Post-Traumatic Stress Disorder (PTSD)

What is it?

Post-traumatic stress disorder (PTSD) is caused by exposure to a traumatic event. It’s natural for children to be upset after a very disturbing experience, such as witnessing or being a victim of violence, an accident, a natural disaster, physical or sexual abuse, or neglect. Children with PTSD don’t recover easily. Behaviors can include dreams about the event, play that reenacts the trauma, difficulty sleeping, irritability, and detachment. PTSD can develop months after the event. Though PTSD-like symptoms are common among children and adolescents exposed to trauma, the disorder is rare in young people.

Signs and Symptoms

If a child experiences a disturbing event, then has anxiety and behavioral changes, she’s having a natural reaction to the situation. If she becomes distant, recreates her trauma during playtime, regularly has nightmares about it, or can’t fall asleep, it could be PTSD. Young children may wet their bed, won’t separate from their parents, or even forget how to speak. Some children with the disorder will also develop separation anxiety disorder.  Adolescents with PTSD may display self-destructive behavior and guilt.

Diagnosis and Treatment

Children diagnosed with PTSD have experienced a traumatic event themselves, witnessed it happening to someone else, or heard about it happening to a close family member or friend. Many children who are initially anxious and distressed in the aftermath of a disturbing event recover without intervention. PTSD isn’t diagnosed until several months, even longer, after the initial trauma occurs. Symptoms may manifest earlier or even several years later.

A child with PTSD commonly shows symptoms in three areas: bad dreams and play that reenact the event; difficulty maintaining relationships or concentrating and disinterest in formerly significant activities; and increased irritability, guilt, sleep problems, or fearful behavior. Children may have stomachaches and headaches. The symptoms significantly affect daily activities.

A combination of behavioral therapy and medication may best treat PTSD. An evaluation is necessary to confirm a child has PTSD, since some symptoms don’t develop into the full disorder.

PTSD therapy sessions seek to create a safe and supportive environment for a child, often focusing on helping him speak, draw, play, or write about his trauma. In other cases, a clinician might recommend behavior modification techniques and cognitive therapy to teach a child to cope with his or her fear instead of addressing the trauma directly. Therapy sessions for children almost always involve a parent, a family member, or another caregiver.

Medication may be prescribed to ease fear and anxiety, starting with antidepressants and anti-anxiety drugs.

What are the risk factors for children?

PTSD is brought on by closely witnessing or experiencing a traumatic event that puts the child or loved ones in danger of serious injury or death. A child exposed to a disturbing experience is at higher risk to develop the disorder depending upon the severity and immediacy of the trauma, and prior exposure to trauma, neglect, or other childhood adversity. Strong social support after the event helps protect the child.

If left untreated, PTSD can lead to depression and a variety of anxiety and behavior disorders. Young people with PTSD may use substances in an attempt to self-medicate. Severe cases are at risk for suicide.