Post-traumatic stress disorder (PTSD)

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Post-traumatic stress disorder (PTSD) is a debilitating condition that often follows a terrifying physical or emotional event - causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. Persons with PTSD often feel chronically, emotionally numb. PTSD in children usually becomes a chronic disorder.

Causes

The event(s) that triggers PTSD may be:

• Something that occurred in the person's life
• Something that occurred in the life of someone close to the child
• Something the person witnessed

A child's risk for developing PTSD is often affected by the child's proximity and relationship to the trauma, the severity of the trauma, the duration of the traumatic event, the recurrence of the traumatic event, the resiliency of the child, the coping skills of the child, and the support resources available to the child from the family and community following the event(s).

The following are some examples of catastrophic, life-threatening events that may cause PTSD if experienced or witnessed as a child or adolescent:

• Serious accidents (such as car or train wrecks)
• Natural disasters (such as floods or earthquakes)
• Man-made tragedies (such as bombings)
• Violent personal attacks (such as a mugging, rape, torture, being held captive, or kidnapping)
• Physical abuse
• Sexual assault
• Sexual molestation
• Emotional abuse
• Neglect

Children are more at risk of exposure to violence at home or on the streets than in school. About 1 million children are confirmed victims of child abuse each year.

Of inner-city elementary school-aged boys:

• 87 percent have seen someone arrested
• 84 percent have heard guns being fired
• 25 percent have seen someone get killed

Whose affected

Traumatic experiences are not common in the lives of most children. However, approximately 3,000,000 children each year are diagnosed with PTSD. No studies have examined the general population incidence of PTSD specifically in children and adolescents. However, it is estimated to be as high as 40 percent in violence-ridden neighborhoods.

Symptoms

The following are the most common symptoms of PTSD. However, each child may experience signs differently.

Children and adolescents with PTSD experience extreme emotional, mental and physical distress when exposed to situations that remind them of the traumatic event. Some may repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day and may also experience any, or all, of the following:

• Sleep disturbances
• Depression
• Feeling jittery or "on guard"
• Being easily startled
• Loss of interest in things they used to enjoy; detachment; general lack of responsiveness; feeling numb
• Trouble feeling affectionate
• Irritability, more aggressive than before, or even violent
• Avoiding certain places or situations that bring back memories
• Flashbacks or intrusive images (flashbacks can come in the form of images, sounds, smells or feelings; a person usually believes that the traumatic event is happening all over again)
• Losing touch with reality
• Reenactment of an event for a period of seconds or hours or, very rarely, days
• Problems in school; difficulty concentrating
• Worry about dying at an early age
• Regressive behaviors; acting younger than their age (i.e., thumb sucking, bedwetting)
• Physical symptoms (i.e., headaches, stomach aches)

Diagnosis

Not every child or adolescent who experiences a trauma develops PTSD. PTSD is diagnosed only if symptoms persist for more than one month and are adversely affecting the child's life and level of functioning. In those who do have PTSD, symptoms usually begin within three months following the trauma, but can also start months or years later.

PTSD can occur at any age, including childhood and may be accompanied by:

• Depression
• Substance abuse
• Anxiety

The length of the condition varies. Some people recover within six months, others have symptoms that last much longer.

A psychological assessment is usually recommended to diagnose anxiety disorders in children or adolescent, with therapy generally being the first line of treatment. If the patient is in danger due to suicidal thoughts or attempts and/or severe impairment in functioning, then they might need medication first to stabilize them. Parents who note symptoms of PTSD in their child or teen can help by seeking an evaluation early. Early treatment can decrease future problems.

Treatment:

Specific treatment for post-traumatic stress disorder will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the disorder
• Your opinion or preference

PTSD can be treated. Early detection and intervention is very important and can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with PTSD. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy for the child. The focus of cognitive behavioral therapy is to help the child or adolescent learn skills to manage their anxiety and to help master the situation(s) that contributed to their PTSD. Some children may also benefit from treatment with antidepressant or anti-anxiety medication to help them feel calmer. The child or adolescent's recovery from PTSD is highly variable and dependent on the child or adolescent's internal strengths, coping skills and resiliency (ability to "bounce back"). Recovery is also influenced by the support available within the family environment. Parents play a vital supportive role in any treatment process.

Prevention:

Preventive measures to reduce the incidence or lessen the chance of traumatic experiences in children include, but are not limited to, the following:

• Teach children that it is okay to say NO to someone who tries to touch their body or approaches the child in any way that makes the child feel uncomfortable.
• Teach children that it is okay to tell an adult the child trusts right away if someone makes the child feel uncomfortable.
• Provide appropriate support and counseling for children and adolescents who have experienced or witnessed a traumatic event.
• Encourage prevention programs within your community or local school system.