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Quick Teach W.E.Krill, Jr.M.S.P.C.Response Particulars to a Stress Disordered Child
Often, in the treatment of children with diagnosed stress disorders, the treatment approach of theadult (
what 
the adult does, and how the adult responds) is counter-intuitive to how we mightordinarily respond to an acting out child.The following response particulars will be presented this way: the behavior the child is engagingin, the
adult response
, and then the reason for that response.Building stress:
Once we become aware that a child is stressed ,we need to respond appropriately. If we do not, the child will likely escalate in their behaviors.
Most adults can spotwhen a child is becoming stressed out. Generally, the child with stress disorder will have muchmore subtle signs over a longer period of time. Adults may need to become much moreobservant of children who have diagnosed stress disorders. One way to understand the stressedchild is to think of a glass of water: we all have some stress in our “glass”. A child with stressdisorder has a glass that is nearly always full. When enough stress is collected, the glass willoverflow with symptoms (behaviors). If signs of stress are spotted early and responded toproperly, there can be very good results in treatment.Cues and triggers:
 Adults in contact with a child who has a stress disorder diagnosis need tolearn about and become sensitive to the child’s cue and trigger behaviors. These can be very dramatic, or they can be very subtle and hard to see. If adults do not attend to this important and basic aspect of the child’s treatment, the child’s healing will be delayed, or even halted entirely.
A stressed child’s behaviors come out of cues and triggers. A cue is something in the child’senvironment that reminds them (often unconsciously) of something related to their trauma eventthat triggers a stress reaction. A cue can be an item, a smell, a taste, a noise, a tone of voice, aphysical gesture, or even just a thought. There can be hundreds of cues for someone with astress disorder, and other people can not do much about avoiding them. Sometimes, a particular few cues and known triggers are revealed, and then these can be avoided, especially by thoseadults treating the child. Cue and trigger behaviors for a child may include such things asincreased distractibility, finger nail chewing, glassy eyed stare, apparent ignoring of adults or peers, combativeness, or physical intrusions. Many other cue and trigger behaviors follow below.Stress Break:
Constructing a routine “stress break” for the child can be very effective in heading off full blown stress episodes. It also supports the treatment objective of helping the child torecognize their own stress levels and learning how to self calm. The break can be as simple asallowing or directing the child to engage in a behavior that is known to be calming to them. Thiscould be cuddling a stuffed animal, listening to music, reading a story book, doing prescribed breathing exercises, or playing with a toy. In the classroom, a “secret signal” can be arranged between the adult and the child, so that the child may access (or the teacher direct) a stressbreak quickly, with little distraction in the classroom.
Many adults feel that such breaks areindulgent to the child. They see the acting out behaviors in the context of either defiance or aspoiled child. Nothing could be further from the child’s reality. These adults are not understandingthe intensity and anguish of internal distress that the child is undergoing. Essentially, when achild has been cued and triggered into a stress episode, their bodies and minds are reacting thesame exact way that they did when their original trauma was taking place (read: flood,earthquake, fire, rape, physical abuse, sexual abuse, food deprivation). Once this is understood,any adult should be able to be compassionate and begin to follow a treatment plan that isdesigned to help the child avoid escalations of this highly painful state.
 
Quick Teach W.E.Krill, Jr.M.S.P.C.Response Particulars to a Stress Disordered Child
Defiance or general acting out:
Use a normal voice tone devoid of pressure and inflection. Try tokeep your voice as neutral as possible, but firm. Make your directive brief and to the point. You may repeat the directive once more, but do not keep repeating or elaborating. You may chooseto direct the child to take a “stress break.” 
 
Following your initial presentation, turn away from thechild and give them opportunity to self calm, or comply with directive to take a stress break. (See“stress break”).
You are trying to avoid adding any extra stress or pressure to the child than isabsolutely necessary. Most adults add more pressure by raising their voices or making threats toget an oppositional child to respond. With stress disordered children, this only increases their resistance to us, and will likely trigger a full blown stress episode.Tears, pouting, crying:
First, use all of the suggestions above. Try not to react to the tears , pouting, or crying. Treat the upset with matter of fact recognition of their distress. (“I can see that you are upset”). You might offer a choice to the child, and identify the choice that you think is thebetter one. If the child is expressing tears in an over reaction, you may also say to the effect:“There is no reason to be crying right now….(give directive).” Do not over elaborate or engage indebate with the child. Turn away from the child and allow them time to either self calm or take astress break.
You are trying to communicate to the child that while you can see that they aredistressed, they need to follow your directions Your calm voice and low intensity approach tellthem that your directions are not threatening to them. If you would raise your voice or intensity,the child will likely trigger to a full blown stress reaction. Children with stress disorder are easilycued and triggered by adults who react to the child in ways the child is anticipating. When wereact to the child in ways that (perhaps a perpetrator) did, the child will escalate.Demanding, hostile, nasty, oppositional:
Use all of the responses that appear in “defiance or general acting out.” Using a neutral, non-intense tone of voice, give an immediate directive for a“time out”. It is important that this “time out” be immediate, and not “later”. It is also important that this “time out” be clearly different from a “stress break”. This can be done by making the “timeout” a particular chair or place (never the bedroom, or out of an adult’s sight). You may also call the “time out” place something like “the naughty chair”. When giving your directive to go to timeout, be very careful about physically approaching the child; do not make sudden gestures, keep proximity reasonably distant. If you approach, approach slowly.
It is important to keep your voicetone normal, because if you raise it, you may trigger a larger reaction. Adults do not have to yellor threaten to be effective in being firm! Once again, we need to respond to the child in amanner that is different than what they may have experienced in the past. A stressed child needsto have immediate penalties for misbehavior because one of the symptoms that they may haveis a poor memory. This is an effect of the trauma they have experienced. If we wait until later (asin, “no recess for you today“), they will simply experience the later penalty as cruelty. They mayalso trigger into a stress reaction when recess time comes around.When the child balks at a directive or given task:
By now, you should have the “neutral, firm toneof voice” idea firmly in mind! Remember to avoid debating with the child. Give a choice whenappropriate, and encourage that the child “make a good choice”. Give your directive, and repeat it once if needed. Give advisement about the consequence of not following the directive or completing the task. Then, turn away and give the child time to self calm or take a stress break.Follow up within five to ten minutes by repeating the directive. If the child continues to refuse,apply the (immediate) consequence.
When a child with stress disorder has a negative behavior,it does not always mean that it is stress related, but it could be. That is why you use the samebasic “neutral firm tone” when approaching them. Many adults begin to anticipate that each timea stress disordered child is upset, the child will escalate. In anticipation of this, the adult behavior and approach may change subtlety, become more anxious of a bigger upset. It is important tonote that the adult’s anxiety and stress can actually trigger the child !
Response Particulars to a Stress Disordered Child
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