A cognitive developmental approach to understanding how children cope with disasters.

TOPIC: This paper applies cognitive developmental theory to explain how preschoolers, school-age children, and adolescents process and respond to disasters. PURPOSE: To help clinicians understand the disaster experience from a child's point of view, recognize age-specific reactions, identify symptoms that may signal coping difficulties, and plan effective interventions. SOURCES: Case examples from the author's work with flood victims illustrate typical reactions for children (preschool to adolescents) within a family context, along with developmentally appropriate interventions. CONCLUSIONS: Children affected by disasters need nursing interventions geared toward their particular developmental level and sensitive to their perception of the disaster.

The cascade model: an alternative to comorbidity in the pathogenesis of posttraumatic stress disorder.

Comorbidity has been used extensively to explain the numerous co-occurring psychiatric syndromes accompanying chronic posttraumatic stress disorder (PTSD). A cascade model is proposed as an alternative to comorbidity for the pathogenesis and clinical course of the condition. This model allows for a dynamic, integrated conceptualization of disease progression in PTSD. Findings in the clinical, epidemiological, neurobiological, and psychosocial literature which might support this model are described. Conceptual and heuristic difficulties and/or potential objections to the model are also examined. Finally, diagnostic and treatment implications as well as potential research applications of the model are discussed.

Dealing with difficult students in the classroom.

Despite the proliferation of literature on dealing with difficult people, little has been written on how to manage problematic students in the classroom. Every teacher encounters difficult students because the classroom is merely a microcosm of the outside world. Nursing educators strive to create an open and caring atmosphere in their classes, but it is still necessary to intervene when students disrupt the class by showing disrespect for others or by getting the discussion off track. The authors describe the most common difficult student roles seen in the classroom and suggest strategies for dealing with them.

Should there be a clinical typology of posttraumatic stress disorder?

OBJECTIVE: The current classification of posttraumatic stress disorder in acute, chronic and delayed-onset types is incomplete and of limited usefulness. The present paper explores the possibilities of a clinically-based typology that would reflect both the patients' syndromic presentation and modern research findings. METHOD: Review of current clinical and research literature, with a critical examination of proposed typologies, parameters utilised, applicability and relevance; elaboration of theoretical and practical bases of a clinical typology of posttraumatic stress disorder. RESULTS: None of the existing posttraumatic stress disorder typologies presents a clinically comprehensive scope. A typology supported by literature findings and clinical observations is proposed. The six clinical types are depressive, dissociative, somatomorphic, psychotomorphic, organomorphic and 'neurotic-like'. Substance abuse and personality disorder-like variants remain as areas of investigation. CONCLUSIONS: The proposed typology, while accepting the nuclear manifestations of posttraumatic stress disorder, highlights prominent coexisting symptoms that define the clinical appearance of different patients. The typological approach in posttraumatic stress disorder does not carry the ambiguities of comorbidity, and facilitates a more specific and appropriate management of the cases.

Unique patterns of comorbidity in posttraumatic stress disorder from different sources of trauma.

While there are many studies of comorbidity in combat veterans with posttraumatic stress disorder (PTSD), studies of PTSD from other sources of trauma (e.g., disasters, crimes, and civil violence) are just beginning to emerge. This is the first formal review comparing patterns of comorbidity in PTSD from different sources of trauma. Specific attention is given to the relative frequencies of substance abuse, depression, generalized anxiety, phobic, panic, somatization, psychotic, and personality disorders. The findings reveal that although similarities exist, the comorbidity profiles differ according to the type of trauma experienced and the population studied. Additionally, the evidence suggests that the associated psychiatric disorders are not truly comorbid, but are interwoven with the PTSD.

Parallel process in the supervision of child psychotherapy.

Parallel process is a phenomenon in which therapists unconsciously replicate the problems and dynamics of their clients during supervision. It has the unconscious aim of provoking the supervisor to demonstrate how to handle a perplexing situation. Recognizing and resolving parallel process when it occurs is an important supervisory skill. This paper focuses on the unique characteristics of parallel process in child psychotherapy. It reviews various types and manifestations, discusses several case examples, and outlines strategies for intervention.

A review of the borderline diagnosis for children.

The concept of the "borderline child" has gained increasing attention in the past 10 years. New diagnostic criteria are being proposed, and research is attempting to identify the salient features of the syndrome. This article examines the childhood borderline concept, reviews some new diagnostic systems, identifies the major diagnostic controversies, lists considerations for differential diagnosis, and discusses implications for practice. The intent is to present the state of the art of the diagnosis and to discuss some potential problems with its use. Unique aspects of the childhood syndrome in contrast to the adult disorder are highlighted. Overlap with other disorders, questions about the continuity of symptoms, lack of attention to developmental variables, and countertransference issues are a few of the problems identified.

Adopted children in psychotherapy.

Research shows that a larger than expected proportion of children in psychiatric treatment are adopted. When these children present with more pressing symptomatology, it is often difficult to determine how and when to address the adoption issue. This report provides a brief analysis of adoption from the perspective of attachment theory and family of origin theory. Case examples illustrate typical themes and dilemmas that arise in therapy. The authors conclude the report with an analysis of factors to consider in clinical decision-making and guidelines for intervention.