Post-traumatic Stress Disorder (PTSD) (cont.)

Children and Post-traumatic Stress Disorder

Today, children are exposed to various forms of traumatic events and violence. Natural disasters, such as tornados or earthquakes, have little potential for being personalized, so they lie on one end of this continuum. In contrast, victims of rape or torture usually face their assailants. In between are technological disasters, such as dam bursts or airplane crashes, that usually occur as the result of human error on a grand scale.

Children question whether someone is trying to hurt them. They want to know what's wrong with them. Someone they trust may betray that trust, for example, if a child is sexually abused by a parent or trusted caregiver or authority figure.

The more personal the trauma, evidence suggests, the more likely long-term psychological problems are to arise from it. Such traumas are also more likely to include elements of anger and hostility. In addition, childhood experiences such as sexual abuse may interfere with a child's development and affect him or her throughout life. For example, women who had been sexually abused as children, according to research, almost universally experienced trauma later in life as well. In contrast, women who were physically but not sexually abused as children had a rate of trauma later in life that was similar to that of people who were not physically abused.

• Five million children are exposed to a traumatic event in the United States every year, amounting to 1.8 million new cases of post-traumatic stress disorder (PTSD). Some 36% of children who experience traumatic events develop PTSD, compared with 24% of adults. 



• The younger a child is at the time of the trauma, the more likely he or she is to develop PTSD. Thirty-nine percent of preschoolers develop PTSD in response to trauma, while 33% of middle school children and 27% of teens do.



• By age 18 years, 1 in 4 children has experienced a personal or community act of violence. (It is estimated that, during their lifetime, 4 million teenagers have been victims of serious physical assaults, and 9 million have witnessed an act of serious violence. More than 3 million children are exposed to domestic violence every year.) 

Violence on TV: Parents should guide this kind of television viewing, either making sure that they talk to their children about what they are reading and seeing—or, for very young children, limiting it or turning it off altogether. As kids get older, limiting even then is important so they are not constantly barraged by these images. Coming up with other ways to try to process what is happening, such as talking with adults, rather than just watching it over and over and over again, is helpful.

Stress at home: Kids know what's going on in their environments, even if parents don't think they do. Children can pick up on our feelings, whether it’s stress over a traumatic event or worries about a parent losing a job. Children notice the subtle, outward signs, both happy and sad. How parents react to a trauma often affects how the children are going to react.

Signs and symptoms of PTSD in children (according to the National Center for PTSD):

Young children (1-6 years)

• Helplessness and passivity, lack of usual responsiveness



• Generalized fear



• Heightened arousal and confusion



• Cognitive confusion



• Difficulty talking about the event



• Difficulty identifying feelings



• Nightmares, sleep disturbances



• Separation fears and clinging to caregivers



• Regressive symptoms (for example, returning to bed-wetting or loss of speech/motor skills)



• Inability to understand death as permanent



• Anxieties about death



• Grief related to abandonment by caregiver



• Somatic symptoms (such as stomach aches, headaches)



• Startle response to loud noises



• Freezing (sudden immobility)



• Fussiness, uncharacteristic crying, neediness



• Avoidance of or alarm response to specific trauma-related reminders involving sights/physical sensations

School-aged children (6-11 years)

• Feelings of responsibility and guilt



• Repetitious traumatic play



• Feeling disturbed by reminders of the event



• Nightmares, other sleep disturbances



• Concerns about safety, preoccupation with danger



• Aggressive behavior, angry outbursts



• Fear of feelings, trauma reactions



• Close attention to parents’ anxieties



• School avoidance



• Worry/concern for others



• Behavior, mood, personality changes



• Somatic symptoms (complaints about bodily aches/pains)



• Obvious anxiety/fearfulness



• Withdrawal



• Specific trauma-related fears, general fearfulness



• Regression (behaving like a younger child)



• Separation anxiety



• Loss of interest in activities



• Confusion, inadequate understanding of traumatic events (more evident in play than in discussion)



• Unclear understanding of death, causes of "bad" events



• Giving magical explanations to fill in gaps in understanding



• Loss of ability to concentrate at school, with lower performance



• Spacey or distractible behavior

Preadolescents and adolescents (12-18 years)

• Self-consciousness



• Life-threatening re-enactment



• Rebellion at home or school



• Abrupt shift in relationships



• Depression, social withdrawal



• Decline in school performance



• Trauma-driven acting out, such as sexual activity or other reckless risk-taking



• Effort to distance self from feelings of shame, guilt, humiliation



• Excessive activity/involvement with others, or retreat from others in order to manage inner turmoil



• Accident proneness



• Wish for revenge, action-oriented responses to trauma



• Increased self-focusing, withdrawal



• Sleep/eating disturbances, including nightmares 

Treatment: Treatment of children should include the involvement of parents and other important people such as teachers and school counselors in the child’s life. Treatment of traumatic stress in adults is generally focused on individual treatment or group therapy with other individual adults who have experienced a similar type of trauma.

Next: Medical Care »

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