10 September 2003 - WordPress.com · Web viewPost-traumatic Stress Disorder Checklist Student Name:...
3
Post-traumatic Stress Disorder Checklist Student Name: Student Age: Name of person completing form: Posttraumatic stress disorder (PTSD) in children and adolescents can occur as a result of a child’s exposure to 1 or more major traumatic events. These events can include physical or sexual assault, emotional abuse or neglect, natural disasters, accidents, traumatic death or injury of a loved one. NB: This checklist is not a diagnostic tool but provides information about a student’s behaviour. Read each phrase below and mark the response that best describes the individual’s behaviour. Please add comments below each item relating to observations of the student. Re-experiences of the traumatic event Re-enactment of event/s through play, stories or drawings, unusual, inappropriate themes in which aspects of the trauma are repeated Has new phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters) TIM DANSIE PSYCHOLOGY Trading as Dansie’s Head to Toe Pty Ltd T2, 33 Warwick Street, Walkerville SA 5081 Telephone (08 82691818 Fax (08) 82691802 Email – [email protected] ABN: 43 103 052 991
Transcript of 10 September 2003 - WordPress.com · Web viewPost-traumatic Stress Disorder Checklist Student Name:...
Post-traumatic Stress Disorder ChecklistStudent Name:
Student Age:
Name of person completing form:
Posttraumatic stress disorder (PTSD) in children and adolescents can occur as a result of a child’s exposure to 1 or more major traumatic events. These events can include physical or sexual assault, emotional abuse or neglect, natural disasters, accidents, traumatic death or injury of a loved one.NB: This checklist is not a diagnostic tool but provides information about a student’s behaviour. Read each phrase below and mark the response that best describes the individual’s behaviour. Please add comments below each item relating to observations of the student.
Re-experiences of the traumatic event Re-enactment of event/s through play, stories or drawings, unusual,
inappropriate themes in which aspects of the trauma are repeated Has new phobias and anxieties that seem unrelated to the trauma
(such as a fear of monsters)
Avoiding of things associated to the trauma experience Spending more time than usual in imaginary places Difficulties with physical contact (for abuse) Avoidance of distressing memories, thoughts, feelings or external
reminders of the event Shows an inability to remember aspects of the event
Negative thinking and negative mood Shows an increase in protective behaviours towards loved ones
TIM DANSIE PSYCHOLOGYTrading as Dansie’s Head to Toe Pty Ltd
T2, 33 Warwick Street, Walkerville SA 5081Telephone (08 82691818 Fax (08) 82691802 Email – [email protected]
ABN: 43 103 052 991
Is withdrawing socially from friends and others Is disinterested in activities that were previously enjoyed Shows a loss of previously-learned skills and abilities Has developed irritability, is on edge and shows aggressive or
reckless behaviour
Physical responses to re-experiencing the event or negative mood Shows fears of being separated from their parent or loved ones Has apparent tiredness and fatigue Complains of aches and pains with no apparent cause Experiences intense physical reactions to reminders of the event
(e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)
Is tired and reports of poor sleep
Tim Dansie Psychology – 82691818 2
