Post-Traumatic Stress Disorder

What  is  PTSD  ?

什么是严重创伤后的后遗症障碍？

- Post-traumatic stress disorder ( PTSD ) is a type of anxiety disorder that can develop after experiencing a very traumatic or life-threatening event.

严重创伤后的后遗症障碍是在经历了很大的创伤或威胁生命的事件后所产生的一种严重焦虑症的症状。

 e.g  feeling physically threatened or witnessing violence, even if you were not physically injured.

例子： 感觉身体受到威胁或曾目睹暴力行为，即使你不是受害者。

-  Post-traumatic stress disorder (PTSD)  can cause flashback, sleep problem &      nightmares, feelings of isolation,  feelings of intense guilt  (especially if you  survived when others died), paranoia  &  panic attacks.

 严重创伤后的后遗症障碍可以导致倒叙反映效果， 睡眠问题及恶梦，孤立的感觉，激烈的内疚（特别是你生存而其他人死亡），有过度怀疑和恐慌。

How to deal with children’s grief and loss?
怎么样处理孩子的悲伤与失落?

- Parents must accompany and recognize their children in order to help them in manage their lost. Inability to deal with this soon could lead to anger or worse, depression and suicide.在这段期间父母需要陪伴与接纳孩子们，帮助他们一起走出悲伤与失落。无法处理这个问题很快会导致愤怒或更糟的是，抑郁症和自杀。

Examples of traumatic events that can lead to PTSD 
可导致严重创伤后的后遗症障碍的创伤事件例子

•       Terrorist attacks 恐怖袭击

•       Tsunami 海啸

•       Fire 火灾

•       Robbery  被抢劫

•       Snatch theft 抢夺盗窃

•       Domestic violence 家庭暴力

•       Torture 酷刑

•       Child sexual abuse 儿童性虐待

•       Physical abuse 身体虐待

•       Emotional abuse 精神虐待

•       Sexual abuse 性虐待

•       Rape 强奸

•       Physical attack 身体攻击

•       Flood 洪水泛滥

•       Earthquake 地震

•       Serious accident 严重事故

•       Plane crash 飞机坠毁

•       Death of a friend or loved one 朋友或亲人死亡

•       Sudden Death of parents父母突然去世

•       Sudden Death of grandparents 祖父母突然去世

•       Sudden Divorce  闪电离婚

•       Sudden  Loss of a job  突然间失去工作

•       Change of environment  ( nanny’s home, parents’ transfer, school transfer & migration) 环 境改变（保姆家中，父母的转移，转校及移民）

•       Serious injury  严重损伤

•       Physical assault  身体受到虐打

•       Physical attack  身体攻击

•       Violent crimes  暴力犯罪

•       Child abuse  虐待儿童

•       War combat  战争

•       Abandoned by parents   遭父母遗弃

•       Unexpected separation of parents  父母突然分离

What are the symptoms of  PTSD  ?
严重创伤后的后遗症障碍的特征是什么？

•       Recurring, intrusive & distressing memories of the event.

  时常遭受反复性痛苦的回忆困扰

•       Avoiding situations that remind you of the event.

   逃避让你想起那事情的情景

•       Becoming emotionally numb  &  withdrawing.

   成为情感麻木和逃避者/逃离现实

•       Difficulty in sleeping  &  concentrating &   fearing for personal safety.

   难以入睡及集中精神，时常疑神疑鬼

•       Feel upset by things that remind you of past happening.

   在接触到某些提醒你过去发生的事情的事件时而感到悲伤。

•       Have nightmares, vivid  memories, hallucinations  or  flashback of the event.  Feeling like it’s happening all over again.

   做恶梦，拥有生动不可思议的记忆，幻觉或倒叙反映效果。感觉就像历史重演。

•       Avoid places ,people  ,thought  , situations  or things that remind you of past happening.

   避免接触到提醒你过去曾经发生过的事情的地点，人士，感想，情况或事情。

•       Feel numb or lose interest in things you used to care about.

   感觉麻木或对你以前所关心的事物失去兴致。

•       Feel that you are always in danger.

   觉得自己总是处于危险之中。

•       Feel anxious or grumpy ,irritation ，unreasonable tearing ,outbursts of anger & difficult  concentrating

   感到焦虑或脾气暴躁，敏感，无故哭泣，愤怒和难以集中精神。

•       Problem  in  sleeping or focusing.

   睡眠以及集中力面对问题。

•       Increased blood pressure &  pulse rate, ,rapid breathing , muscle tension, nausea & diarrhea.

   血压以及心跳速度偏高，急促呼吸，肌肉僵硬，呕吐以及腹泻。

•       Change in behavior .

    行为转变

•        Change in life style.

    生活规律调整

•       Withdraw from  people , become workaholic or addition to drugs or alcohol.

    拒绝与别人接触，成为工作狂，吸毒与酗酒

•        Finding it hard to be in relationship.

    很难与别人建立友好关系

•       Intimacy problem with  spouse & family members.

   夫妻与家庭亲密关系面临问题

•       Depressed  & have anxiety.

   悲伤以及过度焦虑

•       Panic attacks.

   感到恐慌

•       Feelings of fear or worry that something bad is about to  happen.

   拥有恐惧感以及担心坏事将会发生。

Who Gets PTSD  ?
谁患上了严重创伤后的后遗症障碍？

•       People who have been abused as children or who have been repeatedly exposed to life-threatening situations are potential victim of  PTSD  and always being trapped in the past memory and cannot free themselves(in self prison)　　　

   童年饱受虐待或生命曾经受到威胁者是患上严重创伤后的后遗症障碍的潜在受害者, 时常被困在过去的记忆和不能自拔（自我监狱）。

•       Victims of  physical & sexual assaults face the greatest risk of  PTSD.

   身体及性遭受侵犯的受害者在患上严重创伤后的后遗症障碍面临非常大的风险。

•       PTSD  can happen to children too  &  may have same symptoms as adults. 

重创伤后的后遗症障碍也可以发生在孩子的身上，并且同样拥有与成人相同的症状

•       A family history of depression or history of abuse or trauma may also increase your risk of  PTSD.

   家庭成员拥有沮丧或虐待的历史和患上严重创伤后的后遗症的历史，也同样会增加其他家庭成员患上此后遗症的风险。

PTSD  IN CHILDREN
儿童严重创伤后的后遗症障碍

•       Children can have PTSD.

    小孩子也可能会患上严重创伤后的后遗症障碍。

•       Children’s  PTSD symptoms may be same as adults,   depending on how old the children are.

   依据孩子们的年龄，小儿严重创伤后的后遗症障碍的症状也可以与大人们的症状相

•       CASE STUDY真实案例:-

   Young children may become upset if their parents are not close by, have trouble sleeping（first time sleep alone) , or suddenly have trouble with toilet training or going to bathroom. This may early program the fear in the child.

 当孩子们需要父母时，父母不在身边（一个人睡觉），那时候孩子们会面对相当的恐惧，如小孩自己上厕所的训练。因而可能造成小儿严重创伤后的后遗症。例如早期负面的灌输。

•       Children who are at the age of 6 to 9 may act out trauma through plays,  drawings or stories.

儿童在六到九岁时，会通过游戏，画画以及故事潜意识地不经不觉显示他们的恐惧以及创伤.

•       Children may complain of physical problems or become more irritable or aggressive . They may develop fears & anxiety that don’t seem to be caused by the traumatic event.
儿童可能会抱怨身体不适或变得更加急躁。他们对其他不是造成他们创伤事件也会感到恐惧和焦虑.

•       Children who suffer from separation anxiety will be isolated because they been rejected by peers, no social skill (too close or too cold) , cannot blend into  social group because they miss out this learning during their adolescent stage . Their anger are very explosive. Behind the anger there will be hurt . Therefore  they  are likes to become antisocial & turn into destroyer or animal abuser. As parents  they must not over react and must stay calm to resolve  it .

        患有分离焦虑的儿童将被孤立因为他们被别人排挤，他们拥有非常差的社会功能，不能融入社会正常的交往， 他们在青少年时失去和没有这种学习功能。他们的愤怒非常具有爆发力。在愤怒的背后，他们拥有一段悲痛的记忆。所以他们都成为反社会和破坏王或动物虐待者。作为家长，他们必须作出适当的反应，冷静地解决问题。

 

THE  3 PTSD IMPACTS IN SPECIAL NEEDS CHILDREN
三大影响

•       Educational Impact    教育影响

•       Behavioral Impact      行为影响

•       Social Impact               社交影响

PTSD IN CHILDREN WITH SPECIAL NEEDS
严重创伤后的后遗症障碍对特殊儿童影响

•       Special needs children – ADHD, ASD, Dyslexia, Dyscalculia， Dysplexia or learning disorder :-

    特殊儿童 – 过动儿，自闭症，阅读障碍， 计算障碍，语言障碍，学习障碍

   

•       PTSD may cause the  special children emotionally shut down or  avoidance, socially withdraw or become very hyperactive  & impulsive behavior. They  have very low self esteem & no sense of security  and totally disconnected from “self”.

   严重创伤后的后遗症障碍对特殊儿童可能造成情感关闭或逃离，社会脱节，个性变得十分过动活跃和冲动。他们很低自信与缺乏安全感, 和自我分离。

Possible causes of PTSD in children with special needs :-

严重创伤后的后遗症障碍对特殊儿童的成因 ：-

•     Sudden change in child’s life – death of parents or parents’ divorce. 孩子的生活面对突然巨变  -  父母死亡或父母离婚。

•      Childhood trauma  童年创伤

•      Anxiety  or depression  焦虑/抑郁

•      Accidents – especially head injury 意外 - 尤其是头部受伤

HOW PTSD CAN AFFECT ON LEARNING DISORDER?
严重创伤后的后遗症障碍怎样影响学习障碍

•       An increasing number of children in our country are born with learning disorders.

   在我国越来越多的儿童有与生俱来的学习障碍

•       Survey done, have estimated that 15% (Malaysia) of the children at school going showed some form of learning disorders

   调查显示在大马大约有15%的儿童会有一定程度的学习障碍

•       Early intervention is provided, the effect  of  these learning disorders can lessen and  these  children may　be able to attend normal classes learn how to interact with society and eventually be self reliant as an adult.

   早期适当的治疗会减轻学习障碍，这些儿童可以和普通小孩一起上课，学习正常社交和最终成为自力更生的成人。

HOW IS  PTSD  TREATED   ?
如何治疗严重创伤后的后遗症障碍？

Treatment  for  PTSD  includes

严重创伤后的后遗症障碍的治疗包括:-

•     Medications 药物调理      

You may need medications to reduce symptoms of depression and anxiety associated with  PTSD. 您可能需要药物来减少严重创伤后的后遗症障碍的抑郁和焦虑的症状。

•    Psychotherapy 心理治疗

Psychotherapy for PTSD involves helping patient acquiring  skills in managing symptoms&   developing ways of coping. Helping patient work through the fears associated  with the  traumatic event.

对严重创伤后的后遗症障碍的心理治疗是帮助病人掌握病症的症状及对治方式。帮助病人走过创伤事件的恐惧。

Psychotherapy  approaches are

心理治疗的方法是 : -

        -   Exposure   Therapy 情景重演疗法

        -   Family   Therapy 家庭疗法

        -   Group  Therapy 团队疗法

        -   Transformational  Therapy / Change Therapy 透过察觉提升内在资源治疗

•          Stress management 压力处理

Reducing stress in your daily life can help you manage symptoms of PTSD.

降低日常生活压力可帮助您处理严重创伤后的后遗症障碍症状。

Ways to help reduce stress include  降低生活压力的方法包括:-

               -  Relaxation exercises  放松运动

               -  Getting regular exercise  经常运动

               -  Getting enough sleep  拥有足够睡眠

               -  Eating a balanced diet  均衡饮食

               -  Meditation & prayer  默想与祈祷

               -  Massage 按摩

•            Non Verbal Therapy 非口语治疗

- Expressive Art  表达性艺术治疗（画画/手作品）

- Psychodrama   心理剧治疗

- Sculpting   雕塑治疗

- Role play  角色扮演治疗

- Therapeutic story  有治疗内容的故事治疗

- Sand play   沙箱游戏

EXPRESSIVE ART THERAPHY  :-  (NON VERBAL THERAPY)

表达艺术治疗（非口语治疗）:-

•     Expressive art therapy  is a form of non verbal emotional detoxification that can help those adult or children unable to verbalize their feeling or emotion.

表达艺术治疗是一种非口语的情绪排毒，可以帮助那些无法用语言表达自己的感觉或情感的成人或儿童的方式。

•     It can help children or adult to externalize their hidden pain or trauma.

它可以帮助儿童或成人外部化其隐藏的痛苦或创伤。

Art  therapy can help in  :-     

艺术疗法可以帮助 :-

•       Elevating self esteem  提升自尊

•       Express freely  自由表达

•       Release stress and anxiety  释放压力和焦虑

•       Crisis intervention  危机干预

•       Grief and loss   悲痛和失落

•       Cancer, old age, injury body part  癌症，老年失落，身体伤害的一部分

•       Learning disorder children, stroke, sex abuse, rape, molest ,spiritual abuse, emotional imbalance, depression, childhood trauma , phobia   学习障碍儿童，中风，性虐待，强奸，性骚扰，精神虐待，情绪失调，抑郁症，儿童创伤，恐惧症

•       PTSD  can be treated through  EXPRESSIVE ART THERAPY :-  
严重创伤后的后遗症障碍是可以通过表达性艺术去治疗:-

•      Expressive Art therapy is a form of treatment using simple art materials. Spontaneous art expression in a non-judgmental atmosphere  allow the person to freely articulate repressed thoughts and feeling without the threat of repercussion. Once previously undisclosed feelings have been externalized, client and art therapist are able to explore issues that have surfaced.

 表达性艺术治疗是一种使用简单美术材料的治疗形式。非判断气氛的自发艺术表现允许个人自由地表达人的思想和压抑的潜意识问题而且没有威胁的感觉。 先前未公开的情感一旦被外在，患者和艺术治疗师能够探讨这自然浮出水面的问题。

•     Art therapy is useful as primary or secondary tool for healing. It can be used with children, adolescents and adults, and deal with a variety of need.

艺术治疗是有效的主要或辅助治愈工具。 它可用于儿童，青少年和成人，处理各种需要。

 Because  of the Organic nature of the materials, as well as the imaginative process, art therapy encourage creativity.
由于材料的原始性质，以及富有想象力的过程，艺术治疗鼓励创造性

TREATMENT  PLAN 处理方案

•     Psychotherapy approaches are used  in  helping patient to learn to recognize & change  of thought patterns  from her troublesome emotions, feeling ,coping stance , perception, expectation & behavior.  The most important is to strengthen & reconnect in ‘self’ level & raise up her self value.

心理治疗方法可用于帮助患者认识学习及改变病人的思维模式。例如她的烦躁情绪，感觉，应对立场，看法，期望和行为。最重要的是加强和重新连接在‘自我’水平及提高自我价值。   

•     Psychotherapy also can help patient to enhance client’s special awareness , transforming his/her inner resources.  

心理治疗也可以帮助病人提高特殊的自觉，转化他/她的 内心资源。

GOOD STRATEGY
好方法

•     Family, school and social support are very important for the child’s growth.

家庭，学校和社会的支持对孩子的成长十分重要。

•     The home is very important because home environment and family are the main support base for a healthy child’s growth.

家庭是非常重要的，因为居家环境和家庭是孩子健康成长的主要支柱。

•     Happy marriage and happy divorce will be the best gifts for the children.

幸福的婚姻与和谐离婚是献给孩子最佳的礼物。

•     Secure attachment  (good impact) –child very independent & emotionally would be more stable.

安全感（良好的影响），孩子会很独立和情感上会更稳定。

•     Good parenting style :-   AUTHORITATIVE   (more balance & acceptance).

 为人父母的态度： -   平衡（更多平衡与接纳）

•     Practice for creativity 培养创意

•     Good communication skill  :-  CONGRUENT

良好的沟通技巧： -   一致性

 In conversation - take care of self，others& context ，  to accept self .             在谈话中   -    要照顾到自我，他人和环境，和接受自我

      Case study： 个案 :       

      (parents’ perceptions or expectations), （父母的观念或期望）

       others (child’s feeling) . 其他（孩子的感觉）

       and context (right timing & environment). （对的时机)

•     Special needs children   -  Special class, small group, structured timetable , one-to-one tuition/shadow teacher, creative  teaching，life coach，stop watch， short & clear instruction with example and prompting

特殊小孩   -      特殊班，小班制，定制时间表，一对一辅导/影子老师，创意教学，生命教练， 秒表，请楚教学o

•       Structured and self control timetable  定制生活作息表

•       Cultivate their talent   培养他们的天分

•       Input good early programming    输入良好的早期思想程序

•       Don’t over control  不要过度控制

•       Build confidence in child   建立孩子的信心

•       Special dietary consideration may be needed 可能需要特别膳食

•     Participate in extracuriccular in school or outside school activities : Eg sports club, art class, music course, chess club, dance and drama, National Service, survival camp, First Aid Program and etc to learn extra skills in order to boost up their confident level.

   参加学校或学校活动以外的额外的活动：如体育俱乐部，美术班，音乐班，国际象棋俱乐部，舞蹈和戏剧，服务全国，生存训练营，急救课程等学习额外的技能，以提高他们的自信水平。

•     In extracuriccular activities , children will learn :-孩子们可以学习到：

- Learn something new other than school structure program. 学习到在学校课程以外的新东西

- Time management  时间管理

- Communication skills  沟通技巧

- Planning, Problem solving  布署，问题解决技巧

- Organization skill  组织能力

- Teamwork  团队合作精神

- Creativity  创意

- Special children can learn special social & communication skills in this environment  that  can help them overcome their shy  & withdrawn behavior.  特殊儿童可在这样的环境学习到帮助他们克服害羞 和自我封闭 行为的社会及沟通技巧。