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Discussion: Special Topics in Child and Adolescent Psychiatry
Impact of terrorism on children
Introduction
Although most terrorist attacks do not trigger a substantial loss of life, the psychological effects
of terrorist acts and threats can be widespread. Although the reactions of the public may vary
from mild to moderate after the adjustment period, it is necessary to consider and avoid severe
and dangerous reactions in the minority that may include temporary hysteria; retaliatory attacks
on local minority groups, non-compliance with medical or other guidelines (e.g. decreased air
travel). These reactions can involve reactions to information that is sensationalized by the media
or inadequate implementation of evidence-based communication methods by public officials.
Any degree of behavioral symptoms and adaptation responses are expected for children
following a traumatic incident. Children's psychological responses to disasters can vary from
acute mild stress reactions to more serious and sustained effects of PTSD. These responses are
affected by gender, developmental stage, intrinsic resilience, and child social support, and the
degree of child trauma exposure. Exposure to trauma and violent events results in expressions of
terror, anxiety and depression. In most cases, these responses are within the normal range of
reactions to a stressful event, and when children are encouraged to learn how to deal with this
stress, their symptoms vanish.
Psychological Issues as a result of terrorism attack
Psychological stress due to a traumatic experience is typically short-term for a large
percentage of children and adolescents. However, some other children in the same age group can
experience psychological symptoms that do not improve naturally and end up being clinically
relevant, debilitating, and permanent. Such children may be diagnosed with post-traumatic stress
disorder (PTSD). The prevalence of PTSD in children and adolescents is between 1 and 60 per
cent, depending on the target population and the measurements taken while making a diagnosis
(Al-Attar, 2020). Despite the act of terrorism, PTSD can also arise from other causes, such as
various forms of disasters and traumatic injuries, among others. As a consequence, some other
psychiatric complications other than PTSD can be associated with a traumatic incident. These
complications, most of which can occur along with PTSD, include mental disorders, mood
disorders, sleep disorders, emotional numbness, depressive illness, and suicidal ideation. Once
diagnosed earlier, these psychiatric disorders can be better controlled to support the health and
well-being of the patient.
Most effective assessment
Diagnosis for PTSD is very complicated with a few variables. According to the
Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), children and
adolescents over 6 years of age can only be diagnosed with PTSD if they meet all 8 of the
requirements outlined above. Second, the participant must have been subjected to a threatened or
real death, following direct experience or witness in person, or by the discovery of a traumatic
incident that has occurred to a near family member (Mikolajewski, Scheeringa, & Weems,
2017). Second, the person must exhibit at least one of the following symptoms (intrusive),
persistent depressive memory of the incident, nightmares, hallucinations, prolonged or extreme
psychological distress, and physical reactivity when subjected to a painful reminder. The third
criteria observes the behavior of individuals to prevent triggers linked to a traumatic incident by
either thoughts or emotions or external reminders.
The fourth criteria focuses on whether the patient suffered negative changes in mood and
cognition in a number of ways, such as feeling isolated, reduced involvement in everyday
activities, negative symptoms, inability to remember substantial aspects of the traumatic event,
and exaggerated self-denial for the traumatic event. The fifth aspect of the criterion relates to the
arousal and reactivation of symptoms associated with a traumatic incident, such as aggression or
irritability, hypervigilance, sleeping problems, failure to focus and disruptive actions (Kletter, &
Carrion, 2018). The sixth factor points out that the length of the symptoms must be at least one
month. The seventh factor calls for symptoms arising from a traumatic experience to deteriorate
the normal functioning of people, such as social and occupational, among others. Lastly, the
eighth requirement specifies that the effects may not have been triggered by drug use, medication
or other illnesses.
Treatment Options available
The treatment of PTSD includes the integration of both pharmacotherapy and therapeutic
therapies. However, among girls, no SSRIs have been accepted. As such, trauma-focused
psychotherapy is recommended as the first line for the treatment of PTSD in children and
adolescents with adjunctive medication for symptoms that do not respond to psychotherapy
(Danzi, & La, 2020). The adjunct drugs prescribed for this age group include prazosin, alpha-1
adrenergic antagonist, nightmare control, and sleep disturbance. Guanfacine has also
demonstrated considerable efficacy in the reduction of hyperarousal and intrusive symptoms.
Other drugs include risperidone and sertraline, which can only be used with strict control of
adverse reactions and modification of sufficient doses for children in this age group.
Cultural Influence on Treatment
Cultural complexity is a significant obstacle in the treatment of patients with psychiatric
disorders. Different societies have different views of the occurrence and treatment of mental
illness. For example, some societies may assume that the child has also been bewitched, as a
result of which they may opt for a divine intervention rather than a modern approach (Schnyder
et al., 2016). Consequently, considering that the child is a child, the parents or guardians are
responsible for taking decisions about their welfare. It is also very difficult to persuade such a
parent of the most suitable therapeutic approach for the management of the psychiatric
complication of the patient.
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