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Acute Stress Disorder Appendix A Acute Stress Disorder Scale (ASDS) Name: ______________________________ Date: _________________________________ Briefly describe your recent traumatic experience: _______________________________ ____________________________________________________________________________ ____________________________________________________________________________ Did the experience frighten you? Yes No ____________________________________________________________________________ Please answer each of these questions about how you have felt since the event. Circle one number next to each question to indicate how you have felt. Not at all Mildly Medium Quite a bit Very much 1. During or after the trauma, did you ever feel 1 2 3 4 5 numb or distant from your emotions? 2. During or after the trauma, did you ever feel in a 1 2 3 4 5 daze? 3. During or after the trauma, did things around 1 2 3 4 5 you eve1 feel unreal or dreamlike? 4. During or after the trauma, did you ever feel 1 2 3 4 5 distant from your normal self or like you were watching it happen from outside? 5. Have you been unable to recall important aspects 1 2 3 4 5 of the trauma? 6. Have memories of the trauma kept entering your 1 2 3 4 5 mind? 7. Have you had bad dreams or nightmares about 1 2 3 4 5 the trauma? 8. Have you felt as if the trauma was about to 1 2 3 4 5 Acute Stress Disorder happen again? : 9. Do you feel very upset when you are reminded 1 2 3 4 5 of the trauma? 10. Have you tried not to think about the trauma? 1 2 3 4 5 11. Have you tried not to talk about the trauma? 1 2 3 4 5 What Educator’s Should 12. Have you tried to avoid situations or people that 1 2 3 4 5 remind you of the trauma? 13. Have you tried not to feel upset or distressed 1 2 3 4 5 about the trauma? 14. Have you had trouble sleeping since the 1 2 3 4 5 Know trauma? 15. Have you felt more irritable since the trauma? 1 2 3 4 5 16. Have you had difficulty concentrating since the 1 2 3 4 5 trauma? 17. Have you become more alert to danger since the 1 2 3 4 5 trauma? Jessica Humphrey 18. Have you become jumpy since the trauma? 1 2 3 4 5 19. When you are reminded of the trauma, do you 1 2 3 4 5 sweat or tremble or does your heart beat fast? University of Pittsburgh, School of Education Source: Bryant, R. A., and Harvey, A.G. (2000). Acute stress disorder: A handbook of theory, assessment, and treatment. Washington, D.C.: American Psychological Association. © Humphrey, 2010 24 Table of Contents References Alat, Kazim. (2002). Traumatic events and children: How early childhood educators can help. Childhood Education, Fall 2002, 1‑8. What is ASD? 3 Brewin, C. R., Andrews, B., Rose, S., and Kirk, M. (1999). Acute stress disorder and posttraumatic stress disorder Common Symptoms 5 in victims of violent crime [Electronic version]. American Journal of Psychiatry, 156(3), 360‑366. Bryant, R. A., and Harvey, A. G. (2000). Acute stress disorder: A handbook of theory, assessment, and treatment. Facts 7 Washington, D.C.: American Psychological Association. Bryant, R. A., Moulds, M. L., Guthrie, R. M., and Nixon, R. D. (2005). The additive benefit of hypnosis and Research 8 cognitive‑behavioral therapy in treating acute stress disorder [Electronic Version]. Journal of Counseling and Clinical Psychology, 73(2), 334‑340. Treatment 9 Bryant, R. A., Sackville, T., Dang, S. T., Moulds, M., and Guthrie, R. (1999). Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques [Electronic version]. Children Stories 10 American Journal of Psychiatry, 156(11), 1780‑1786. Kassam‑Adams, N., Garcia‑Espana, J. F., Miller, V. A., and Winston, F. (2006). Parent‑child agreement regarding What can educator’s do? 11 children’s acute stress: The role of parent acute stress reactions [Electronic version]. American Academy of Child and Adolescent Psychiatry, 45(12), 1485‑1493. doi: 10.1097/01.chi.0000237703.97518.12 Child Responses to Trauma 12 Meiser‑Stedman, R., Smith, R., Glucksman, E., Yule, W., and Dalgleish, T. (2007). Parent and child agreement for Classroom Exercises 14 acute stress disorder, post‑traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single‑event trauma. Journal of Abnormal Child Psychology, 35, Obstacles and Suggestions 16 191‑201. doi:10.1007/s10802‑006‑9068‑1 Project Reassure. (2007). Project Reassure: Printable Resources for Caretakers of Traumatized Children and Youth. Resources 18 Retrieved from http:www.projectreassure.com on December 10, 2010. Salmon, K., and Byrant, R. A. (2002). Posttraumatic stress disorder in children: The influence of developmental Glossary 22 factors. Clinical Psychology Review, 22, 163‑188. References 23 2 23 Glossary What is Acute Stress Disorder (ASD)? Affective: emotion or feeling Acute Stress Disorder (ASD) occurs when and individual experi‑ Comorbidity: pertaining to two things which occur together ences posttraumatic stress reactions that occur in the initial Depersonalization: a state in which one no longer perceives the month after a traumatic experience. Approximately 80% of peo‑ reality of oneʹs self or oneʹs environment; sense that one’s body ple, adults and children, who initially meet the criteria for ASD subsequently develop chronic posttraumatic stress disorder is detached or one is seeing oneself from another perspective (PTSD) (Bryant et al., 1999). Derealization: an alteration in perception leading to the feeling Criteria for ASD: that the reality of the world has been changed or lost; percep‑ The first requirement of ASD is the experience of a precipitating tion of one’s environment is unreal, dreamlike, or occurring in stressor: the person has experienced or witnessed an event that has a distorted time frame been threatening to themselves or another person. This event causes the person to feel fear, helplessness, or horror. Disorder: a disturbance in physical or mental health or func‑ The person must also display at least three dissociative symptoms tions either at the time or trauma or in the first month posttrauma. Dissociative: disconnection or interruption of consciousness Dissociative symptoms include: (1) numbing: detachment from expected emotional reactions, (2) reduced awareness of Epidemiology: scientific study of the causes, distribution, and surroundings: being less aware than one would expect of events at control of disease in the population the time of trauma or immediately after, (3) derealization: perception of one’s environment is unreal, dreamlike, or occurring Enuresis: bedwetting in distorted time frame, (4) depersonalization: sense that one’s Ideation: process of forming ideas or images body is detached or one is seeing oneself from another perspective, and (5) dissociative amnesia: inability to recall a Inoculation: introduction critical aspect of the trauma. Intrusive: to intrude; interfere; distract The trauma needs to be re‑experienced in at least one way: recurrent images, thoughts, dreams, illusions, flashback episodes, Maladaptive: marked by poor or inadequate adaptation or a sense of reliving the event. Meta‑analysis: a quantitative statistical analysis of several The person must display marked avoidance of thoughts, feelings, activities, conversations, places, and people that may remind the separate but similar experiments or studies in order to test the person of their traumatic experience. pooled data for statistical significance Marked symptoms of anxiety or arousal must be present after the Provision: providing or supplying trauma for at least two days (see Table 1). 22 3 Table 1 Diagnostic Criteria for ASD in DSM‑IV Organizations: Criterion ASD American Academy of Experts in Traumatic Stress. 368 Stressor Both: Veterans Memorial Highway, Commack, NY 11725. Threatening event Telephone: (631) 543‑2217 www.aaets.org Fear, helplessness, or horror Anxiety Disorders Association of America. 11900 Parklawn Dissociation Minimum of three: Numbing Dr., Ste. 100, Rockville, MD 20852. Telephone: (301) 231‑9350 Reduced awareness International Society for Traumatic Stress Studies. 60 Revere Depersonalization Drive, Suite 500, Northbrook, IL 60062. Derealization Telephone: (847) 480‑9028 www.istss.org Amnesia Re‑experiencing Minimum of one: Recurrent images/thoughts/distress Local Resources: Consequent distress not Western Psychiatric Institute and Clinic (WPIC). 3811 O’Hara prescribed Street Pittsburgh, PA 15213. Telephone: (412) 624‑1000 Intrusive nature not prescribed http://www.upmc.com/HospitalsFacilities/Hospitals/ Avoidance Marked avoidance of: wpic/Pages/default.aspx Thoughts, feelings, or places Local clinicians Arousal Marked arousal, including: Social support groups relevant to the trauma Restlessness, insomnia, Family/ Friends/ Teachers/ Peers irritability, hypervigilance, and concentration difficulties Duration At least 2 days and less than 1 month posttrauma Dissociative symptoms may be present only during trauma Impairment Impairs functioning Source: Bryant, R. A., and Harvey, A.G. (2000). Acute stress disorder: A handbook of theory, assessment, and treatment. Washington, D.C.: American Psychological Association. 4 21 Further Resources Common Symptoms Children’s Books continued: Individuals are not effected the same way by trauma. Some may Let’s Talk About Feeling Sad never experience symptoms and other may experience less or very Joy Berry (Author), Maggie Smith (Illustrator) severe trauma‑related symptoms. Evidence of ASD may not ap‑ New York: Scholastic (1996) pear on the same day as the traumatic event.
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