Week 4: Trauma and Stressor-Related Disorders in Childhood
\”He was drunk again, so I should have known better. I should have stayed away from the house, but that would have made him madder. He has done this before, but not nearly this bad. He broke my wrist as I was protecting my mom. The neighbor heard the screaming and called the cops. They hauled him away, but I know he will be back. She always lets him come back.\”

Avery, age 14

In August of 2005, thousands of children lost their homes in Hurricane Katrina. On December 14, 2012, the students at Sandy Hook Elementary School experienced the death of 20 of their classmates and six of their teachers. Every day, children experience physical and sexual abuse and neglect by their parents or caregivers. These types of trauma have a lifelong impact on the children involved and those witnessing the events. As much as we try to prevent unwanted childhood trauma and stressors, the phenomena are present in our culture. Childhood trauma is a significant contributor to both physical and mental health problems in children and adults.

This week, you examine several cases of child abuse and neglect, and you recommend strategies for assessing for abuse. You analyze influences of media and social media on mental health and evaluate the need for mandatory reporting of abuse.

Learning Resources
Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

“Trauma- and Stressor-related Disorders”
American Psychiatric Nurses Association. (2017). Childhood and adolescent trauma. Retrieved from http://www.apna.org/i4a/pages/index.cfm?pageID=4545

Pfefferbaum, B., & Shaw, J. A. (2013). Practice parameter on disaster preparedness. Journal of the American Academy of Child & Adolescent Psychiatry, 52(11), 1224–1238. Retrieved from http://www.jaacap.com/article/S0890-8567(13)00550-9/pdf

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 31, “Child Psychiatry” (pp. 1216–1226)
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Note: All Stahl resources can be accessed through the Walden Library using the link. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on the following medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

Posttraumatic stress disorder
prazosin (nightmares)
propranolol (prophylactic)

Note: Many of these medications are FDA approved for adults only. Some are FDA approved for disorders in children and adolescents. Many are used “off label” for the disorders examined in this week. As you read the Stahl drug monographs, focus your attention on FDA approvals for children/adolescents (including “ages” for which the medication is approved, if applicable) and further note which drugs are “off label.”

Document: Childhood Abuse Case Study (PDF)

Optional Resources
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Hoboken, NJ: Wiley Blackwell.

Chapter 50, “Provision of Intensive Treatment: Intensive Outreach, Day Units, and In-Patient Units” (pp. 648–664)
Chapter 58, “Disorders of Attachment and Social Engagement Related to Deprivation” (pp. 795–805)
Chapter 59, “Post Traumatic Stress Disorder” (pp. 806–821)
Chapter 64, “Suicidal Behavior and Self-Harm” (pp. 893–912)
Discussion: Treating Childhood Abuse
In 2012, statistics in the United States indicated that state CPS agencies received 3.4 million referrals for child abuse and neglect. Of these, nearly 700,000 children were found to be victims of maltreatment: 18% were victims of physical abuse and 78% were victims of neglect (CDC, 2014). Child sexual abuse makes up roughly 10% of child maltreatment cases in the United States (CDC, 2014). The CDC considers sexual abuse at any age a form of violence. Child abuse of any kind can lead to an increased state of inflammatory markers in adulthood, as well as multiple physical illnesses and high-risk behavior such as alcoholism and drug abuse. If a PMHNP identifies child abuse, there may be a need to report the abuse to authorities. Once able to provide treatment, the PMHNP can be instrumental in reducing the long-term effects of child abuse.

In this Discussion, you recommend strategies for assessing for abuse and analyze influences of media and social media on mental health. You also evaluate the need for mandatory reporting of abuse.

Learning Objectives
Students will:
Recommend strategies for assessing for abuse
Analyze influences of media and social media on mental health
Evaluate the need for mandatory reporting of abuse
To Prepare for this Discussion:

Read the Learning Resources concerning treating childhood abuse.
Read the Child Abuse Case Study in the Learning Resources.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit!

By Day 3

What strategies would you employ to assess the patient for abuse? Explain why you selected these strategies.
How might exposure to the media and/or social media affect the patient?
What type of mandatory reporting (if any) is required in this case? Why?


Child Abuse Case Study
NURS 6660: Psychiatric Mental Health Nurse Practitioner Role I: Child
and Adolescent
Morgan, a 19-year-old male comes to your office to discuss his current mood and
symptoms. This is his first visit to a mental health clinic. “I’ve had 26 jobs in the last 2
years; I finally have a job that I like and I want to make it work.” As you begin to get to
know him, he tells you that his mood is down and that he also has times where he has
“more energy and motivation”: “That’s when I am able to get a new job.” He says that he
has difficulty interacting with coworkers. “I feel like I can’t talk to them.” If it wasn’t for
his supportive girlfriend, he wouldn’t be able to function. “She understands me and
accepts me; she knows what I have been through.”
As the PMHNP listens to the client and explores what he means by some of his
statements, you try to put together his story. He mentions that he has been having
nightmares and is not sleeping well. He says he startles easily. He becomes withdrawn
when he begins to talk about the reason for the nightmares.
“This all started a few weeks ago when a cousin of mine got out of jail.” He haltingly tells
the story of his parents’ mental illness and how he had to live with various relatives.
“One cousin who I stayed with a lot took advantage of me. He molested me.” They
found out he also molested other children and he went to jail. “It gives me the creeps
that he is out of jail. I have to face what he did to me.”
Morgan asks about his diagnosis. The PMHNP tells him that he has some symptoms
that sound like depression and anxiety, and that when a child has a traumatic
experience, it can reoccur and stay with a person for many years. He acknowledges
that he thought about PTSD but wasn’t sure what the symptoms look like.
As you think about Morgan’s story, consider the following questions: Where did he fall
between the cracks? Are there agencies who advocate for children like him?
There are thousands of children like Morgan. They were in a vulnerable family situation
and the “responsible” adult was not able to care for the child. Sometimes it takes years
for clients to remember and disclose the abuse.



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