How can a teenage PTSD overcome ADHD

Again and again, children and young people experience incredible things. They experience the loss of a loved one, become involved in serious accidents or have to undergo medical interventions due to illness. They become victims of natural disasters, wars, torture, flight and displacement. Millions of children are neglected, sexually abused and abused by their caregivers (1). When the incomprehensible occurs, the lives of these children and young people will be permanently changed. The consequences of the experiences are all the more serious, the younger the child and "the closer the relationship to the person causing it" (2).

 

Stressful experiences do not always have to occur in such extreme form in children in order to cause persistent painful symptoms. Children experience and evaluate experiences differently than adults (3). The death of a pet, separation experiences or a move can also have a traumatic effect (4). Media consumption can also traumatize children (5).

 

Psychotraumatisation: When emotional wounds arise
Traumatic experiences are extreme experiences in which those affected feel subjectively threatened and their resilience is insufficient to process the experience. The term “trauma” means “the injury and lasting damage to an existing structure” (6). Psychotraumas are psychological injuries caused by the outside world. As most physical wounds heal after a while, emotional wounds caused by stressful experiences can also heal. Often, however, scars remain that can break open again when exposed to stress later on (7). In rare cases, the consequences of trauma may not show up until many years later. Similar to physical wounds, inadequate wound care can lead to serious infections that can lead to death.

 

After a severe trauma, nothing is as it was before. Traumas change life (4). In addition to a variety of psychosomatic reactions, such as headache and stomach ache or digestive and eating disorders, the children and adolescents affected suffer from their terrible memories, which inevitably invade them and trigger fears of death through so-called flashbacks. Flashbacks are not normal memories where you can feel safe in the here and now and look back on past events. The victims feel like they have been transported back to the middle of the catastrophe and show corresponding symptoms and reactions. For others, the experiences were so unbearable that they push the events into the unconscious and can no longer remember them at all, which is known in technical terms as amnesia.

 

Difficulty concentrating and sleeping are signs of traumatic overexcitation as well as restlessness, fears and panic attacks. Arrhythmias of all kinds can also occur after trauma. Many children and adolescents are sad, depressed and seem paralyzed after traumatic experiences. The shock is literally in their limbs. Others show symptoms such as hyperactivity and aggressive bursts of impulse. Relationship trauma in early childhood usually results in dissociative symptoms. The children withdraw mentally from their bodies and from what is happening to them. In the middle of the catastrophe, there is numbness and inner peace in the cemetery. Later on, these children and adolescents often show self-damaging behavior. They cut themselves to find out in the physical pain that they are still alive at all. Regressive behavior is also common in children. They try to save themselves by retreating to "safe islands of previous experiences" (7), which is shown by bed-wetting, thumb sucking, baby talk or separation fears. It can be understood that children seek to avoid the triggers that could trigger flashbacks of the trauma. Trigger stimuli can be images, smells, noises, colors, movements, etc. Avoidance strategies can also lead to emotional numbness, numbing, and, together with irrational feelings of shame and guilt, burden everyday life and relationships.

 

All of the above symptoms that occur after extreme stress are normal reactions to an abnormal situation. The symptoms make sense. Fear can protect against danger and overexcitation can warn. When a danger is perceived, the human body is put into an increased wakefulness. But if extreme stress persists for a long time or occurs again and again, the brain is put into a permanent alarm state. Through this overexcited alertness, dangers are finally perceived that objectively do not even exist (8). The body's own substances are released in order to prepare the body for an argument that does not even exist. “Acute stress is a biologically sensible adaptation to a dangerous situation. Chronic stress, on the other hand, is a major cause of lifestyle diseases ”(2).

 

During the first three years, the child's brain is particularly vulnerable to extreme stress (9). “The psyche can suffer injuries from the extreme stress that occurs during abuse, which correspond to physical 'micro-injuries' and which in children can have a lasting effect on the development of the brain and overall physical development” (2). Most of the time, the children lack a conscious memory of the trauma. Nevertheless, it still exists as a memory of the body (8) (10) and can, for example, be "constantly present as an overwhelming emotion or diffuse avoidance impulse" (11).

 

Psychotrauma sequelae: When emotional wounds infect
In the acute shock phase after experiencing extreme stress, the children and adolescents are mostly “shock frozen” (7). They often react with mental numbness and chaotic actionism. This phase only lasts for a few hours and then usually changes to the phase of post-traumatic stress reaction with a wide range of possible symptoms. In around 85% of the accident victims and 75% of the earthquake victims, the trauma symptoms decrease more and more during this phase and usually disappear completely after six to eight weeks. In the case of rape and war experiences, the coping rate drops to 50%. Relationship trauma in early childhood can no longer be dealt with independently at all. If traumatic symptoms persist even after weeks and months, one speaks of a trauma-related disorder. Most often, post-traumatic stress disorder (PTSD) is diagnosed. A distinction is made between simple PTSD with a one-off traumatization (type I trauma) and complex PTSD (12) with multiple and multi-traumatizations as well as sequential traumatizations and developmental trauma (type II traumas). Complex trauma in children is often associated with a high proportion of comorbidities. However, all symptoms that occur in response to traumatic stress can develop into disorders in their own right: anxiety disorders, compulsions, depression, etc. (2). Separation anxiety (59%), oppositional behavior (36%), phobias (36%) and ADHD (29%) are often diagnosed in children after trauma. All of these disorders are part of the symptoms of PTSD (13). Chronic secondary trauma disorders can lead to persistent identity and personality disorders after extreme stress (23). Those affected are usually socially intolerant and isolated as a result. They fail in their job and their relationships, become addictive, delinquent and suicidal. (24)

 

Emergency pedagogy: first aid for the soul
“Trauma pedagogy sees itself as a (curative) pedagogical approach to stabilize and support traumatized children and adolescents and is a necessary prerequisite, accompaniment and supplement to a corresponding therapy process” (11). Emergency pedagogy is part of trauma pedagogy (25). It begins at the time when it is decided whether the trauma can be coped with or whether a psychotrauma sequela will develop. It's not about trauma therapy. The self-healing powers of the traumatically stressed child are to be stimulated by means of Waldorf-oriented interventions. Emergency educational interventions can stabilize traumatized children. They help to process the trauma and to integrate it into one's own biography. Waldorf pedagogical methods are used in emergency pedagogy for psychosocial stabilization. Emergency pedagogy is first aid for the soul (26).

 

Through targeted rhythm maintenance, the traumatized child's organism should be harmonized again and its self-healing powers activated. This includes structured and rhythmic daily routines, regulated eating and sleeping times. Rituals such as prayers at the table, morning rituals and bedtime rituals provide security, support and new orientation. Movement therapy approaches of eurythmy and Bothmer gymnastics as well as massages and rhythmic rubs can help to relieve trauma-related cramps (contraction). Artistic activities such as painting, drawing, kneading, dancing or making music can help to give creative expression to what is actually indescribable, verbally not communicable and thus to process it.

 

Experiential educational approaches can e.g. through climbing exercises rebuild trust in oneself and others that has been lost due to the trauma, practice the often severely impaired ability to concentrate e.g. through thread games, memory or mikado and playfully compensate for the trauma-related loss of social competence and develop new social skills. Telling fairy tales and stories as well as puppet shows have also proven to be helpful in emergency pedagogical intervention.

 

Traumas fix victims to the past and block the future. Future prospects must first be conquered anew. This can be achieved through joint planning and implementation of projects such as B. happen a meal together or an excursion. In this way, trauma-related feelings of powerlessness and helplessness are overcome, new skills are acquired and experiences of self-efficacy are opened up.

 

After psychotraumatisation, children and adolescents need competent immediate human help and security. You not only have to be really safe but also feel safe, because without this feeling of security the emotional wound cannot heal. “The experienced loss of security in the outer world as a 'safe place' permanently destroys the perception of an inner sense of security of the individual self” (11). “Safe places” can be educational institutions, but also emergency tents in refugee camps or simply marked open spaces in ruins (14). In these structured, safe child protection centers, children and young people should receive educational support. "The educational place as an external safe place offers clear structures and sets rules and consequences for (...) children" (13). This curbs the internal chaos caused by the trauma. The limitation gives new support.

 

The most important factor in healing trauma is the formation of relationships (15). It can lead to a strengthening of the personality of the traumatized person (12). Neurobiological research shows that the correction of the "violation of the basic trust" (16) through new, reliable relationship offers can be considered the most important approach to trauma processing (9).

 

Waldorf education as an emergency educational crisis intervention
The damaging consequences of trauma vary in the various phases of child development (7). The resources for coping with trauma are also age-dependent (17). The following statements are based on sketches by the Israeli doctor Meron Barak (18):

 

In the first seven years, trauma mainly has a damaging effect on the connection between the vital organization (etheric body) and the body (physical body). The metabolic limb system is particularly affected. Rhythms have to be cultivated and the basic senses strengthened. The children should be instructed in imitation.

 

In the second seven-year period, trauma mainly damages the relationship between vital organization (etheric body) and psyche (astral body) as well as the rhythmic system. Visual, artistic lessons as well as eurythmy, painting and music are healing.

 

In the third year seven, during puberty, adolescence and coming of age, psychotraumatisation mainly disrupts the relationship between psychological organization (astral body) and individual-personal organization (ego) as well as the nerve-sensory system. There is then the risk that the astral body will either connect too deeply or not deeply enough with the metabolic-limb system. It is therefore beneficial to stimulate social activities, to pay attention to clear thinking and to enable young people to come to terms with ideals by means of biographies.

 

Waldorf education sees itself as an education that is based on a spiritually expanded, holistic view of mankind (19). Man is understood as a being that already exists before birth and will continue to live after death. One of the specific tasks of Waldorf education is to support and promote the incarnation process of the child, i.e. the phase-specific connection of the soul-spiritual dimension with the foundations of the body, by means of educational interventions.

 

A psychotrauma can be understood as a state of shock against the background of anthroposophical considerations (20). In the process, the human being's “essential elements” (21) (19) are torn out of their normal functional structure. Near-death experiences can occur during this process of excarnation. It is possible that the partially detached, "crazy" structure of the human limbs no longer works together in an orderly manner. These states of displacement can lead to psychopathological symptoms (ibid.)

 

It is the task of emergency pedagogy oriented towards Waldorf education to help re-harmonize the structure of the human body after trauma. Waldorf education, which sees itself as accompanying incarnation, is particularly suitable as emergency education to make its contribution to this healing process.

 

 

Bernd Rufwas co-founder and for over 20 years senior teacher at the Waldorf School in Karlsruhe. Bernd Ruf's activities spread worldwide with the growing Waldorf school movement, especially in socially disadvantaged areas and crisis areas. Since 1990 he has been the managing director of the Friends of Waldorf Education. In addition, Bernd Ruf co-founded the Parzival schools in Karlsruhe in 1999. Today the center comprises six schools: a special needs school, a technical school, a school for soul care, and a special educational and advisory center (SBBZ), the Karl-Stockmeyer Waldorf School, refugee classes (VAB-O) and classes for vocational preparation (VAB). There is also a children's house, which includes a day-care center, a children's flu and a special school kindergarten. There is also a zoo and a school farm on the grounds of the Parzival school center, social therapy and an outpatient clinic for emergency pedagogy, as well as youth welfare. In 2006 Bernd Ruf discovered another field of work: emergency pedagogy. He is also a member of the International Conference of the Waldorf Education Movement (Hague Circle) and regularly gives lectures and seminars on Waldorf and emergency education in Germany and around the world.

 

literature
(1) Ruf, B. (2008b): When worlds collapse. Emergency pedagogy in the earthquake region of Sichuan / China. In: Waldorf Education. Journal of Rudolf Steiner's Pedagogy, Volume 72, September 9, 2008, pp. 979 - 983.
(1) Ruf, B. (2009a): Rubble and Trauma. Crisis intervention in Gaza. In: Waldorf Education. Journal of Rudolf Steiner's Pedagogy, Volume 73 / March 2009, 297 - 301.
(1) Ruf, B. (2009b): The shooting continues in the mind. Waldorf education as emergency education with psycho-traumatized children in the Gaza Strip. In: Care of the soul in curative education and social therapy, 28th year, 2009, no. 4, pp. 6-15.
(1) Ruf, B. (2009c): Education in the ruins of Gaza. Emergency pedagogy with war-traumatized children in the Gaza Strip. In: Punkt und Kreis, Christmas 2009, no. 18, pp. 8-11.
(1) Ruf, B. (2010a): First aid for the soul. In: Waldorf Education. Waldorf Education Today. Volume 74, 2/2010, pp. 48-49.
(1) Ruf, B. (2010b): Desperate, disturbed and abandoned. Emergency pedagogical deployment in Haiti. In: Waldorf Education. Journal of Rudolf Steiner's Pedagogy, Vol. 74, May 5, 2010, pp. 40f. (1) Ruf, B. (2015) Escape Trauma School. Schooling and care of unaccompanied minor refugees at the Parzival school center in Karlsruhe. Parzival school center. Brochure.

(1) Ruf, B. (2016) Escape Trauma Pedagogy. How Waldorf Education can help refugee minors to overcome their stressful experiences. Friends of Rudolf Steiner's art of education. Karlsruhe. Brochure.
(2) Dehner-Rau, C., Reddemann, L. (2007): Trauma.Recognize, overcome and grow with consequences. Stuttgart.
(2) Krüger, A (2007b): Psychotrauma in children and adolescents: diagnosis and therapy. In: Child abuse and neglect. Interdisciplinary journal of the German Society against Child Abuse and Neglect (DGgKV) e.V., Vol. 10, Issue 2, pp. 42-64.
(3) Landolt, M. A. (2004): Psychotraumatology of childhood. Goettingen.
(4) Eckardt, J. J. (2005): Children and Trauma. Göttingen: Vanderhoeck & Ruprecht

(4) Karutz et Al (2017) Civil Protection. Emergency preparedness and crisis management in theory and practice. Heidelberg: Springer.

Karutz, H., Juen, B., Kratzer, D., Warger, R. (Eds) (2017): Children in Crises and Disasters. Especially aspects of psychosocial emergency care. Crisis Intervention and Emergency Care, Vol. 4. Innsbruck.
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(6) Hausmann, C. (2006): Introduction to Psychotraumatology. Vienna. P. 31.
(7) Krüger, A. (2007a): First aid for traumatized children. Dusseldorf.
(8) Levine, P.A., Kline, M. (2005): Healing Wounded Children's Souls. How children and young people can overcome traumatic experiences. Munich.
(9) Hüther, G. (2002): And nothing will be the same from now on. The consequences of traumatic childhood experiences for further brain development. In: PAN, Foster and Adoption Families NRW e.V. (Hg): Traumatized children in foster and adoptive families. Ratingen.
(10) Rothschild, B. (2002): The body remembers. The psychophysiology of trauma and trauma treatment.
(11) Kühn, M. (2009): “Finally make your world mine again!”. Notes on the concept of trauma pedagogy. In: Bausum J., Besser, L., Kühn, M., Weiß, W. (2009): Trauma pedagogy. Basics, fields of work and methods for educational practice, Weinheim-Munich, pp. 23-35.
(12) Herman, J. 20062, The scars of violence. Understanding and overcoming traumatic experiences. P. 166f. Paderborn: Jungfermann.

(13) Kumberger, E. (2007): Trauma in Childhood. Traumatic situations, effects and educational aspects. In: Trauma Pedagogy. Curative educational approaches to people with trauma. Specialized Academy for Curative Education Regensburg. Pp. 27 - 48. Regensburg.
(14) Ruf, B. (2010c): Shelters for children. Waldorf education-oriented “Child friendly Spaces” for traumatized children in Haiti, which was destroyed by the earthquake. In: The Christian Community. 7-8 / 2010, 405-409.
(15) Weiß, W. (2008): Philipp is looking for his self. For the pedagogical handling of trauma in development aid. Weinheim-Munich.
(16) Erikson, E. H. (2000): Identity and Life Cycle. Frankfurt a. M.
(17) Krüger, A. (2008): Acute psychological trauma in children and adolescents. A manual for outpatient care. Stuttgart
(18) Barak, M. (2006): Guidelines for the treatment of mental trauma. Harduf. (unpublished manuscript)
(19) Leber, S. (19923): The pedagogy of the Waldorf school and its basics. Darmstadt.
(19) Leber, S. (1993): The study of man in Waldorf education. Anthropological foundations for the upbringing of children and young people. Stuttgart.
(20) Ruf, B. (2008a): When the indescribable happens. Waldorf education as emergency education in dealing with psychotraumatized children and adolescents. In: Schiller, H. (2008): Reality and Idea. Stuttgart.
(21) Steiner, R. (19924/ 1907 / GA 34): The education of the child from the point of view of spiritual science. Dornach.

(22) Fischer G., Riedesser, P. (20094) Textbook of Psychotraumatology. Munich: Reinhard Verlag.

(23) Ruf, B. (2014) Loarnas search for oneself. - Trauma pedagogy and identity formation in complex traumatized children and adolescents. In: Neider, A. (2014) Learning, Development and Memory. Anthropological and pedagogical aspects of identity formation in children and adolescents. Pp. 100-131. Stuttgart. Edition Waldorf.

(24) Reveriego, M & Bernd Ruf (2013) When children fall out of the ordinary. Trauma-oriented intensive education. In: Kaschubowski, G. Maschke, T. (Ed.) Anthroposophical curative education in schools. Basic method examples. 206-237. Stuttgart: Kohlhammer Verlag.

(25) Karutz, H. (2011) Emergency Pedagogy. Concepts and ideas. Edewecht: Publishing company Stumpf & Kossenday.

(25) Weiß, W., Kessler, T. Gahleitner, S. (Eds.) (2016): Handbuch Traumapädagogik. Weinheim-Basel: Beltz Verlag.

(26) Ruf, B. (2011) First aid for the soul. How children learn to overcome severe trauma through emergency pedagogy. In: Neider, A. (2011) Crisis Management Resistance forces, social ties in childhood and adolescence. Pp. 173-228. Stuttgart: Verlag Free Spiritual Life.


further reading
Bausum, J., Besser, L., Kühn, M., Weiß, W. (Eds.) (2009): Trauma pedagogy. Basics, fields of work and methods for educational practice. Weinheim-Munich.
Bölt, F. (2005): Making young people strong against adversity and stress. Dealing with stress disorders in children and adolescents in school. In: Pedagogy, Volume 57, Issue 4, Hamburg.
Egle, U., Hoffmann, S., Joraschky, F. (20053): Sexual abuse, mistreatment, neglect. Stuttgart.
Endres, M., Biermann, G. (2002): Traumatization in Childhood and Adolescence.
Fischer, G. (2003): New ways out of trauma. First aid for severe mental stress.
Glanzmann, G. (20042): Psychological care for children. In: Bengel, J. (Hg): Psychology in emergency medicine and rescue services. Berlin. P.133ff.
Gschwend, G. (20042): Emergency Psychology and Trauma Therapy. A guide for the practice. Hausmann, C. (20052): Handbook of Emergency Psychology and Trauma Management. Basics, interventions, care standards. Vienna
Hilweg, W., Ullmann, E. (1998): Childhood and Trauma. Separation, abuse, war. Goettingen.
Herbert, M. (1999): Post-Traumatic Stress. The memory of the disaster and how children learn to live with it. Bern.
Juen, B. (2002): Crisis Intervention in Children and Adolescents. Innsbruck.
Karutz, H. (2004): Psychological first aid for uninjured - affected children in emergency situations.
Karutz, H., Lagossa, F. (2008): Children in emergencies. Psychological first aid and aftercare.
Kocija-Hercigonja, D. (1998): Children in War. Experience from Croatia. In: Hilweg, W., Ullmann, E. (1998): Childhood and Trauma. Separation, abuse, war. Göttingen, p. 177 ff.
Kolk, B. A. van der (1999): On the psychology and psychobiology of childhood trauma (developmental trauma). In: Streeck-Fischer, A .: Adolescence and trauma. Goettingen.
Krüsman, M., Müller-Cyran, A. (2005): Trauma and early intervention.
Landolt, M. A. (2000): The Psychology of the Accident Child. In: Anaesthesiology, intensive care medicine, emergency medicine, pain therapy, 35, p. 615ff.
Landolt, M. A. (2003a): The psychologically traumatized child. In: Pädiatrische Praxis, 63, pp. 599ff.
Landolt, M. A. (2003b): Coping with acute psychotraumas in childhood. In: Praxis der Kinderpsychologie und Kinderpsychiatrie, 52, p. 71ff.
May, A. (2003): Traumatized Children. Educational and therapeutic options for intervention. Berlin.
Perry, B. (2003): Violence and Childhood. How constant fear can affect a child's brain as it grows. In: May, A., Remus, N .: Traumatized Children. Berlin.
Servan-Schreiber, D. (200610): The new medicine of emotions. Stress, anxiety, depression: getting well without medication. Munich
Streeck-Fischer, A. (1999): Adolescence and Trauma. Goettingen.