Post Traumatic Stress Disorder (PTSD)
What is post-traumatic stress disorder?
Post-traumatic stress disorder, or PTSD, is a mental health disorder affecting children, adolescents and adults who have survived a traumatic experience or series of traumatic events. Children with PTSD typically experience three types of symptoms:
Re-experiencing the trauma
- The child continues to mentally re-live the traumatic experience, over and over again.
- He may have “flashbacks” of the event, feeling like he is actually going through the experience again. He may even hallucinate scenes, sounds or smells from the experience.
- He may have severe nightmares (either about the traumatic event or about other frightening things).
- He may feel the need to “hash out” the event verbally or in play.
- He cannot stop thinking about the traumatic experience, no matter what he does.
- The child deliberately avoids any thought, object, place or situation that is related to the traumatic experience or reminds him of the event in any way.
- He may have difficulty remembering details about the event (“blocking it out”).
- He may become numb to his feelings and surroundings in general as a coping mechanism.
- The child feels as though he must constantly be “on guard,” in case the trauma happens again or another dangerous situation emerges.
- He might be easily startled or frightened.
- He may have trouble falling or staying asleep.
- He may experience difficulty concentrating on schoolwork and other routine tasks.
- He might have outbursts of unprovoked or excessive anger.
A very young child who cannot verbalize feelings or thoughts about a trauma may demonstrate the following after the experience:
- out-of-control, disruptive behavior
- extreme fear of being separated from the primary caregiver
What are some of the events that can cause PTSD in children?
While any traumatic event can cause a child to develop PTSD, the disorder most often results from:
- witnessing domestic violence in the home
- experiencing physical abuse
- experiencing sexual abuse
- sustaining a severe injury
- being involved in a serious accident
- witnessing or experiencing an act of violence in school or in the community (for example, a school shooting)
A child develops PTSD when:
- he perceives the experience as life-threatening or extremely dangerous
- he responds to the event with intense fear, helplessness or horror
Treatment for PTSD is complex, ongoing and depends very much on the child’s individual symptoms and circumstances. However, psychotherapy “(talk therapy”), family support and—in some cases—the addition of medication to the treatment regimen have all shown excellent results in helping kids with PTSD return to a normal, healthy life.
Children’s Hospital Boston has many years of experience in treating children and families affected by trauma, and we are here for you.
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What can cause post-traumatic stress disorder in a child?
Any child who witnesses or goes through a life-threatening experience is at risk of developing PTSD. While any traumatic event can trigger PTSD symptoms, common traumas that have been linked to the disorder include:
- accidents, such as car or plane crashes
- natural disasters, such as floods or earthquakes
- acts of war or terrorism
- violent crimes, such as a home invasion, kidnapping or murder
- physical, emotional or sexual abuse (either of the child or of another family member in front of the child)
- house fires
- exposure to violence at school or in the community
- suicide of a family member or friend
It’s important to note, however, that not all children who live through one of these traumas will develop PTSD.
Are there certain factors that can affect the likelihood of a traumatic event causing PTSD?
There are several factors that can contribute to developing or preventing PTSD, including:
- how close the child was to the trauma itself (was she physically affected? Did she witness the trauma while it was happening, or encounter the aftermath?)
- how close the child is to the people involved (did the trauma involve her immediate family?)
- the severity of the trauma
- how long the traumatic event lasted
- whether the trauma has recurred (for example, ongoing gang violence in a neighborhood)
- the coping skills of the child and her family
- the mental health history of the child’s family
- how much support the child is receiving at home, at school and in the community
Signs and symptoms
What are the symptoms of post-traumatic stress disorder?
If your child is suffering from PTSD, she is most likely working through extreme emotional, mental and physical distress. Symptoms of PTSD can emerge as early as three months after the event, or can take as long as a year to show up. (A child who develops symptoms immediately after the event—within four weeks—is considered to have acute stress disorder. Treatment for this disorder is very similar to treatments prescribed for PTSD.)
PTSD symptoms can vary depending on the age of the child and the circumstances of the trauma, but tend to include:
- intense anxiety when separated from family members or around strangers
- disturbances in sleep (unable to fall or stay asleep)
- sad, withdrawn mood
- feeling jittery, “on edge” or “on guard”
- easily startled, especially by sounds or sudden movements
- loss of interest in activities and subjects previously enjoyed
- physical or emotional detachment from family members and friends
- feeling or acting “numb”
- difficulty displaying affection
- excessive or illogical irritability
- aggressive (or even violent) attacks on others
- avoidance of particular places, situations or objects that bring back memories of the trauma
- “flashbacks” (feeling like the traumatic experience is happening again; may include seeing or hearing parts of the event that are not really occurring)
- inability to distinguish reality from thoughts or dreams
- constantly re-enacting the trauma through play, drawings, writings or conversation
- problems in school
- difficulty concentrating
- preoccupation with death and dying
- worrying about dying at an early age or losing other loved ones
- regressive behaviors (acting younger than their age), such as bedwetting or thumb-sucking
- physical complaints, such as stomachaches or headaches, with no identifiable medical cause
Many of these symptoms can also point to another mental health condition, such as depression or an anxiety disorder. Your child’s clinician will help determine the cause of her symptoms and develop an appropriate treatment plan to meet all of her needs.
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Q: Is post-traumatic stress disorder common among children?
A: While traumatic experiences affecting children are all too common, PTSD itself is not: According to the National Center for Post-Traumatic Stress Disorder, 15 to 43 percent of girls and 14 to 43 percent of boys have experienced a traumatic event in their lifetimes. However, only 3 to 15 percent of girls and 1 to 6 percent of boys suffer from PTSD.
Q: What is the difference between PTSD in kids and PTSD in adults?
A: The symptoms and feelings associated with PTSD are very similar in kids and adults—but the difference is that adults are usually better able to verbalize how they are feeling and what they are experiencing.
Children also have a more difficult time recognizing that the frightening thoughts and sensations they feel during flashbacks and memories of the trauma are not real—that the trauma is not actually happening again. A child with PTSD is more likely to physically react to these traumatic thoughts and feelings—for example, screaming, hiding or fighting—than an adult.
Q: Are some events more likely to cause more post-traumatic stress disorder than others?
A: While any traumatic experience can cause a child to develop PTSD, certain events are linked more strongly to the onset of the disorder. According to the National Center for Post-Traumatic Stress Disorder:
- as many as 100 percent of children who witness the murder or sexual assault of a parent develop PTSD
- 90 percent of children who are sexually abused develop PTSD
- 77 percent of children who are injured in, or witness, a school shooting develop PTSD
- 35 percent of children in urban areas who are exposed to community violence develop PTSD
Q: How long can post-traumatic stress disorder last? When will my child be back to normal?
A: How quickly your child goes back to normal depends on a variety of things, including the severity of the trauma and how soon you reach out for help after the event. Some kids with PTSD recover in as little as six months with treatment, while others may take much longer to begin a return to normalcy.
Q: Can post-traumatic stress disorder be prevented?
A: While you can try to protect your child from any potential harm, sometimes things are out of your hands despite your best efforts. The most critical actions you can take to reduce the chances of PTSD in your child include the following:
- Teach your child that it’s okay to say NO to someone who tries to touch him in an uncomfortable way—even if that person is a “grown-up,” or even another family member.
- Teach your child to tell a trusted adult right away if someone does or says something that makes him feel uncomfortable.
- Create a strong family and community support network around your child, should a traumatic event occur.
Q: What if my child has been diagnosed with another mental health problem, in addition to PTSD?
A: Kids who have experienced a traumatic event may develop another mental health problem, such as depression or separation anxiety disorder. If your child has another condition requiring professional intervention, your Children’s clinician will work with you to treat both disorders at the same time.
Questions to ask your doctor
You and your family play an essential role in your child’s treatment for PTSD. It’s important that you share your observations and ideas with your child’s treating clinician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.
You’ve probably thought of many questions to ask about your child’s condition. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)
Initial questions to ask your doctor might include:
- What criteria did you use in reaching this diagnosis?
- Is it possible that these symptoms could point to any other condition?
- What are the treatment goals for my child?
- How can I encourage my child to talk to me and ask questions about his condition?
- What role should I play in my child’s treatment?
- How should I respond if my child is in the midst of a “flashback”?
- How long do you expect my child to need therapy?
- How can I tell if my child is making progress?
- Should I involve my child's school in treatment, and if so, how?
- How should I explain my child's condition to other members of the family?
- Will you prescribe medication for my child? If so, what are the possible side effects of this medication?
- How can my family and I best support my child through treatment?
- Does anything in my child’s day-to-day routine need to change?
- How long will it take for my child to start feeling “back to normal”?
- What other resources can you point me to for more information?