As expected, the onus is customarily on Psychiatric Mental Health Nurse Practitioners (PMHNPs) to act responsively and apply empathy during the evaluation of sensitive issues that threaten children and adolescents. Acts of terrorism have recently emerged as the archetypal representation of a special issue and with the potential to impart long-lasting trauma on children. According to Browne (2019), exposure to trauma, both directly or indirectly, may vary in its impact on individual juveniles but still considered a major risk factor in the development of various forms of psychopathology in children and adolescents (p. 190). An evaluation of possible psychological issues, assessment measures applied within this section of society, treatment options for children and an analysis of cultural influences on treatment are, therefore, warranted when aspiring to gain an in-depth comprehension of the impact of acts of terrorism on children.
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Psychological Issues Among Children Caused By Terrorism
Acts of terror cause a great deal of psychological stress among children. This is habitually the result of direct or indirect exposure to trauma or knowledge of someone close to them having been involved is such fateful incidences. Children below the age of 19 years, are normally still in the developmental stages in risk assessment, psychological coping mechanism, and cognitive abilities and are likely to be affected significantly by trauma (De Young & Scheeringa, 2018). Post-Traumatic Stress Disorder (PTSD) is one of the main geneses of psychological issues witnessed among children and adolescents.
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The 5th edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) classifies PTSD for children and adolescents under Trauma-and-Stress-Related Disorders. This diagnostic criterion relies upon exposure to a psychologically stressful event, prominent dissociative symptoms, and distorted sense of reality as major signs of PTSD in children above the age of six (American Psychiatric Association, 2013). PTSD among children causes psychological issues with sweeping outcomes. PTSD is associated with the emergence of neurodevelopmental disorders, schizophrenia spectrum disorders, depressive disorders, obsessive-compulsive related disorders, and bipolar disorder as major psychological issues (Rothbaum & Rauch, 2020). Furthermore, PTSD among children may also present with frequent suicidal ideations, frequent anxiety, emotional numbness, and sleep disturbances. PMHNPs are among an integral class of professionals providing crucial mental health services to children and adolescents as part of health promotion.
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Assessment Measures
Identifying cases of PTSD among children is one of the most challenging practices today. DSM-5 is a leading assessment measure used in categorizing childhood PTSD in individuals above 6 years of age. The diagnostic criteria subsequently identifies direct or indirect exposure to a traumatic event, witnessing a traumatic event, and learning of its impacted on a close family member are major factors to consider during the initial assessment (American Psychiatric Association, 2013). Furthermore, recurrent flashbacks can be intrusive, and accompanied by an overall repression of memories associated with the event, the presence of frequent nightmares, a high level of psychological distress, and avoiding stimuli associated with the event.
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The preliminary assessment of juvenile patients in alleged cases of PTSD normally evaluates subjects for any overt evidence of changes in cognition and mood, devoid of an organic basis (Loeb et al., 2018). Children and adolescents living in war zones such as Syria or in low-income inner-city environments in the U.S. with a relatively high per-capita homicide rate such as neighborhood zones and housing project blocks in Chicago, Illinois are highly likely to be exposed to trauma-and-stress related trauma (Rothbaum & Rauch, 2020). Children and adolescents exposed to a considerable degree of trauma feel secluded, have noticeable memory issues, and experience excessive self-blame, especially after surviving a terrorist onslaught (Garro, 2016). An additional assessment measure involves identifying signs of hyperarousal, hypervigilance, frequent sleep disturbances, irritability, and concentration problems. Symptoms should have persisted for at least a month and directly linked to a traumatic event (Kerig et al., 2018, p. 165). The condition should also interfere considerably with normal functioning and not as a consequence if illness or substance abuse.
Treatment Options
Although numerous treatments for PTSD have arisen in recent years, a suitable intervention would be to essentially to combine pharmacological options and psychotherapeutic practices. However, the U.S. Food and Drug Administration (FDA) is yet to approve any selective serotonin reuptake inhibitor (SSRI) antidepressant to treat PTSD among minors (Espinel & Shaw, 2018). A viable alternative option relies on cognitive behavioral therapy (CBT), trauma-focused therapy and exposure to stimuli as a viable treatment options in successful managing PTSD in minors. Furthermore, such efforts are further buttressed by prescribing Alpha-1 adrenergic antagonist to manage sleep disturbances, nightly awakenings, and sleep disturbances (Haag et al., 2019).
Cultural Influences on Treatment
Cultural competence is vital when treating various psychiatric conditions due to variations in perception about mental health issues amongst different cultures. These differences are also present in notions regarding the most appropriate intervention to implement in the management of a psychiatric disorder (Rothbaum & Rauch, 2020). For instance, mental health disorders are shrouded in superstition within the Puerto Rican folk belief system where a psychiatric patient is routinely thought to have gone “loco” (crazy), signifying their exposure to evil spirits (Carlos, 2017, p. 297). Other cultures may assume the child is bewitched and propose mystical interventions by inviting a spiritual medium or exorcist. However, ethical practice dictates that PMHNPs should participate in health promotion initiatives by guiding parents or legal guardians through some of the most suitable treatment options and, demystifying myths surrounding mental health conditions.
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Conclusion
Acts of terrorism present a constant threat to children and their overall wellbeing. Exposure to trauma may cause PTSD and the emergence of associated psychological issues such as neurodevelopmental disorders, schizophrenia spectrum disorders, depressive disorders, obsessive-compulsive related disorders, and bipolar disorder. Assessment measures rely on major gauges identified in DSM-5s diagnostic criterion for PTSD. Cognitive behavioral therapy (CBT), trauma-focused therapy, and exposure therapy are the only treatment options currently recommended for children with PTSD. PMHNPs must, therefore, implement learnt cultural competence skills during initial assessments; dispelling cultural misconceptions and guiding the parent or guardian in choosing the most feasible treatment option available.
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