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✍🏾 Amarachi Ike | Licensed Physician, Health Writer, and Medical Journalist
What is post-traumatic stress disorder? 🧠
Post-traumatic stress disorder (PTSD) is a stress-related mental disorder characterised by a prolonged and recurrent physical, mental and behavioral response to a previously stressful event of profoundly dangerous or life-threatening nature.
Some examples of events that fall under this category include:
Active warfare
Domestic violence
Severe plane or automobile crash
Sudden and unexpected death of a loved one
Rape
Life-threatening medical emergencies
Terrorist activity
Natural disasters, such as hurricanes, floods, earthquakes
Media portrayal in recent decades frames PTSD as a condition disproportionately affecting uniformed men, often overshadowing its impact on children exposed to various forms of trauma.
A study published in Lancet Psychiatry found that 1 in 13 young persons in the United Kingdom have or will experience post-traumatic stress disorder before the age of 18. Nearly 50% of trauma-exposed children and adolescents will develop PTSD yet it is significantly underdiagnosed in many at-risk communities.
The cost of late diagnoses is an increased risk of developing co-morbid psychopathologies, which sets these children up for bad outcomes in adulthood. This is why it's all the more necessary to identify at-risk populations to ensure early diagnosis.
Some examples of traumatic events that predominantly affect the young population and may lead to PTSD include:
Parental death
Community violence e.g. school shootings, bombings etc.
Severe car accidents or injury
Bullying by peers
Adult maltreatment
Sexual assault/abuse
Child rape
Physical abuse
Emotional neglect
Animal attacks/bites
What are common signs and symptoms of PTSD in children? 👧🏽
In determining if a child is suffering from the effects of PTSD, it is important to ascertain prior exposure to traumatic events as the symptoms exhibited by children with this condition are identical to those seen in kids with anxiety, depression, and other mental health disorders by therapists and professionals alike.
In the short term, children exposed to traumatic events may have varied reactions depending on factors such as their level of development, ethnicity, culture, and the presence of mental health resources.
Some of the more commonly seen symptoms in children and adolescents with PTSD include:
Emergence of new fears
Heightened separation anxiety (especially in younger children)
Sleep disruptions, including nightmares and insomnia
Re-experiencing symptoms such as flashbacks
Feelings of sadness
Increased aggressiveness
Loss of interest in usual activities
Re-enacting the traumatic event during play
Difficulty concentrating at school
Drop in academic performance
Increased irritability or anger
Physical complaints or unexplained aches
How does PTSD manifest differently in young children? 👶🏼
PTSD diagnosis can be made in a child with history of exposure to a previous traumatic event if their symptoms persist for more than one month and significantly impacts the child's ability to function in daily living.
The symptoms of PTSD do not always show up right away. It may take from a few months to as long as a year before setting in, depending on how the child responds.
A clinical psychiatrist or mental health professional may make a diagnosis of PTSD following a mental evaluation. Due to differences in development, communication, symptom presentation and treatment approaches, the DSM-V has distinct diagnostic criteria for children under 6 years (preschool PTSD) and those above 6 years old.
In younger children, PTSD presents predominantly with behavioral changes and a regression in previously reached development milestones, evidenced by regression in speech and increased bedwetting. It is more difficult to diagnose due to communication barriers and treatment options are tailored to the child's developmental level and needs.
In older children, the symptoms may fall into four broad categories:
Intrusive memories: The child complains of recurring, intrusive, and involuntary flashbacks, nightmares, and thoughts about the traumatic event that is emotionally distressing.
Avoidance: The child may detach from people, places, conversations, activities, thoughts or items that are associated with the traumatic event or cause them to recollect.
Negative changes in mood and cognition: They may suffer from persistent negative thoughts about themselves, the world, or others and display difficulties in showing positive emotions. They may begin to isolate from others and show a lack of interest in activities they previously enjoyed.
Changes in aggression and reactivity: The child may display hypervigilance, being easily startled. They may also show increased aggression and irritability, with patterns of insomnia and other sleep disturbances.
How can PTSD impact child development long term? 🏥
PTSD is a debilitating condition that can have serious long-term effects on a child’s mental health and well-being, if left unmanaged.
Some of the known long-term effects include:
Conduct disorders
Developmental delays
Anxiety and depression
Substance abuse disorders
Borderline personality disorder
Increased suicidality
Problems with sexual intimacy in adulthood
Occupational and educational problems in adulthood
How can families support children with PTSD? ❤️🩹
Family members and caregivers are intrinsic members in the management and treatment process of childhood PTSD.
Here is a list of do's and don'ts on how to support children suffering from this condition:
Do:
Be patient and understanding
Respect their boundaries - only provide physical comfort if they are comfortable with this
Seek and encourage professional help
Offer the child stability and a routine
Educate yourself on PTSD
Don't:
Force them to talk about their trauma
Minimise their traumatic experience
Assume you understand their struggle
Use labels like 'damaged' or 'broken' when referring to them
What are the treatment options for children with PTSD? 📚
Several treatment modalities exist for childhood PTSD with varying levels of efficacy.
Cognitive Behavioral Therapy
According to studies, trauma-focused cognitive behavioral therapy is the first-line treatment with best empirical evidence. This approach involves regularly discussing the traumatic event with the child directly and employing anxiety management techniques as well as correction of inaccurate and distorted thoughts done in a controlled setting.
Eye Movement Desensitization and Reprocessing (EMDR)
This is a multi-phasic approach done multiple times a week in which the child is encouraged to focus on the traumatic event while undergoing bilateral stimulation (BLS) in an attempt to blunt the emotions associated with the traumatic event and reduce recollection. This approach is more suited for older children.
Medications
In the setting of other co-morbidities like anxiety and depression, medications such as SSRIs, mood stabilisers, and sleeping medications may be prescribed by a doctor to help with the child's condition.
Play Therapy
For younger children who may not be able to deal with trauma directly, a therapist may use games, drawings, and other techniques to help children process their traumatic memories.
Psychological First Aid
For school-aged children and adolescents, this can be employed to teach children how to process their trauma. It allows the child to process their trauma in a safe and supportive environment. Alternative treatments may be necessary for children exhibiting problematic behaviors or with co-morbidities.
Edited by: Grace Pountney (Founder and Copywriter)
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