Post-traumatic Stress Disorder (PTSD) in Children and Teens

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) can begin after a child sees or is involved in a very stressful event. The event usually involves a real or potential severe injury or the threat of death. It causes feelings of extreme fear, helplessness, or horror. After being involved in such an event, children may have trouble sleeping, have nightmares or daytime memories of the event, and feel emotionally numb and cut off from others. For most children, these symptoms stop within a month after the stressful event. When these symptoms continue for a long time, it is called post-traumatic stress disorder.

The stressful event may be:

• physical or sexual abuse
• violence such as shootings, national tragedies, or violence in the home
• a severe accident
• the death of a loved one
• natural disasters such as floods, earthquakes, hurricanes, tornados, or fires.

How does it occur?

PTSD can occur at any age. A child's risk of developing PTSD is related to:

• whether the frightening event happens again
• how close the child was to the event
• family and friends' reactions to the event
• how severe the trauma is
• how close the child is to the victims.

If you, or others in your family, have had PTSD or depression, then your child may be more likely to develop PTSD.

What are the symptoms?

The symptoms usually begin right after the event, but they may not start until days or weeks later. When the trauma is a series of ongoing bad events, the symptoms may come on slowly and get worse over time.

Children may feel very fearful, helpless, angry, sad, or guilty that they somehow caused the traumatic event. They may deny what happened. Children who suffer trauma again and again may dissociate, which means they may not show much emotion and may appear to be "in a trance" or daydreaming. This behavior is most likely when something reminds them of the trauma.

The 3 core symptoms of PTSD are:

• fear of things that remind a child of the abuse
• acting or feeling like the event is happening again in dreams or disassociating (being in a trance)
• a sudden loss of interest in things that used to be fun.

In addition, children with PTSD may:

• avoid people or get scared around people or things that remind them of the event. For example, a child might become unhappy and withdrawn when around an adult who has sexually or physically abused them.
• have trouble with toilet training or bedwetting
• be on guard all the time and startle easily
• be very irritable or have angry outbursts
• eat very little or be a very picky eater
• have trouble concentrating and perform poorly in school
• have physical symptoms such as headaches or stomachaches when reminded of the event
• have trouble falling or staying asleep, or have nightmares
• repeat the trauma over and over when they play (For example, the child with PTSD from a car accident may repeatedly use toy cars to reenact the accident.)
• show more sudden and extreme emotional reactions such as anxiety, panic, anger, or guilt
• talk about death and suicide, such as saying "I wish I were dead."

How is it diagnosed?

PTSD is not diagnosed until at least 1 month has passed since the trauma. Symptoms of PTSD usually develop within the first 3 months after the trauma, but they may not surface until months or even years have passed.

Sometimes it is difficult to tell PTSD from other childhood problems like depression, anxiety, or bipolar disorder. You may want to contact a mental health professional who specializes in working with children and teens.

A mental health professional will ask about your child's behavior and symptoms, medical and family history, and any medicines your child takes. Sometimes your child may need lab tests to rule out medical problems like a thyroid disorder.

Along with PTSD, children and teens may have other disorders as well, such as:

• anxiety problems, for example, panic attacks
• depression
• conduct disorder (delinquent behavior, such as stealing, and criminal acts)
• oppositional defiant disorder (ODD)
• obsessive-compulsive disorder.

How is it treated?

Psychotherapy is usually the first and most effective treatment.

Play therapy allows children under 9 years old to act out their fears with toys and people figures. It is often very helpful. Play therapists help children feel more confident and less fearful.

Older children, teens, and adults often do very well with eye movement desensitization and reprocessing (EMDR). In EMDR the therapist helps the child remember distressing past experiences and gain new understanding of feelings and thoughts about the event. The "eye movement" involves the child moving his or her eyes back-and-forth, usually following the therapist's hand or pen, while recalling the event.

Cognitive behavior therapy (CBT) helps children learn about PTSD. CBT teaches specific skills for managing fears and negative thoughts about the stressful event.

Other behavioral therapies are also useful. Gradual exposure therapy teaches the child to stay relaxed while being exposed to situations that remind him or her of the trauma.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Medicines are sometimes needed when the symptoms are very severe. Medicines may help reduce symptoms of being scared and having flashbacks. If your child also has depression, medicines for depression may be prescribed.

It is important to have an experienced professional working with you and your child. The mental health professional treating your child may recommend continuing treatment after your child begins to feel better. Symptoms may return if children are exposed to something that reminds them of the trauma.

How long will the effects last?

Anniversaries of the event can often cause a flood of emotions and unpleasant memories.

If children have had PTSD once, then they are at greater risk for future PTSD if they experience another traumatic event.

Most children and teens can get over PTSD with good treatment and family support.

What can I do to help my child?

After a stressful event happens, get help as soon as possible. It is very important to help your children feel safe.

• If you suspect that your child is suicidal, get professional help right away. Thoughts of suicide are serious at any age.
• Let your child talk about the stressful event when and if he or she feels ready. Do not force the issue if your child does not feel like sharing his or her thoughts.
• Reassure children that their feelings are normal and that they are not "going crazy." The support and understanding that you provide can help children accept frightening emotions.
• Let your child make simple decisions when appropriate. Because PTSD often makes children feel powerless, you can help by showing them that they have control over certain parts of their lives. For example, you might consider letting your child decide what to have for dinner or how to spend the day.
• Tell your child (repeatedly if necessary) that the stressful event is not his or her fault.
• Check your local library or bookstore for books written for children who have been exposed to traumas. Books are available for children of different ages and for different kinds of stressful events. Read and discuss the books with your child.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Do not criticize your child for acting younger than his or her age. If your child wants to sleep with the lights on or take a favorite stuffed animal to bed, it's perfectly normal and can be soothing.
• Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.

When should I seek professional help?

If the symptoms have lasted more than 4 weeks, the problem is serious. The symptoms may not go away or they may get worse without professional help.

Get emergency care if your child or teenager has ideas of suicide or harming others or harming him- or herself.

For more information, contact organizations such as:

PTSD Alliance Resource Center
Telephone: (877) 507-PTSD
Web site: http://www.ptsdalliance.org

National Institute of Mental Health
Telephone: 866-615-NIMH (6464)
Web site: http://www.nimh.nih.gov

National Mental Health Alliance
Telephone: 800-969-NMHA (6642)
Web site: http://www.nmha.org