November 23, 2017
Recognizing PTSD in Children

Recognizing PTSD in Children

by Joseph Saling  

When we think of post-traumatic stress disorder, or PTSD, we usually think of soldiers who have come back from war. But PTSD can occur in anyone. It is increasingly being recognized in children and adolescents who have been exposed to traumatic events such as car accidents, violence—at home or in a public place—or savage weather.

Stress and fearare normal responses to these types of events. They trigger a cascade of physical changes needed to defend against danger or get away from it, often called the fight-or-flight response. In most people, the mind and body return to a normal state over time once the threat has passed. For some, however, the emotional and physical symptoms persist and increase. This condition is PTSD. If not treated, PTSD can cause major disruptions in a person’s life for many years. In children, the toll of untreated PTSD can extend well into adulthood.

What causes PTSD in children and adolescents?

Any event that poses a serious threat of physical or emotional harm or that is life-threatening can lead to PTSD. Sexual, physical, and emotional abuse, including neglect, can all trigger PTSD symptoms. The abuse doesn't have to happen to the child. Simply witnessing it—for example, seeing the abuse of a parent or a sibling—can have the same effect. Other triggers include natural or man-made disasters such as floods or fires as well as exposure to violence at home or in the community. Sometimes, just learning about a trauma that has happened to someone close to the child can be a trigger.

In 2010, researchers from the National Institute of Mental Health (NIMH), using diagnostic criteria from the American Psychiatric Association, estimated that about 5 percent of adolescents have PTSD, with more girls affected (8 percent) than boys (2.3 percent). Their data came from a nationwide face-to-face survey of more than 10,000 teenagers ages 13 to 17.

Both the intensity and the type of threat have an effect on the risk of developing PTSD. So does proximity: One study of a sniper shooting at an elementary school, for example, showed that 77 percent of students who witnessed the shooting on the playground developed severe PTSD symptoms. That number dropped to 67 percent of those inside the building, and 26 percent of those who had left for the day.

Other factors that affect a child’s risk of developing PTSD include previous exposure to trauma, a history of other mental health problems, the presence or absence of family and social support, and whether parents or caregivers have PTSD.

PTSD in children is not the same as in adults

The signs of PTSD in children are different from adult symptoms and also differ among children based on age. Among children younger than 6, symptoms may include:

  • Fear, such as fear of strangers or fear of being separated from parents
  • Tantrums
  • Sleep problems, including bad dreams
  • Repeating events or themes from the trauma in play
  • Losing skills learned earlier, such as bathroom training or even verbal skills
  • Fussiness, irritability, or aggressive behaviors

Signs of PTSD in elementary school-age children can include:

  • Believing there were warning signs that were missed and looking for them to prevent future trauma
  • Mixing the sequence of trauma events in their mind
  • Reenacting elements of the trauma in play, with drawings, or verbally
  • Nightmares
  • Outbursts of anger or aggression
  • Depression
  • Emotional numbness
  • Poor performance in school

Symptoms of PTSD in adolescents include many of the same ones that appear in adults, such as having flashbacks; abusing substances like alcohol, drugs, or tobacco; and avoiding reminders of the event. There are, however, symptoms that are specific to their age group, including:

  • A sense of guilt about having been unable to prevent the event or to keep others from being injured or dying (this may also occur in some younger children)
  • A desire for revenge

In children of any age, it is important to note that symptoms may not show up until months after the traumatic event.

What parents can do

Before you can completely help your child, you may need to get in touch with your own feelings about the events. If necessary, reach out for help from your support network, doctor, or a mental health provider. It's also important to learn as much as you can about post-traumatic stress and its effects. Good resources include the NIMH’s free online publication Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do. The final section of the booklet contains a list of "Trauma Resources" with phone numbers and links to websites where you can get more information and help. Another excellent resource is the National Center for PTSD, a website maintained by the U.S. Department of Veteran Affairs.

Children need to know that you love them and are doing your best to take care of them. They also need help understanding that the event was not their fault and that it's OK to be upset. Allow them to experience their sadness, and help them talk and write about their feelings in their own time. Don't insist they talk about their reactions before they're ready to do so.

When to seek help

For most children and teens, recovery without treatment typically takes from 1 to 6 months. Monitor your child's progress. If it suddenly slows down or things get worse after 3 months, or symptoms remain after 6 months (at which point it’s unlikely that they’ll improve on their own), contact your pediatrician, who may provide a referral to a mental health specialist. Any mental health provider who treats your child should have experience working with PTSD in young people. If you’re not sure, ask. Also ask about the therapist's view of the role parents and family should play in the child’s recovery. In some cases, treatment will involve sessions with you to discuss your own challenges and their effect on your child.

Also be aware that depressioncommonly occurs alongside PTSD. If the depression becomes major, or if your child expresses thoughts about or takes any action toward hurting him or herself or others, seek help from a mental health provider immediately. If your child already has a therapist, call the emergency number that's been provided. If he or she is not currently seeing a mental health professional, call your child's doctor to recommend one. If you believe there is an imminent threat of harm, go to the emergency room.

Treatment for PTSD commonly begins with cognitive behavioral therapy (CBT), a type of talk therapy that focuses on your child's thoughts and feelings about the traumatic event.The goal is to help your child gain a more objective perspective. It may also be necessary to treat other mental or physical issues that often accompany PTSD. In addition to depression and anxiety, those can include sleep disturbances, substance abuse, ADHD, and conduct disorders.

Other treatments that may be helpful include:

  • Play therapy, especially with young children, which uses games, drawings, and other techniques to help children process their memories.
  • An approach called “Psychological First Aid,” jointly developed by the National Child Traumatic Stress Network and the National Center for PTSD. Typically used in the aftermath of a disaster or terrorism, it focuses on providing comfort and support and on helping parents and caregivers deal with emotional and behavioral changes they see in the child as a result of the event.
  • Specialized interventions to deal with problematic symptoms such as sexual behavior or substance abuse.

A class of antidepressants called SSRIs are approved for treating symptoms of PTSD in adults. Although these drugs have been approved for treating some children with depression or obsessive compulsive disorder, studies have not shown them to be particularly helpful in treating PTSD in children. If your child's doctor recommends a medication as part of the treatment, be sure to ask why he or she thinks it would be helpful and what the possible risksare.

Bottom line: Treatment for PTSD in children can be effective, especially if it’s initiated early enough. Keep in mind that if symptoms don't go away on their own, leaving them untreated can lead to serious problems years later, even in adulthood. So investing in appropriate therapy now can prevent a wealth of difficulties down the road.

Also see Recognizing and Treating PTSD in Adults.