Kentucky Partnership for Families and Children

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder. The diagnosis of PTSD requires that an individual experience an event that involves a threat to one's own or another's life or physical integrity and that they respond with intense fear, helplessness, or horror.

Causes:
PTSD is caused when a child is either the victim or a witness of a traumatic event. Such events include:

• Physical assault/abuse
• Sexual abuse
• Natural disasters
• Family/Community violence
• Murder/Rape
• Accidents (automobile or plane)
• War
• Peer suicide

Risk Factors for PTSD:
There are three main factors that have been shown to increase the likelihood that children will develop PTSD: the severity of the traumatic event, the parental reaction to the traumatic event, and the temporal proximity to the traumatic event. Children or adolescents who experience more severe traumas consequently develop higher levels of PTSD symptoms. Also, fewer symptoms and lower levels of symptoms are reported when children have healthy family support and less parental distress. Lastly, children who are farther away from the traumatic event experience less distress. Some other factors include whether or not the event was interpersonal (such as rape), exposure to more than one event, and age at time of traumatic experience.

CHARACTERISTICS:
Children with PTSD may exhibit a variety of symptoms, ranging from one to many symptoms. However, due to more recent findings, symptoms have been found to be age specific.

Young Children may show few PTSD symptoms. This is probably a result of assessments asking for a verbal description of one's thoughts and feelings about the event. Instead, young children report more generalized symptoms such as fear of strangers, separation anxiety, sleep disturbances, and avoidance of situations related to the event. Additionally, children may lose an acquired skill such as (such as toilet training) as a result of a traumatic event.

Elementary-aged Children do not typically experience amnesia or flashbacks as in adults, but they do experience "time skew" where they missequence trauma-related events when recalling the memory. These children also may show posttraumatic play or reenactment behaviors. Posttraumatic play is distinguished from reenactment in that posttraumatic play involves compulsively repeating some aspect of the trauma (e.g., increase in playing shooting games after witnessing a shooting) while posttraumatic reenactment involves recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

Adolescents may carry on some symptoms common to elementary-aged children, such as traumatic play. However, PTSD in adolescents also tends to resemble PTSD in adults. What is distinctive about adolescents is that they often exhibit impulsive and aggressive behaviors following stressful events.

The following symptoms are prevalent of PTSD Children throughout childhood:
• Repeated nightmares and dreams of death
• Pessimism about the future and expectation of early death
• Avoiding reminders of traumatic event
• Behavioral re-enactment
• Emotional numbness (except anger)
• Diminished interest in significant activities
• Feeling constantly on guard, nervous, or jumpy

Treatment:
Unfortunately, there is no clear-cut treatment for PTSD. Treatment of PTSD in children generally involves "talking therapies," such as Cognitive Behavioral Treatment (CBT), indirect therapy, such as play therapy, pharmacotherapy (medication), and parental involvement (education on PTSD and child support). CBT for children commonly involves exposure (child directly discusses traumatic event), anxiety management techniques (e.g. relaxation or assertiveness training), and elimination of false beliefs (e.g. convincing child that the world is not "totally unsafe"). Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other techniques to help the child process their traumatic memories. Medication is also used to combat the symptoms of PTSD. Such symptoms include sleep problems, generalized anxiety, and behavioral impulsivity or hyper-activity. Parental involvement includes primary caregivers understanding the effects of PTSD and helping their child cope with the trauma. As mentioned earlier, research shows that the better the parent copes, the less severe the symptoms will be for the child with PTSD.

Thus, it is helpful for parents or caregivers to seek treatment and education to develop the necessary coping skills to support their children. In all therapies the goals are the same:

• Help the child to remember the traumatic event(s) safely
• Address the child's family life, peer relations, and school performance
• Deal with grief, guilt, anger, depression, anxiety, and behavioral disturbances

What Caregivers can do to Help:
Knowing the facts is the first step toward helping your child. Gather information on PTSD and pay attention to how your child is functioning. Watch for warning signs such as sleep problems, irritability, avoidance, change in school performance, and peer problems. Consider having your child evaluated by a mental health professional with experiences in treating PTSD in children and adolescents. Many therapists with this experience are members of the International Society for Traumatic Stress Studies, whose membership directory contains a geographical listing of those who treat children and adolescents (http://www.istss.com).