In this review we have attempted to cover as many of the major areas as possible in order to present a reasonably comprehensive overview of the subject.
The definition of a traumatic experience is subjective from both the point of view of the child concerned and also form the observer. Some commentators have suggested that the only workable definition of a traumatic experience is one that, by definition, produces demonstrable psychological sequelae. (Abikoff 1987) This may be the case, but as other commentators observe, some psychological sequelae may not surface for years, if at all. This does not mean that the original triggering episode was not traumatic. There is also the view that that the worst kind, or most extreme type of trauma may be the most likely to be actively suppressed at either a conscious or subconscious level. (Haddad & Garralda. 1992)
With an area of literature as vast as the one that we are considering here, it is often difficult to find a place to start. In this instance we will consider the paper by Prof. Harry Zetlin (1995) who starts with a short monograph on the screening of a television programme which dealt with arguably the most catastrophic of stresses to befall a child, that of the loss of a parent through murder or violence. He makes several thought provoking comments which are worthy of consideration as they are germinal to the thrust of this article. The first is a plea that the diagnostic label of post-traumatic stress should not be a catch-all basket for all emotional and behavioural problems that can occur after a traumatic experience. (Gorcey et al.1986)
The second is the realisation that in the particular circumstances portrayed on the television where a parent is murdered have two consequences. The first is the obvious catastrophic trauma that the child experiences with the violent loss of a parent, but the second is the much less obvious fact that the child has, at a stroke, also lost a valuable, and normally available resource, of the protective family environment, which is often one of the most useful therapeutic tools available to the therapist. He adds to this two further insights. The first is that the surviving parent has their own trauma to deal with and that is invariably transmitted to the child and that, because such events are mercifully comparatively rare, only a comparatively few professionals are ever able to build up any significant expertise and experience on the subject.
The main issue of the piece is, however, the very relevant point that considering the apparent obsession of the media with intrusive fly-on-the-wall documentaries and the almost equally insatiable public hunger for sensation, the very fact that such a programme is made at all, almost inevitably adds to the trauma felt by the victims. (Koss et al 1989) One could argue that actually confronting and talking about such issues is part of the healing process. Such considerations may be of value in the adult who is more able to rationalise the concepts involved, but to the child this may be very much more difficult and being forced to relive the episodes in a very public and unfamiliar arena, may do little more than add to the psychological stresses and damage already caused. (Mayall & Gold 1995)
This paper offers a wise and considered plea for sense and moderation, not to mention reservation and decency. It is written in calm and considered moderate tones which makes the impact of its message all the more powerful. The next few papers that we would like to analyse deal with the thorny issue of Attention deficit hyperactivity disorder (ADHD) in children. It has to be...