They’ll Never Be the Same

There is a new book about children and Posttraumatic Stress Disorder (PTSD), specifically written for parents. The author, the psychiatrist Michael Scheeringa, has an incredible amount of experience in treatment and research with children and young people in the USA.

I got to read a copy of “They’ll Never Be the Same: A Parent’s Guide to PTSD in Youth” provided by the publisher.

While it may not be what one would call a ‘modest’ book, it’s certainly informative. Scheeringa gives parents a helpful overview of what is known about traumatic stress among children in America, how to go about finding and choosing a therapist and what to expect from therapy. Many parents reading it will feel that Scheeringa is on their side. For clinicians and researchers it may be different, but then again they are not the intended audience.

Scheeringa shares multiple interesting insights. One that struck me was about barriers to mental health care. Only a small percentage of children who experience traumatic stress start and complete mental health treatment. What are the barriers for them and their parents? Several factors may be at play:

  • Stigma – seeking treatment is like admitting failure
  • Stoicism / Altruism – thinking that other people are more deserving of limited treatment resources
  • Privacy – talking about trauma seems more painful than having PTSD symptoms
  • Marshmallow children – adults expecting they will bounce back naturally without treatment
  • No clear ‘front door’ to care – it’s hard to find treatment even if you want to

The author’s view is that these factors can’t be the full explanation. He suspects people don’t want mental health care. Mental health is not a sufficiently attractive goal:

“Stigma, stoicism, privacy, marshmallow children, and problems of access with the lack of a ‘front door’ are all good guesses, but they do not quite add up in my mind. All of those guesses seem to have an underlying assumption that people want mental health. Through many of my interactions with patients and potential patients, over the years, I have wondered if that assumption is just plain wrong. What if people are not that interested in mental health?”

“If people truly are not too interested in better mental health, then it will never matter how much we reduce stigma or make access easier. There may be a fundamental issue that the process of asking for help is worse than the problem of living with psychiatric problems. …. (It) seems that many, if not most, trauma victims just don’t want the services bad enough to put up with our business model, or they just don’t want the services at all. Maybe we are trying to engage people the wrong way.”

Is he correct? What do you think?

One in six children develops PTSD after trauma, but differences exist

children and PTSDHow many children develop Posttraumatic Stress Disorder after a traumatic experience such as an assault, a car crash, war or disaster? William Yule – one of the godfathers of child traumatic stress research – once pointed out that rates reported in separate studies varied from 0 to 100%.

So what is the average rate to be expected? With an international team of collaborators, we conducted a meta-analysis to answer this question.

The wide variety in individual study results suggests that various factors may be in play: apparently not every type of exposure, set of circumstances or group of children is related to similar PTSD rates. In addition, there may be methodological variation in the studies. Continue reading