Posttraumatic Stress Disorder (PTSD)

All children and adolescents experience stressful events which can affect them both emotionally and physically. Their reactions to stress are usually brief, and they recover without further problems. A child or adolescent who experiences a catastrophic event may develop ongoing difficulties known as posttraumatic stress disorder (PTSD). The stressful or traumatic event involves a situation where someone’s life has been threatened or severe injury has occurred (ex. they may be the victim or a witness of physical abuse, sexual abuse, violence in the home or in the community, automobile accidents, natural disasters (such as flood, fire, earthquakes), and being diagnosed with a life threatening illness). Children’s risk of developing PTSD is related to the seriousness of the trauma, whether the trauma is repeated, the children’s proximity to the trauma, and their relationship to the victim(s).

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 They may also become less responsive emotionally, depressed, withdrawn, and more detached from their feelings.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
• Ddeveloping 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, thumbsucking)
• Showing increased alertness to the environment
• Repeating behavior that reminds them of the trauma

The symptoms of PTSD may last from several months to many years. The best approach is prevention of the trauma. Once the trauma has occurred, however, early intervention is essential. Support from parents, school, and peers is important. Emphasis needs to be placed upon establishing a feeling of safety. Psychotherapy (individual, group, or family) which allows the child to speak, draw, play, or write about the event is helpful. Behavior modification techniques and cognitive therapy may help reduce fears and worries. Medication may also be useful to deal with agitation, anxiety, or depression.

Child and adolescent psychiatrists can be very helpful in diagnosing and treating children with PTSD. With the sensitivity and support of families and professionals, youngsters with PTSD can learn to cope with the memories of the trauma and go on to lead healthy and productive lives.

For more information, see Answers for Families and Patients:

• Anxious Children  [In Preparation]
• Abuse of Children:  The Hidden Bruises  (Open New Window)
• Comprehensive Psychiatric Evaluation  (Open New Window)
• Depressed Children  (Open New Window)
• Sexual Child Abuse  [In Preparation]
• Stress, Helping Teenagers Cope with  (Open New Window)

See also:

• Your Child (1998 Harper Collins

• Your Adolescent (1999 Harper Collins).

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