A nurse is caring for a child whose guardians report that the child consistently cannot speak during class and other social situations.
Which of the following anxiety disorders should the nurse identify that the child is experiencing?

Choice A rationale
Chronic trauma refers to repeated exposure to traumatic events over a long period. Abuse and neglect since early childhood, as in the case of the adolescent in the question, is a clear example of chronic trauma.
Choice B rationale
Vicarious trauma occurs when an individual becomes traumatized not by directly experiencing a traumatic event, but by exposure to graphic or traumatic material as part of their work. This is not the case for the adolescent in the question.
Choice C rationale
Acute trauma results from a single, unexpected, and stressful event. This does not apply to the adolescent in the question, who has been subjected to abuse and neglect since early childhood.
Choice D rationale

Historical trauma refers to the cumulative emotional and psychological wounding of an individual or generation caused by a traumatic experience or event. This does not apply to the adolescent in the question.

Choice A rationale
The adolescent’s experimentation with drugs could be a coping mechanism to deal with the trauma of the sexual assault and the subsequent posttraumatic stress disorder (PTSD).
Substance use, including drug use, is often a maladaptive coping strategy used by individuals

who have experienced trauma to numb their feelings, escape from their reality, or attempt to regain control. This must indeed be a difficult time for both the adolescent and the parent.
Choice B rationale
While experimentation is a part of normal adolescent behavior, it is not normal or healthy for an adolescent to use drugs, especially in response to a traumatic event such as a sexual assault. Drug use can lead to addiction, health problems, and further psychological distress. Therefore, it is something to be concerned about and addressed appropriately.
Choice C rationale
While it is important to understand and address the parent’s concerns, the focus should be on the adolescent’s needs. The adolescent is dealing with the aftermath of a sexual assault and a diagnosis of PTSD, and is using drugs. These are serious issues that need to be addressed with professional help. The question of which behavior to address first should be determined based on the adolescent’s immediate safety and well-being.
Choice D rationale
It is not helpful to label the adolescent’s behavior as misbehavior or to compare them to their siblings. Each child is unique and may react differently to stress and trauma. Instead of focusing on rules and comparisons, it would be more beneficial to provide support, understanding, and appropriate professional help.