Traumatic Stress and Children

175 Presentation TRAUMATIC STRESS AND CHILDREN CARL C BELL, M.D. Associate Professor of Psychiatry University of Illinois School of Medicine; Executive Director Community Mental Health Council 8704 South Constance Avenue Chicago, Illinois 60617 ESTHER J. JENKINS, Ph.D. Professor of Psychology Chicago State University; Research Director Community Mental Health Council News reports, official statistics, and research data indicate that relatively large numbers of inner-city children are exposed to violence on a regular basis. Furthermore, the exposure occurs in such a manner that it and its pernicious effects are often subtle and underestimated. While child victims of violence elicit considerable concern, and rightfully so, many more children witness extreme acts of violence, often perpetrated against family and friends. This direct observation of the violent assault of another person, referred to as "co-victimization" by Shakoor1, is frequently accompanied by immersion in a violent milieu in which the child is in constant danger if, in fact, never actuaUy victimized. Such exposure to violence has serious consequences for the child's mental health, often resulting in post-traumatic stress disorder (PTSD) symptoms similar to those resulting from direct victimization. In the absence of understanding the symptoms and the circumstances under which they occur, the child's dysfunctional behavior, which often includes poor achievement and acting out, maybe misinterpreted, inaccurately diagnosed, and inappropriately treated. This paper discusses black youths' exposure to violence, the traumatic Journal of Health Care for the Poor and Underserved, Vol. 2, No. 1, Summer 1991 176 Traumatic Stress effects of such exposure, and some approaches to treating the effects as well as preventing the initial exposure. We conclude with research questions that need to be addressed in order to better serve these at-risk youth. Children's exposure to violence Although very little data exist on the actual extent of children's witnessing of violence, there is evidence that such exposure is considerable, particularly for children in the inner city. For example, in Los Angeles county in 1982,10 to 20 percent of the 2,000 homicides were witnessed by a dependent youngster.2 An examination of one-half of the homicide cases in Detroit in 1985 found that 17percentwere witnessed byatotal of 136 youths age 18oryounger.3 In about one-quarter of these cases, a family member was the victim. In an informal sample of 10 mothers in a Chicago public housing development, Dubrow and Garbarino4 found that "virtually all" of the children had had a first-hand encounter with a shooting by age five, and the majority of those incidents appeared to have involved witnessing someone get shot. Our research at the Community Mental Health Council, a comprehensive community mental health center on Chicago's south side, provides further evidence of the extent of the exposure and the types of incidents that are witnessed. Our first study surveyed 536 African-American school children in grades two, four, six, and eight.5 A 32-item questionnaire asked about background , involvement in fights and arguments, and exposure to violence. It also asked whether the child had seen someone shot or stabbed. While the study contained many of the flaws that have characterized similar studies6 elsewhere, most notably that the measures were self-reports, it revealed that a disturbing number of these children had in fact witnessed violence in their environment. Approximately one-quarter (26 percent) of these children reported that they had seen a person get shot and 29 percent indicated that they had seen an actual stabbing. A subsequent screening of over 1,000 middle and high school students found very similar results.17 Among these students from relatively high crime areas on the south side of Chicago, 35 percent had witnessed a stabbing, 39 percent had seen a shooting, and almost one-quarter (24 percent) had seen someone get killed. In the majority of cases, the students reported that they knew the victims, and about half (47 percent) of the victims were known as friends, family members, classmates, or neighbors. In addition, 46 percent of the sample reported that they had personally been the victim of at least one of eight violent crimes, ranging from having a weapon pulled on them to being robbed, raped, shot...