How to Recognize PTSD in the Classroom… And Why it...

I recently watched a Ted Talk¹ by Dr. Nadine Burke Harris where she addressed the effects of childhood trauma on health. Her 16 minute talk discussed how trauma leads to higher risks of heart disease, early death, and even lung cancer. At the heart of her talk was the Adverse Childhood Experiences Study², a groundbreaking research project that examined the relationship between the exposure to different types of trauma during childhood, and adult health outcomes. Listening to the passionate doctor speak about the life long implications of childhood trauma caused me to immediately think of the students I serve on a daily basis. If the exposure to childhood trauma had such dire implications for health later in life, what kind of effects were these experiences having on my students right now?

Urban Youth and Trauma

It’s no secret that urban youth, particularly minority urban youth, are exposed to higher rates of violence than in other areas³. One study found that 80% of “inner-city kids” has experienced one or more traumatic life events⁴. Recent studies done in urban hospitals have found that as many as 4 in 10 victims of violent crimes displayed many of the same symptoms of Post-Traumatic Stress Disorder (PTSD) as Vietnam War veterans. When put into perspective, this makes sense. War veterans are put into areas where their lives are constantly in danger. They may see their comrades killed right before their eyes, and then, once the war is over, they are sent home, where they are seemingly safe but they can’t immediately put their defense down. In the same way, young people who are repeatedly exposed to traumatic events may feel like they are in a warzone since, like soldiers, they are in a state where their safety is a constantly questioned. Like soldiers, even when put into seemingly safe environments, their defenses are up.

Different Types of Stress

As an educator, I’m often stressed. I always have more papers than I have time to grade, more parents to call than I can manage, lessons that need to be planned, data that needs to be analyzed and the list goes on. While I’ve become numb to the stress that my job entails, the everyday stress of being a teacher does not produce the kind of stress that a traumatic event does. Depending on the situation, your brain produces positive, tolerable or toxic stress responses. There are several different types of stress and how your brain and body reacts to each of them is different. Harvard’s Center on the Developing Child⁵ defines three types of stress responses as follows:

• Positive stress responses are a necessary part of development. They are characterized by brief increases in heart rate and elevations of hormone levels. Some situations that might trigger a positive stress response are the first day of school or getting a shot at the doctor’s office.
• Tolerable stress responses cause the body to react a bit stronger, the heart rate increases even more and hormone levels are higher. Events such as losing a loved one, or a natural disaster can cause this response in children. The severity of this stress response is directly correlated to the presence of supportive adults to help the child adapt.
• Toxic stress responses can occur with the experience of prolonged traumatic events, such as abuse (physical and emotional), neglect, or the exposure to violence without the support of an adult. Toxic stress responses cause the most severe reactions. This kind of prolonged activation of the stress response system can disrupt the development of brain functioning.

The stress that most people deal with on a daily basis most likely causes positive or tolerable stress responses. While sometimes uncomfortable, you are physiologically able to deal with this kind of stress. Traumatic events such as divorce, can cause a toxic stress response in children if they don’t have the support of a caring adult to help them navigate the situation. Neglect, abuse and household dysfunction are all types of traumatic experiences that can cause the body’s stress management system to be in overdrive. It’s important to note that the key factor that results in a toxic stress response is time. The dangers are greatest when children are faced with theses traumatic situations over extended periods of time, without a strong support system to help them get through it.

Implications for Educators

Not every student experiencing traumatic events will experience a toxic stress response, but it’s important for educators to be aware of this risk. One possible manifestation of such exposure is PTSD. Students suffering from PTSD are at risk for a plethora of health concerns as noted in Dr. Burke-Harris’ TED Talk, but aside from their health, PTSD has other implications. Children suffering from PTSD often have lower grade point averages and reading abilities, more missed days of school, and decreased high school graduation rates⁶. As educators, this is where we can make a difference. Knowing the signs and having strategies to help our students be successful can make a huge difference. Certain behaviors in a classroom setting may signify that a student is suffering from PTSD. Students should be referred to the school’s social worker if you suspect he/she is suffering from PTSD. While not all teachers are equipped to help students dealing with PTSD, there are steps that we can all take to help our students be successful in school.

What to look for and what to do about it⁷

1. Student is overly aggressive with other students.
If a student has an overly unexpected response to a situation in the classroom, (e.g. getting very angry in a situation that does not seem to warrant such a reaction), it’s important to remain calm. Modeling calm behavior in your tone and body language can make a huge difference in how a student reacts. When a student is in “defense mode” it is best to not engage with the student in a way that could cause more aggression. Give the student time to cool off and then address the situation later to prevent escalation.
2. Student seems withdrawn, sad or distracted in class.
Following a traumatic experience, it is very common for people to experience emotional and social isolation. This is something that can occur subconsciously without the student even realizing they are doing it. Simply checking in on the student and asking how he/she is doing is an important step. The student will need to rebuild his/her support system. Encourage the student to work with friends on group projects and to take responsibility in the classroom. These kinds of activities allow students to feel they have the support of consistent adults, in this case teachers, in their lives; a key to coping with traumatic events for children.
3. Student is engaging in self-destructive behaviors or showing signs of depression.
If you ever suspect a student is hurting him/herself, you should contact your school social worker immediately. Students who are suffering from depression should also be referred to a social worker. While wanting to help our students is natural, it’s just as important to know when something is too big for us to handle.

The Power of Resilience

While the topic of trauma and young people can seem disheartening, it’s important to remember that you do not have to be a psychologist to be a positive support system in your students’ lives. While trauma does have adverse effects on our youth, they can overcome, and we can help. As educators, it’s important that we educate ourselves on topics that affect the lives of our students. Teachers especially can play an important role in helping their students prevail through tough situations. We may not be able to control what happens to our students outside of our classrooms, but we can control how we react to the consequences; and for some students, that could make all the difference.

References & Further Reading

1. Burke-Harris, Nadine. (2015). How childhood trauma affects health across a lifetime. Ted Conferences. [Ted Talk]
2. Felitti, V. J., & Anda, R. F., et al. (1997) The Adverse Childhood Experiences (ACE) Study. Centers for Disease Control and Prevention. [Study Report].
3. Roberts, A. L., Gilman, S.E., Breslau, J., Breslau, N., and Koenen, K.C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine, 41, pp 71-83. [Paper]
4. Collins, K., Connors, K., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F. Thompson, E. (2010). Understanding the impact of trauma and urban poverty on family systems: Risks, resilience, and interventions. Baltimore, MD: Family Informed Trauma Treatment Center. [White Paper]
5. Center for the Developing Child (2015). Key Concepts: Toxic Stress. [Article]
6. Kataoka, S., Langley, A., Wong, M., Baweja, S., & Stein, B. (2012). Responding to Students with PTSD in Schools.Child and Adolescent Psychiatric Clinics of North America, 21(1), 119–x. [Paper]
7. Minnesota’s Association for Children’s Mental Health. (n.d.) Children’s Mental Health Fact Sheet for the Classroom: Post-Traumatic Stress Disorder. [Classroom Resource]