Post Traumatic Stress Disorder

Definition

Children and teens could have PTSD if they have lived through an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend’s suicide, or seeing violence in the area they live.

Child protection services in the U.S. get around three million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur:

  • 65% neglect
  • 18% physical abuse
  • 10% sexual abuse
  • 7% psychological (mental) abuse

Also, three to ten million children witness family violence each year. Around 40% to 60% of those cases involve child physical abuse. (Note: It is thought that two thirds of child abuse cases are not reported.)

Signs and Symptoms

School-aged children (ages 5-12)

These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.

Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.

Teens (ages 12-18)

Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.

What are the other effects of trauma on children?

Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of what we know about the effects of trauma on children comes from the research on child sexual abuse. This research shows that sexually abused children often have problems with

  • Fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others
  • Behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol.

Intrusive thoughts or memories of the event

  • unwanted memories of the event that keep coming back
  • upsetting dreams or nightmares
  • acting or feeling as though the event were happening again (flashbacks)
  • heartache and fear when reminded of the event
  • feeling jumpy, startled, or nervous when something triggers memories of the event
  • children may reenact what happened in their play or drawings

Avoidance of any reminders of the event

  • avoiding thinking about or talking about the trauma
  • avoiding activities, places, or people that are reminders of the event
  • inability to remember important parts of what happened

Negative thinking or mood since the event happened

  • persistent worries and beliefs about people and the world being unsafe
  • blaming oneself for the traumatic event
  • lack of interest in participating in regular activities
  • persistent feelings of anger, shame, fear or guilt about what happened
  • feeling detached or estranged from people
  • not able to have positive emotions (happiness, satisfaction, loving feelings)

Persistent feelings of anxiety or physical reactions

  • trouble falling or staying asleep
  • feeling cranky, grouchy, or angry
  • problems paying attention or focusing
  • always being on the lookout for danger or warning signs
  • easily startled

Symptoms usually develop within the first month after the trauma, but they may not show up until months or even years have passed. These symptoms often continue for years after the trauma or, in some cases, may ease and return later in life if another event triggers memories of the trauma. (In fact, anniversaries of the event can often cause a flood of emotions and bad memories.)

Risk Factors

Three factors have been shown to raise the chances that children will get PTSD.

These factors are:

  • How severe the trauma is
  • How the parents react to the trauma
  • How close or far away the child is from the trauma

Children and teens that go through the most severe traumas tend to have the highest levels of PTSD symptoms. The PTSD symptoms may be less severe if the child has more family support and if the parents are less upset by the trauma. Lastly, children and teens who are farther away from the event report less distress.

Other factors can also affect PTSD. Events that involve people hurting other people, such as rape and assault, are more likely to result in PTSD than other types of traumas. Also, the more traumas a child goes through, the higher the risk of getting PTSD. Girls are more likely than boys to get PTSD.

It is not clear whether a child’s ethnic group may affect PTSD. Some research shows that minorities have higher levels of PTSD symptoms. Other research suggests this may be because minorities may go through more traumas.

Another question is whether a child’s age at the time of the trauma has an effect on PTSD. Researchers think it may not be that the effects of trauma differ according to the child’s age. Rather, it may be that PTSD looks different in children of different ages.

Helping Your Child

First and foremost, your child needs your support and understanding. Sometimes other family members like parents and siblings will need support, too. While family and friends can play a key role in helping someone recover, it’s usually necessary to seek help from a trained therapist.

Here are some other things parents can do to support kids with PTSD:

  • Most kids will need a period of adjustment after a stressful event, so during this time, it’s important for parents to offer support, love, and understanding.
  • It can help to try to keep kids’ schedules and lives as similar as possible to before the event. This means not allowing your child to take off too much time from school or activities, even if it’s hard at the beginning.
  • Let them talk about the traumatic event when and if they feel ready. It’s important not to force the issue if they don’t feel like sharing their thoughts. Praise them for being strong when they do talk about it. Some kids may prefer to draw or write about their experiences. Either way, encouragement and praise can help them get their feelings out.
  • Reassure them that their feelings are typical and that they’re not “going crazy.” Support and understanding from parents can help with processing difficult feelings.
  • Some kids and teens find it helpful to get involved in a support group for trauma survivors. Look online or check with your pediatrician or the school counselor to find groups nearby.
  • Get professional help immediately if you have any concern that a child has thoughts of self-harm. Thoughts of suicide are serious at any age and should be treated right away.
  • Help build self-confidence by encouraging kids to make everyday decisions where appropriate. PTSD can make kids feel powerless, so parents can help by showing their kids that they have control over certain aspects of their lives. Depending on the child’s age, parents might consider letting him or her choose a weekend activity or decide things like what’s for dinner or what to wear.
  • Tell them that the traumatic event is not their fault. Encourage kids to talk about their feelings of guilt, but don’t let them blame themselves for what happened.
  • Stay in touch with caregivers. It’s important to talk to teachers, babysitters, and other people who are involved in your child’s life.
  • Do not criticize regressive behavior (returning to a previous level of development). If children want to sleep with the lights on or take a favorite stuffed animal to bed, it might help them get through this difficult period. Speak to your child’s doctor or therapist if you’re not sure about what is helpful for your son or daughter.

Also, take care of yourself. Helping your child or teen cope with PTSD can be very challenging and may require a lot of patience and support. Time does heal and getting good support for your family can help everyone move forward.

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