Post-traumatic stress disorder and trauma responses — formative SAQs

SAQ 1 — Sorting a reaction from a disorder and choosing first-line care (10 marks)

A 9-year-old presents five weeks after a serious house fire with nightmares, avoidance of the kitchen where the fire began, hypervigilance, and a clear decline in school concentration. The parent asks for "something to calm him" and wonders whether a counsellor should make him "talk it through" straight away. [1] [11]

Questions

1. Using time and impairment, classify this child's presentation and justify the diagnosis. (3 marks) [11]
2. Outline the first-line definitive management, naming the evidence class and the key components of the therapy. (4 marks) [1] [11]
3. Address the parent's request for medication and "debriefing", with evidence. (3 marks) [10] [11]

Model answer

Classification (3). Symptoms of intrusion, avoidance and arousal persisting beyond one month with functional impairment meet PTSD; an acute stress reaction (hours–days) and Acute Stress Disorder (three days to one month) are excluded by the five-week duration, and recovery has not occurred. [11]

First-line management (4). Trauma-focused cognitive behavioural therapy is first-line, established by the Cohen multisite RCT in children and cost-effective per Mavranezouli. A full course runs roughly eight to sixteen sessions and includes psychoeducation, parenting skills, gradual exposure and a trauma narrative, cognitive restructuring, affect regulation, and in-vivo mastery of avoided reminders, with caregiver involvement integral to the paediatric model. [1] [11]

Medication and debriefing (3). An SSRI is not first-line for a prepubertal child; it may be considered only as an adjunct in adolescents under specialist care. Single-session psychological debriefing is not recommended as routine prevention, with evidence of no benefit and possible harm. Advise instead that the first month warranted watchful waiting and that he has now stepped into active TF-CBT. [10] [11]

SAQ 2 — Risk factors, safeguarding and disposition (10 marks)

A 12-year-old discloses PTSD symptoms eight weeks after ongoing domestic violence, and during the assessment hints that she is no longer safe at home. [7] [13]

Questions

1. List four recognised risk factors that predict persistence of PTSD in children. (2 marks) [8]
2. What is the correct immediate priority when an unsafe placement or ongoing abuse is disclosed during a trauma assessment, and why? (4 marks) [9] [13]
3. Describe the closed-loop disposition plan you would put in place. (4 marks) [11]

Model answer

Risk factors (2). Perceived life threat; peri-traumatic fear or dissociation; lack of social support; prior psychopathology; severity and repetition of exposure; female sex in adolescence (any four). [8]

Immediate priority (4). Ensure immediate safety; do not begin exposure-based trauma work in an unsafe environment; initiate child-protection and mandatory reporting via the local pathway; provide crisis support and a same-day safety plan with supervision and restriction of means. Trauma processing waits until the child is safe and stabilised. [9] [13]

Closed-loop disposition (4). Name the clinician who owns the plan and the follow-up date; document an interim coping and safety plan with return precautions (re-emergence, self-harm, new disclosures, abuse recurrence); coordinate child protection, school and the general practitioner; arrange stepped TF-CBT once safe; and avoid an open-loop CAMHS referral that leaves the child exposed. [11]