By Michael S. Scheeringa MD
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Extra info for Treating PTSD in Preschoolers: A Clinical Guide
Record the child’s scores on the Scary Feelings Scores form (Therapist Form 1: Reluctance Checklist). These systematic data will help you judge whether the exposure task is having its intended purpose (to create some anxiety that rises and then falls). Watch out for some children, particularly boys, who don’t want to admit to being scared. ” Some children feel relatively more anger than fear from these exposures. If you only use the words scared, nervous, or anxious with them, the task may not have the needed salience, and it will look like it is not working for them.
That is true for psychotherapy for all ages because psychotherapy is a voluntary activity, but it has unique challenges with very young children. Many young children are relatively unfocused, uncooperative, and energetic in the office for the first two to three sessions. They often settle down quickly as they learn the routine. They also settle down in Session 3 and beyond because that is when the caregivers start going into the next room and the children are alone with the therapists. In most cases, no special plan is needed to manage this behavior if it can be waited out.
This may seem redundant, and it is. It is meant to create more exposures while changing things up a bit. In addition, imaginal exposures may be easier or more productive for some children. Tips on Creating Drawings/Narratives and Homework for Different Types of Traumatic Events The following descriptions of cases, drawings, and homework assignments are derived from work with actual patients. Identifying details have been changed in all examples to protect the personal information of the individuals.