failure patients get markedly better, an international team of researchers reported. While the doctors are not sure just what the cells did, the patients who got the treatment saw their heart function improve to nearly healthy levels. The study, presented to a meeting in Florida of the Society for Thoracic Surgery, is the latest of a series of different experiments that show that the so-called adult stem cells seem to be able to help repair a damaged heart. Dr. Amit Patel of the University of Pittsburgh Medical Center and colleagues at the Asociacion Espanola Primera de Socorros Mutuos in Montevideo, Uruguay, the Benetti Foundation in Rosario, Argentina, and Baylor University in Texas worked on 30 volunteers. All had severe congestive heart failure, a chronic condition in which the failing heart progressively pumps less and less blood. Patients feel breathless and tired, and the only cure for the worst cases is a heart transplant. The patients got either their own bone marrow cells, or a sham treatment. Patel's team filtered out the stem cells, which have the power to generate blood, heart muscle and other cells. All the patients had severe heart failure, meaning they had an ejection fraction of less than 35 percent - indicating very poor pumping action by the heart. Fifteen of the patients were given infusions of their own stem cells, using four little incisions in the chest. "All the patients were discharged home within two days," the researchers said in a statement."Early echocardiograms showed a 35 per cent improvement in ejection fraction for patients who received the cells, versus only 5 per cent for the control group." Six months after the procedure, those who got bone marrow stem cells improved to an average ejection fraction of 46 per cent, with the range between 38 per cent and 52 per cent, which is close to what is considered healthy. "It is remarkable the level of improvement we've seen in these patients, who came to us with no other medical or surgical options available to them," Patel said in a statement. "However, we don't yet fully understand how these cells work, whether they differentiate to become heart muscle cells or cells that promote vessel growth, or whether they serve as homing signals to other cells and substances that help with repair," he added. |
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| Produced by Lake House |
The recent tsunami has left thousands of children , suffering from Post
Trauma Stress Disorder (PTSD). Teachers can play an important role in
identifying these children in the classroom, says Dr. Rani Goonewardene in
an interview with Carol Aloysius.
