Medizin & Gesundheit

The Association of Posttraumatic Play and Posttraumatic Stress Disorder and How It Can Be Identified in Young Traumatized Children

The 21st century represents a world where the possibility of experiencing trauma is real. Especially the terror attacks on September 11, 2001 with their psychological and sociopolitical impact on the people in the US and in the Middle East, rising civil wars throughout the world and the global warming resulting in more natural disasters increased the risk of being faced with a trauma.

The person’s response to the trauma involves intense fear, helplessness or horror. It is also noted that in children, the response may be expressed by disorganized or agitated behavior. Common clinical characteristics among traumatized children of all ages are repetitive and intrusive thoughts about the trauma as a kind of re-experiencing. Such recollections particularly occur when the child is about to fall asleep or when confronted with some triggers from the environment that remind the child of the experienced trauma. The manner in which the child re-experiences the traumatic event and manifests distress is likely to change with age and maturity, becoming more similar to adults’ responses. Young children often display signs and patterns of re-experiencing through vivid re-enactment of the trauma by play, stories or drawings. Other typical reactions of children under the age of six in the aftermath of a trauma are fear of the dark, nightmares, difficulties in separating from their parents and regressive behaviors such as bed-wetting and thumbsucking.

The purpose of this work is to examine how posttraumatic play (PTP) is associated with posttraumatic stress disorder (PTSD) in young traumatized children between 3.5 and 7.5 years of age. PTP is a phenomenon usually observed in young children in the aftermath of a trauma and so far primarily known from clinical reports. Another objective is to analyze how PTP can be identified in young children in order to be able to distinguish between the play behaviors of traumatized children and of children without a history of trauma.

Current literature suggests that three different patterns of PTP can be identified, based on the coping and defensive strategies expressed by the child during play, and varying in their adaptive function. ‘Re-enactment with soothing’, the most adaptive coping pattern, and ‘overwhelming re-experiencing’ the most maladaptive coping pattern, were found to be significantly associated with both level of PTSD symptoms and diagnosis. Ratings of video-recorded play therapy sessions analyzing children’s play behaviors, using the ‘Children’s Play Therapy Instrument – Adaptation for Trauma Research’ (CPTI-ATR) in one study and the ‘Trauma Play Scale’ (TPS) in another empirical study, received significant differences in the play behaviors of trauma-exposed and unexposed children.

In conclusion, the CPTI-ATR and the TPS can be employed in the diagnostic procedure, helping to assess PTSD in young traumatized children. Moreover, it is suggested modifying existing empirically supported play therapies in that they specifically focus on the different patterns of PTP in order to reduce PTSD symptomatology of young traumatized children.

Further research is needed to validate the correlational findings between PTP and PTSD and to extend the CPTI-ATR’s range of application regarding children traumatized by diverse events.

Joel Neufeld
Lehr- / Forschungsinstitut
Universität Basel

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