Post-Traumatic Stress Syndrome Disorder in Children

Post-Traumatic Stress Disorder is the name given to the psychological problems that can sometimes follow threatening or distressing events. PTSD can occur after a child has been exposed to the following:

• natural disaster
• sexual, physical or emotional abuse
• witnessing a violent death
• a serious accident

The event that causes PTSD can be a single event or from a series of events that take place over months or even years. In adults, the prevalence of post-traumatic stress disorder is one to nine percent of the general population. Approximately twenty percent of children who are exposed to a traumatic event eventually develop a PTSD. Girls are noted to be two to six times greater risk for PTSD than their male counterparts.

For a long time, it was believed that children were protected from the long-term consequences of trauma. Events that occur during infancy and preschool years were thought to be forgotten and older children were thought to get over the exposure quickly. However, more recent research has found that children do in fact experience post-traumatic stress syndrome. The immediate physiologic response to a traumatic event can be significant and can lead to the eventual diagnosis of PTSD. The security of a young child relies heavily on feeling like the adults and older siblings in their lives form a protective shield around them. When this is broken either because the traumatic events happens when they are in the company of the adult or when the trauma happens due to the actions of an adult, their sense of security is, to say the least, seriously damaged. This age group has the most difficulty with their intense physical and emotional reactions.

By the time a child reaches school age, they have fantasies of fighting off perceived danger much like their comic strip heroes do. This can lead to a sense of failure when they witness violence or death of a loved one. Following the event, they will blame themselves for not doing more to protect or save the injured loved one. Furthermore, the ill-effect of a traumatic experience is only heightened when a child in this age group experiences the speeding up of their emotions and physical reactions.

A formal diagnosis requires that the symptoms persist for more than one month. The essential features of PTSD often include the following elements:

• The child is exposed to or threatened death or serious injury, and has a reaction to the event that includes intense fear, horror, or agitated behavior
• The child re-experiences the event through flashbacks or nightmares, or repetitive play
• Child avoids stimuli with the associated trauma
• Child may experience somatic symptoms as evidenced by stomach aches and headaches
• Child demonstrates an exaggerated startle response

The common symptoms of post-traumatic stress syndrome include the following:

• worrying about dying at an early age
• losing interest in their activities
• physical symptoms such as headaches and stomach aches
• sudden and extreme emotional reactions
• regression
• difficulty concentrating
• angry outbursts
• difficulty falling or staying asleep
• some children also forgot significant parts of the event

Other behaviors which can be noted in children experiencing PTSD can include:

• vigilantly on the watch for something bad to happen
• panic attacks
• having serious separation anxiety
• refusal to do things which remind them of the traumatic event
• difficulty managing physical contact because of the sense of vulnerability and because of the reminder of abuse
• dissociation

When a child is experiencing PTSD, it is important that both the child and their primary caregivers are interviewed. However, much consideration should be given to interview the child outside of the presence of their caregiver. This is for two primary reasons; the first is because the child is experiencing or has experienced the trauma at the hands of their primary caregiver. The second is that the trauma is not because of one or more of the caregivers but the child in an effort to either protect the caregiver or because they are feeling shame or guilt regarding the trauma has not shared that information with the caregiver. Of important note, efforts to provide a child with formal debriefing after a traumatic event may in fact increase the long term risk of PTSD symptoms. This occurs because the child is re-exposed to the event without further follow up therapy.

The best treatment of children and young people is to provide them with cognitive behavioral therapy. This therapy focuses on memories, thoughts and feelings associated with the event. During the therapy, the therapist provides encouragement and support aimed at helping the child gradually recall what happened. The also help the child to develop coping techniques to deal with their stress. These sessions need to occur a minimum of 8 to 12 times in order to be effective. Treatment modalities that are not considered beneficial and may even accelerate and enhance the effects of PTSD are; relaxation therapy, play therapy, art therapy, and family therapy.

For more information on this topic please contact our offices for an in-house presentation. Some of our services related to children and Post- Traumatic Stress Disorder includes the following:

Medical Record Review

• Identification of initial traumatic event
• Confirmation of PTSD diagnosis

Time Line Chronology

• Illustrative diagram to help provide a clear time line of time of initial traumatic events and PTSD diagnosis

Research

• Identification of latest research trends in diagnosing and treating PTSD

Expert Witness Identification

• Identification and location of experts who can speak to the diagnosis and treatment of PTSD

References:
American Academy of Child and Adolescent Psychiatry: Post-Traumatic Stress Disorder: Facts for Families. October 1999. Retrieved February 2007 from http://aacp.org/page.ww?name=Posttraumatic+Stress+Disorder.com

Children, Youth and Women’s Health Service: Post-Traumatic Stress Disorder. Retrieved February 2007 from http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx.com

Guzofske, S. Child Abuse & Neglect: Post-Traumatic Stress Disorder. July 17, 2006. Retrieved February 2007 from http://www.emedicine.com/ped/topic2650.htm

National Child Traumatic Stress Network: Understanding Child Traumatic Stress. Retrieved February 2007 from http://www.nctsnet.org/nccts/nav.do?pid=faq_under

For more information on this issue please see Contact Us and see how our services can work for you.