Post-traumatic stress disorder (PTSD) is an anxiety disorder and a serious mental health condition that can affect people of all ages, including children and adolescents. PTSD in children can lead to intrusive, scary thoughts & memories related to a past terrifying event.
PTSD In Children
Most children can experience terrifying or stressful events that can adversely affect their thoughts, emotions and behavior. Although most children may recover quickly from such negative experiences, some children affected by severe stress can be affected in the long run. Traumatic events such as being bullied, school shootings, terrorist attacks, loss of a loved one or even domestic violence, whether experienced or witnessed, can lead to PTSD symptoms and affect a child’s development. Children with this condition can experience delayed development in certain areas, like language, motor skills etc. According to the National Alliance on Mental Illness (NAMI), “Young children lack the ability to convey some aspects of their experience. Behavior (e.g. clinging to parents) is often a better clue than words, and developmental achievements in an impacted child might slip back (e.g. reversion to not being toilet trained in a 4-year-old).”
Research reveals that around 14-43% of boys and 15-43% of girls experience at least one traumatic event. Among them, 1-6% of boys and 3-15% of girls tend to develop post-traumatic stress disorder. If left untreated, the condition can sustain for years and increase the likelihood of the patient to get affected by other psychiatric disorders, impairing their psychosocial functioning in adulthood 1 .
Understanding Pediatric PTSD
Trauma experienced in childhood can substantially affect development and impair psychological, emotional and physical growth. Traumatic stress can deeply impact children and adolescents and can even lead to a number of comorbid mental disorders. Traumatic events like natural disasters, suicide bombings, terrorist attacks, destruction of public property, are common and children may need to confornt with more than one potentially terrifying events. As children lack coping abilities and strategies, feel more vulnerable, and less able to protect themselves and their loved ones, they are highly prone to experiencing symptoms of post-traumatic stress disorder. According to a study 2 , around 20-30% of children and adolescents tend to develop the full condition within the first 6 months. However, PTSD in children has not been studied extensively as children are still in a stage of development and due to the unique characteristics of the disorder. Thankfully, more and more experts are now recognizing the need for understanding how trauma affects children and how we can help young survivors overcome psychological distress arising from it.
It is believed that the symptoms may be different in children than in adults due the developmental stage and the degree of emotional and cognitive maturity. According to a recent 2020 study 3 , “Prevalence and symptomatology of PTSD also vary greatly among children and adolescents depending upon the traumatic event itself, the severity and duration of exposure, and the child’s demographic variables such as gender, age, and ethnicity.” However, there are certain factors which determine whether a child may develop PTSD, including the severity, frequency, and how their parents may react. PTSD in children can often make them feel unable to escape or overcome the effects of the trauma. Not only can they experience flashbacks and nightmares, they may also avoid people or situations that may act as a trigger. It can hamper their development, make daily life a lot more challenging and prevent them from openly expressing themselves.
Causes Of PTSD In Children
Children, adolescents and teens can develop post-traumatic stress disorder if they experience a terrifying and traumatic event(s). This can involve both direct exposure and indirect exposure, such as being a witness, to the event. These traumatic events can include a wide range of negative and life-threatening experiences such as –
- Physical or sexual abuse or assault
- Emotional abuse or neglect
- Violent attacks, like mugging, kidnapping, rape etc
- Crimes, like home invasion or murder
- Terminal illness or death of a loved one
- suicide of a friend or a family member
- Accidents, like car or plane crashes
- Animal attacks
- Manmade or natural disasters
Studies 4 reveal that more than natural or manmade disasters, interpersonal traumatic experiences like physical abuse and sexual assaults are more likely to cause 5 PTSD in children. “Numerous psychological, family, and social factors such as parental mental status and prolonged life disruption could also affect children and adolescents’ post-trauma adaptation and recovery,” adds the recent 2020 study. But it should be noted that not all children may experience PTSD after a traumatic event.
Symptoms Of PTSD In Children
Common symptoms of PTSD in children may include:
- Persistent, terrifying thoughts and memories of trauma
- Having nightmares or flashbacks
- Constantly reliving the traumatic event
- Reenacting the trauma through art or in play
- Intense sadness or fear
- Sleep difficulties
- Lack of positive emotions
- Acting withdrawn, helpless or hopeless
- Avoiding people or places related to the event
- Being easily startled
- Angry outbursts
- Difficulties focusing in school
- Emotional numbness
- Being extremely nervous or anxious
For children below the age of 6, the symptoms can be:
- Being excessively clingy with caregivers
- Repeatedly acting out the trauma in play
- Unable to speak voluntarily
- Bedwetting after being toilet trained
It can also lead to severe depression and suicidal behavior in children as well. A 2005 study 6 states “The persistence of PTSD symptoms coupled with an accumulation of post-trauma adversities can also produce a secondary depression and, when the traumatic context also includes the death of a family member, children can present with complicated grief and bereavement.”
How PTSD Affects Children?
One 2007 study 7 reveals that children tend to experience other related phenomena which may be triggered by the trauma, like drawing or playing repetitively. They may also experience certain behavioral and emotional difficulties, like aggression, regression, fears etc. The National Institute of Mental Health (NIMH) explains “Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.”
Research 8 reports that “young girls are 6 times more likely to have the disorder than boys.” Boys tend to show certain behavioral problems after the traumatic event or experience but may show fewer symptoms. In general, children may experience delayed onset of PTSD symptoms. Their symptoms may also change or evolve as they go through developmental stages and become adults.
Why Treatment Is Necessary?
Although most children can be resilient and may naturally overcome the symptoms over time, some of them may struggle with forgetting the event. If the symptoms are present for over a month, then they may be diagnosed with the disorder. According to the Centers for Disease Control and Prevention (CDC), children may experience long-term effects of post traumatic stress disorder, if left untreated. It adds “Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).”
A child may require early diagnosis, therapy and medicine under the guidance of a pediatrician or child mental health specialist for complete recovery. Moreover, extra care, love and support from parents and other caregivers, like teachers can help them get better by making them feel safe.
Treatment Of PTSD In Children
PTSD in children is both underdiagnosed and overdiagnosed. This is why it is crucial to consult a licensed and certified mental health professional experienced in treating childhood post-traumatic stress disorder. As PTSD is a treatable condition, parents should never hesitate from seeing a doctor and ask for help. Some of the most common available treatment options of children with PTSD include:
Psychotherapeutic interventions for treating PTSD in children usually includes the same strategies used for adult PTSD patients, with age-appropriate modifications. Common components for intervention may include –
- Direct exploration of trauma
- Symptom management & coping techniques
- Exploration & modification of distorted cognitive attributions related to trauma
Psychotherapy can also include some highly effective techniques like –
- Cognitive behavioral therapy (CBT 9 )
- Eye movement desensitization and reprocessing (EMDR 10 )
- Play therapy
CBT is one of the most effective forms of talk therapy. By using a trauma-focused approach, therapists can help children to recognize and correct distorted thoughts related to the trauma. “The effectiveness of cognitive-behavioral therapy (CBT) for PTSD in children has been empirically demonstrated more often than other interventions,” explains a 2005 study. EMDR uses guided eye movement exercises to improve cognitive & emotional responses. “Play therapy represents a unique form of treatment that is not only geared toward young children, but is translated into a language children can comprehend and utilize—the language of play,” describes a 2010 study 11, 7(10), 19–24. )) .
Although there is no specific medication for PTSD in children, certain anti-anxiety medications and antidepressants may be prescribed to relieve some of the symptoms, depending on the individual and the severity of the condition. The 2005 study adds “Effective pharmacological agents are ideally those which: a) target disabling symptoms, b) improve the quality of life of the child/adolescent allowing for normal growth and development in the long-term, and c) facilitate the process of psychotherapy by allowing traumatized children to deal with emotionally distressing material and work through their distress.”
Apart from the anxiety disorder, PTSD can also lead to the development of certain comorbid conditions which must also be addressed by the parents while consulting a mental health professional. “Comorbid conditions should be identified and treated with appropriate medication or psychosocial interventions,” suggests a 2002 study.
What Parents Can Do?
Parents who have children suffering from post-traumatic stress disorder should first and foremost focus on seeking medical help. Here are a few other tips for parents to cope with PTSD in children:
- Acknowledge that your child has experienced trauma and in need of medical treatment.
- Talk to your children and encourage them to talk openly.
- Listen to them without interrupting them or judging them.
- Encourage them to seek help, visit a doctor, attend therapy sessions, take medications properly and follow the treatment plan.
- Support your children mentally and emotionally. Do not judge or criticize them as it may take years to cope with this disorder.
- Book all appointments with the doctor and accompany your child every time.
- Talk to your child’s doctor about how you can help speed up the recovery process.
- Coordinate with the doctor and your child’s school to figure out a sustainable and effective treatment plan.
- Join support groups in your community or online and learn from others in similar situations.
- Always be aware of signs of depression, self-harm and suicide and seek help immediately.
- Make self-care a priority and don’t avoid your own physical, mental and emotional needs.
PTSD In Children Is Treatable
Although post-traumatic stress disorder in children and adolescents is a serious cause for concern 12 , the condition can be treated effectively with therapy and medication. However, it is crucial that parents not only support their children, they should also encourage them to stick to the treatment plan and follow the doctor’s instructions properly. With treatment and support, children can eventually overcome PTSD symptoms and live a healthier life.References:
- Bolton D, O’Ryan D, Udwin O, Boyle S, Yule W. The long-term psychological effects of a disaster experienced in adolescence: II: General psychopathology. J Child Psychol Psychiatry. 2000 May;41(4):513-23. PMID: 10836681.
- Schnurr PP, Friedman MJ, Bernardy NC. Research on posttraumatic stress disorder: epidemiology, pathophysiology, and assessment. J Clin Psychol. 2002 Aug;58(8):877-89. doi: 10.1002/jclp.10064. PMID: 12115712.
- Li, Y., Zhou, Y., Chen, X., Fan, F., Musa, G., & Hoven, C. (2020). Post-traumatic stress disorder in children and adolescents: Some recent research findings. Psychosomatic Medicine. https://doi.org/10.5772/intechopen.92284
- Kar N. Psychological impact of disasters on children: review of assessment and interventions. World J Pediatr. 2009 Feb;5(1):5-11. doi: 10.1007/s12519-009-0001-x. Epub 2009 Jan 27. PMID: 19172325.
- Shaw JA. Children, adolescents and trauma. Psychiatr Q. 2000 Fall;71(3):227-43. doi: 10.1023/a:1004630127000. PMID: 10934747.
- Kaminer, D., Seedat, S., & Stein, D. J. (2005). Post-traumatic stress disorder in children. World psychiatry : official journal of the World Psychiatric Association (WPA), 4(2), 121–125.
- Bisson J. I. (2007). Post-traumatic stress disorder. BMJ (Clinical research ed.), 334(7597), 789–793. https://doi.org/10.1136/bmj.39162.538553.80
- Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
- Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Frontiers in psychology, 9, 1395. https://doi.org/10.3389/fpsyg.2018.01395
- Kool, R., & Lawver, T. (2010). Play therapy: considerations and applications for the practitioner. Psychiatry (Edgmont (Pa. : Township
- Kirsch V, Wilhelm FH, Goldbeck L. Psychophysiological characteristics of PTSD in children and adolescents: a review of the literature. J Trauma Stress. 2011 Apr;24(2):146-54. doi: 10.1002/jts.20620. Epub 2011 Mar 24. Erratum in: J Trauma Stress. 2011 Jun;24(3):370-2. PMID: 21438015.