Post-Traumatic Stress Disorder In Children

Post-traumatic stress disorder, also known as PTSD, is among only a few mental disorders that are triggered by a disturbing outside event, quite unlike other psychiatric disorders such as depression. Many Americans experience individual traumatic events ranging from car and airplane accidents to sexual assault and domestic violence. Other experiences, including those associated with natural disasters, such as hurricanes, earthquakes, and tornadoes, affect multiple people simultaneously. Dramatic and tragic events, like the terrorist attacks on the World Trade Center and Pentagon, and wars occur, and with media exposure such as we have today, even people not directly involved might be affected. Simply put, PTSD is a state in which you “can’t stop remembering.” (WebMD)

Some may think children are not affected by PTSD as adults are. This is not the case. Children are exposed to a wide variety of stressors such as: physical or sexual abuse, violence such as, shootings, national tragedies, or violence in the home, a severe accident, or natural disasters such as floods, earthquakes, hurricanes, or tornados. PTSD can also occur in any age group. A child’s risk of developing PTSD after a traumatic event depends on several factors, some of which being: how many times the event occurs, how close the child was to the event, family and friends’ reactions to the event, how severe the trauma is and how close the child is to the victims.

While the occurrence of PTSD in children following exposure to injuries and disasters varies, exposure to earthquakes and hurricanes caused the most frequent occurrences of PTSD in children. This may indicate that children experience a higher level of distress following exposure to natural disasters than following exposure to traffic accidents and injuries. Children who survive natural disasters may witness more injury and death to family and community members, destruction of their community, and adult distress than children exposed to car accidents and injuries, and these factors may contribute to the higher rates of PTSD. Children exposed to war may be at high risk for developing PTSD. Variables that may affect the occurrence and severity of PTSD in children exposed to war include proximity to the warfare; time elapsed since the war occurred and assessment of symptoms, duration of the war, and age of children. Studies of children exposed to physical abuse, sexual abuse, neglect, hostage situations, and family and community violence found the occurrence of PTSD to be between 22% and 50%. However, a few studies found the occurrence of PTSD to be 100% by clinician interview among children following kidnapping or the witnessing of physical or sexual assault to murder of a parent. A few studies have assessed children’s psychological sequelae following school shootings. Pynoos et al. (1987) observed the occurrence of acute PTSD to be highest (77%) among the 35 children who witnessed a sniper attack on the playground. Acute PTSD also was observed in 67% of the 18 children inside the school, 26% of the 43 children not at school, and 18% of the 63 children on vacation. Sixty percent continued to meet full PTSD criteria 1 year after the attack. Knowing the deceased child and proximity to the attack were associated with PTSD symptoms. Proximity to trauma also was associated with severity of PTSD symptoms in several other studies of children. (Barbara Jonker, 2003, pp. 46-47)

The symptoms of PTSD may begin right after the event occurs, but they may not be noticeable until months later. When the trauma is a series of ongoing events, such as physical or sexual abuse, the symptoms will worsen over time. Following the trauma, children may initially show agitated or confused behavior. They also may show intense fear, helplessness, anger, sadness, horror or denial. Children who experience repeated trauma may develop a kind of emotional numbing to deaden or block the pain and trauma. This is called dissociation. Children with PTSD avoid situations or places that remind them of the trauma. They may also become less responsive emotionally, depressed, withdrawn, and more detached from their feelings. A child with PTSD may also re-experience the traumatic event by: having frequent memories of the event, or in young children, play in which some or all of the trauma is repeated over and over, having upsetting and frightening dreams, acting or feeling like the experience is happening again, and/or developing repeated physical or emotional symptoms when the child is reminded of the event. Children with PTSD may also show the following symptoms: worry about dying at an early age, losing interest in activities, having physical symptoms such as headaches and stomachaches, showing more sudden and extreme emotional reactions, having problems falling or staying asleep, showing irritability or angry outbursts, having problems concentrating, acting younger than their age (for example, clingy or whiny behavior, thumb sucking), showing increased alertness to the environment, and repeating behavior that reminds them of the trauma (American Academy of Child Adolescent Psychiatry, 1999).

PTSD is not usually diagnosed until at least one month has passed since the traumatic event since symptoms usually develop within the first three months after the trauma has occurred. An anxiety disorder that lasts for less than one month is termed “acute stress disorder”. Before a diagnosis of PTSD can be made symptoms must significantly disrupt the patient’s lifestyle and last for more than one month. Children that exhibit symptoms of PTSD also demonstrate concurrent ADHD, anxiety disorders, and mood disorders. Borderline personality disorder is also linked to PTSD.

A wide range of psychotherapeutic and educational techniques have been proved successful in alleviating the PTSD symptoms and distress experienced by children who have been sexually abused. Individual psychoanalytically oriented play therapy and psychotherapy have been used effectively with youngsters who have been sexually abused, as well as group therapy, whereas family treatment modalities have been used with some families that are dysfunctional and abusive According to Yule (1989), group counseling affords the opportunity to reinforce the normative nature of the children’s reactions and recovery, to share mutual concerns and traumatic reminders, to address common fears and avoidant behavior, to increase tolerance for disturbing affects, to provide early attention to depressive reactions, and to aid recovery through age-appropriate and situation-specific problem solving. Ultimately, the clinician must help the child to see that his or her pathological defenses, personality traits, and distorted object relations that have served to master the abusive experience and to control or ward off further assault are not serving him or her in non-traumatic, non-abusive environments. This can only be accomplished when the counselor helps the child to link these PTSD symptoms and defenses back to the original traumatic experiences, which are uncovered, remembered, refrained, and assimilated in the safety of the counseling setting. Family therapy, when warranted, can also help the family understand the manifestations of the symptomatology of PTSD, the meaning the child has attached to the abuse experience, and how to effectively intervene to help the child return to a healthy level of functioning (Putman, 2009).

Research shows that cognitive-behavioral therapy is most effective on PTSD and other anxiety related disorders; however most mental health practitioners use other therapies for children and teens. Children with these types of psychological issues tend to do poorly in school if they are inadequately treated or go untreated. Other behavioral therapies are also useful. Gradual exposure therapy teaches the child to stay relaxed while being exposed to situations that remind him or her of the trauma. Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group. Medicines are sometimes needed when the symptoms are very severe. Medicines may help reduce symptoms of being scared and having flashbacks. Regardless of what types of treatments are used, it is important for any child suspected of having an anxiety disorder to receive professional medical and psychological treatment on a regular basis.

Works Cited
American Academy of Child Adolescent Psychiatry. (1999, October). Posttraumatic Stress
Disorder (PTSD), 70. Retrieved November 22, 2009, from www.aacap.org:
http://www.aacap.org/cs/root/facts_for_families/posttraumatic_stress_disorder_ptsd
Barbara Jonker, M. R. (2003). Acute Stress Disorder in Children Related to Violence. (Poster,
Ed.) Journal of Child and Adolescent Psychiatric Nursing, 16 (2), 41-51.
Gayle Zieman, P. (2008, November). Post-traumatic stress disorder (PTSD) in children and
teens. Retrieved November 2009, from Health and Wellness Resource Center:
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Putman, S. E. (2009, Winter). The monsters in my head posttraumatic stress disorder and the
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WebMD. (n.d.). Post-Traumatic Stress Disorder. Retrieved November 21, 2009, from
www.webmd.com: http://www.webmd.com/mental-health/post-traumatic-stress-disorder

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