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

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) can start 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 such an event, children may have trouble sleeping, have nightmares, and feel emotionally numb and cut off from others. For most children, these symptoms stop within a month after the 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, terrorist attacks, or abuse in the home
• a severe accident
• the death of a loved one
• natural disasters such as floods, earthquakes, hurricanes, tornados, or fires

What is the cause?

A child's risk of developing PTSD is related to:

• whether the scary event happens again
• how close the child was to the event
• family and friends' reactions to the event
• how severe the injury is
• how close the child is to the victims

PTSD can occur at any age. If you, or others in your family, have had PTSD or depression, then your child may be more at risk to develop PTSD.

What are the symptoms?

The symptoms usually start 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, or sad. They may feel guilty, thinking that they somehow caused the event. They may deny what happened. Children who suffer trauma again and again may dissociate. This 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 event
• 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

Children with PTSD may also:

• 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 For example, a child might become unhappy and withdrawn when around an adult who has sexually or physically abused them.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 do 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 constantly 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 event, but they may not surface until months or even years have passed.

Sometimes it is hard to tell PTSD from other childhood problems like depression, anxiety, or bipolar disorder. 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 understand the feelings and thoughts they have about what happened. While thinking about the event, the child moves his or her eyes back-and-forth, usually following the therapist's hand or pen.

Cognitive behavior therapy (CBT) helps children learn about PTSD. CBT teaches specific skills to manage 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 things 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 anxiety and panic. 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. Your child may need continuing treatment even after he or she feels 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 bad 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." Your support and understanding can help children accept scary 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, let 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 too. 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:

National Center for Post Traumatic Stress Disorder
Telephone: (802) 296-6300
Web site: http://www.ncptsd.va.gov

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

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