treading into unknown waters - patient's parent was in traumatic accident and dad wants me to check in with kiddo.

[borne_before]

So I did an eval on a kiddo who had a very classic aspergers vibe (like referred to a type of bugs by their Linnaean classification on a certain test). His parent was shot while waiting for him at a service session. She seems to be out of the woods and is having a miraculous recovery, but is still in the hosp.

Father reached out to me to see if I could meet with him to just see how he doing. Of course, I said "yes." I did tell dad this kind of stuff is new to me, so we will be figuring out together and I would consult and do some research. It appears that everything was handled well. The service agency just said "there's an emergency situation and so you're going to stay a little longer and did some preferred activities until dad came." He didn't witness anything.

Based on phone call with dad, the kiddo seems to be having a minimal reaction to this situation so far and I'm sure they're just letting him engage in preferred activities more. I encouraged to not lie, but to also not be overly honest or overly forthcoming (lies of omission might be indicated) and clearly set boundaries between kids problems and adult problems, while reassuring safety. But, he's not asking a ton of questions. I encouraged him going to school (he went back this week, and the importance of resuming normality as much as possible). Dad is already doing a good job of shielding him from tough conversations.

So my plan for tomorrow is just to meet with kiddo and see if he wants to bring anything up. I probably won't mention what happened to to mom (as to not traumatize him), but might ask about her being in the hospital and how he is handling the changes.

But, if it seems like no more services are in order, I'll just recommend that we can meet on an as needed basis, that I'm here for them, and to watch out for any changes in behavior.

Honestly, I am kind of thinking that the ego centricity (because of autism) might actually be a little protective for this kiddo.

I am def out of comfort zone and if there is clear evidence of PTSD or adjustment issues due to trauma, I will of course refer out.

Sorry, I'm just kind of writing out a game plan. But any feedback would be appreciated. Also, did I put too much info up?

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[bcliff]

consider editing to reduce identifiability...

sounds like kid is pretty resilient and in a stable home environment, all things considered, with good support. maybe compile a list of trauma specialists and give that to parent, in case things w kid's reaction change down the road. not sure what waitlists are like in your location but getting on one sooner rather than later might be indicated (e.g., getting on one now to facilitate initiation of services in 6-to-12 months), even if trauma-focused therapy ends up not being needed.

 

[Doctor Eliza]

How old is kiddo?

 

[borne_before]

How old is kiddo?

Nine

 

[Mojito_15]

I work lots w/ kids w/ lots of childhood trauma & ptsd in my current job. I'd caution that kid trauma reactions don't really look like adult trauma reactions and often kids have pretty limited insight into the relationship between why they're feeling the way they are and the trauma they've experienced. It comes out in any number of ways- at one point a mentor said, "the weirder it looks, the more unusual behaviors that don't make sense show up- the more we think it's trauma." and I think that's helpful when understanding kids and trauma. So don't rule out trauma just because lack of "classic" ptsd symptoms. That being said- I do agree in this case that it sounds like kid has been exposed to minimal trauma, has good home supports, and is coping ok. Agreed- compile a list of appropriate referrals if needed in the future. Maybe schedule a 2nd check in-When mom comes home might bring things up for example. Coach dad that he should have a low threshold for reaching out if concerned. Otherwise, I think what you're doing is fine.

 

[Doctor Eliza]

Agree with the above. At that age, I might consider using a book as a jumping off point for discussion in session. I wouldn't shy away from bringing up what happened because you don't want to make it seem like he can't talk about it if he needs to.

Also make sure dad is in close contact with school teacher. They can alert him if there are any changes in behavior at school.

Good luck!

 

[Sanman]

Agree with the others. Have the parents/school monitor for abnormal behavior, be there to have a conversation with the kid if necessary and find out more about his thoughts or any aberrant behaviors. Beyond that, I agree with the egocentricity related to autism might be a protective factor in this case. He may not be as good at picking up the signs that something is wrong as easily as other children. Often, it is more about how the parents are reacting than just the event in question, so time will tell.

 

[WisNeuro]

Always remember that resiliency to trauma and stress is the modal response, not the exception. Or, at least it was up until Gen Z and TikTok.

 

[cara susanna]

Always remember that resiliency to trauma and stress is the modal response, not the exception. Or, at least it was up until Gen Z and TikTok.

I was about to say this - encourage the kid to feel their feelings and process the trauma by talking about it with supportive people, especially if they have self-blame thoughts. But don't assume that they're gonna need PTSD treatment.

 

[futureapppsy2]

I was about to say this - encourage the kid to feel their feelings and process the trauma by talking about it with supportive people, especially if they have self-blame thoughts. But don't assume that they're gonna need PTSD treatment.

Thirding this--most people that experience a traumatic event never develop PTSD and potentially over pathologizing normal, non-pathological post-traumatic feelings and reactions runs the risk of making things worse, not better (especially because PTSD is an anxiety disorder at its core).

 

[Sanman]

Thirding this--most people that experience a traumatic event never develop PTSD and potentially over pathologizing normal, non-pathological post-traumatic feelings and reactions runs the risk of making things worse, not better (especially because PTSD is an anxiety disorder at its core).

You're wrong, I have been told by several veterans that PTSD is not anxiety.

 

[ClinicalABA]

Is there someone with experience in this area you could refer too? I'd always be weary of, as you say, "treading into unknown waters." Doing so loses you a lot of protections.

 

[borne_before]

Is there someone with experience in this area you could refer too? I'd always be weary of, as you say, "treading into unknown waters." Doing so loses you a lot of protections.

In theory, yes. I'm sure there are about a hundred counselors and psyds from the local for profit schools who will do play therapy with this kid and do their best to create a pathology. However, there aren't really any child psychologists with autism experience, who take their medicaid insurance, and people I trust.

I do have some school trauma experience - which is my main approach here. This type of trauma just isn't my speciality.

Dad reached out because we have an alliance, and made it very clear during our phone that he trusts me, and the kid is taking meds from here. He is in a terribly vulnerable state and I couldn't just leave him on a ledge.

In a perfect world, I would ABSOLUTELY love to refer to someone who is better than me at this stuff. But, this is one of those "immovable barriers" situations that ethics courses never really describe.

/end savior complex

That being said, I view this appointment as more a triage and dad understands that. I really like the parts about helping dad know what to look for and keeping in touch with school.

 

[bcliff]

Always remember that resiliency to trauma and stress is the modal response, not the exception. Or, at least it was up until Gen Z and TikTok.

I was about to say this - encourage the kid to feel their feelings and process the trauma by talking about it with supportive people, especially if they have self-blame thoughts. But don't assume that they're gonna need PTSD treatment.

Thirding this--most people that experience a traumatic event never develop PTSD and potentially over pathologizing normal, non-pathological post-traumatic feelings and reactions runs the risk of making things worse, not better (especially because PTSD is an anxiety disorder at its core).

Fourth-ing this... Louder for the people in the back

I have a colleague who is a big proponent of "disaster mental health," including CISD (...and EMDR, too, for that matter), which drives me nuts because it often flies in the face of this "resilient until proven otherwise" perspective (...not to mention the evidence of iatrogenesis for CISD).

 

[borne_before]

Fourth-ing this... Louder for the people in the back

I have a colleague who is a big proponent of "disaster mental health," including CISD (...and EMDR, too, for that matter), which drives me nuts because it often flies in the face of this "resilient until proven otherwise" perspective (...not to mention the evidence of iatrogenesis for CISD).

I am always of the resilient until proven otherwise camp.

 

[smalltownpsych]

It might not have scared the kid too much. Just because the adults knew that this was a close call and might have been scared doesn’t mean he would. Sometimes a kid, especially if they are a little more spectrummy (fancy clinical term), will be more impacted by disruption to their life and it won’t help if adults try to get the kid to “think of others” or not be so selfish. If the kid did internalize some fears then they will show up in different ways as mentioned by another poster. Final thought, when working with kids, they will typically process something like this for about a sentence or two out of a session. Trying to get them to talk more about it isn’t helpful and is more about our own need to feel like we’re doing something. Play with the kid and talk about whatever they want to talk about and they will throw out their thoughts and feelings about the significant event as you are interacting. One or two direct and obvious questions can be ok. Such as, when did you see your mom? How was she? Do you know when she is coming home? if minimal answers, don’t probe much beyond that. Also, could facilitate by saying something along the lines of “Some kids might struggle when something like this happens because it makes things hard for them, like disruption to schedule or time to play or do homework. Has that happened for you?” A kid like this there might be five minutes total talk about mom and the rest of the time playing and talking about other aspects of life or interests.