Children & Post Traumatic Stress Disorder

Kids and Post-traumatic Stress Disorder—

Today, kids are exposed to various forms of
traumatic events and violence. Natural disasters,
such as tornados or earthquakes, have little
potential for being personalized, so they lie on
one end of this continuum. In contrast, victims
of rape or torture usually face their assailants. In between are
technological disasters, such as dam bursts or airplane crashes,
that usually occur as the result of human error on a grand
scale.

Kids question whether someone is trying to hurt them. They
want to know what's wrong with them. Someone they trust
may betray that trust, for example, if a youngster is sexually
abused by a parent or trusted caregiver or authority figure.

The more personal the trauma, evidence suggests, the more
likely long-term psychological problems are to arise from it.
Such traumas are also more likely to include elements of anger
and hostility. In addition, childhood experiences such as sexual
abuse may interfere with a youngster's development and affect
him or her throughout life. For example, women who had been
sexually abused as kids, according to research, almost
universally experienced trauma later in life as well. In contrast,
women who were physically but not sexually abused as kids
had a rate of trauma later in life that was similar to that of
people who were not physically abused.

•        Five million kids are exposed to a traumatic event in the
United States every year, amounting to 1.8 million new cases of
post-traumatic stress disorder (PTSD). Some 36% of kids who
experience traumatic events develop PTSD, compared with 24%
of adults.

•        The younger a kid is at the time of the trauma, the more
likely he or she is to develop PTSD. Thirty-nine percent of
preschoolers develop PTSD in response to trauma, while 33%
of middle school kids and 27% of teens do.

•        By age 18 years, 1 in 4 kids has experienced a personal
or community act of violence. (It is estimated that, during their
lifetime, 4 million teenagers have been victims of serious
physical assaults, and 9 million have witnessed an act of serious
violence. More than 3 million kids are exposed to domestic
violence every year.)

Violence on TV: Moms & dads should guide this kind of
television viewing, either making sure that they talk to their
kids about what they are reading and seeing—or, for very
young kids, limiting it or turning it off altogether. As kids get
older, limiting even then is important so they are not constantly
barraged by these images. Coming up with other ways to try
to process what is happening, such as talking with adults,
rather than just watching it over and over and over again, is
helpful.

Stress at home: Kids know what's going on in their environ-
ments, even if moms & dads don't think they do. Kids can pick
up on our feelings, whether it’s stress over a traumatic event
or worries about a parent losing a job. Kids notice the subtle,
outward signs, both happy and sad. How moms & dads react
to a trauma often affects how the kids are going to react.

Posttraumatic stress disorder (PTSD) is the development of
characteristic symptoms that occur following direct or indirect
exposure to a traumatic or terrifying event in which physical
harm was threatened, witnessed, or actually experienced.

PTSD also can occur after the unexpected or violent death of
a family member or close friend, or following serious harm or
threat of death or injury to a loved one.

Studies show that PTSD occurs in 1%-14% of the population.
It can be diagnosed at at any age, and can occur as a sudden,
short-term response (called acute stress disorder) or develop
gradually and become chronic or persistent.

Most people with the posttraumatic stress disorder try to
avoid any reminders or thoughts of the trauma. Despite this
avoidance, they often re-experience the ordeal in the form of
intense "flashbacks," memories, nightmares, or frightening
thoughts, especially when they're re-exposed to events or
objects that remind them of the trauma.

Survivor guilt (feelings of guilt for having survived an event in
which friends or family died) may also be a component of PTSD.

Causes of PTSD—

Traumatic events that can cause PTSD
include:

• car accidents
• diagnoses of life-threatening medical illnesses
• fire
• military combat (this form of PTSD is sometimes called "shell
shock")
• natural or manmade disasters
• physical or sexual abuse
• senseless acts of violence (such as school or neighborhood
shootings)
• violent assaults such as rape
• witnessing another person go through these kinds of
traumatic events

Studies indicate that people with PTSD tend to have abnormal
levels of key hormones involved in the stress response. For
instance, research has shown that they have lower than normal
cortisol levels and higher than normal epinephrine and nor-
epinephrine levels — all of which play an important role in the
body's "fight-or-flight" reaction to sudden stress. (It's known
as "fight or flight" because that's exactly what the body is
preparing itself to do — to either fight off the danger or run
from it.)

The severity and likelihood of developing PTSD varies according
to the nature of the event, as well as individual factors such
as social support, family history, childhood experiences,
personality, and any existing mental health problems or stress.

Signs and Symptoms—

Symptoms of posttraumatic stress disorder usually develop
within the first 3 months after the trauma, but they may not
surface until months or even years have passed. These
symptoms often continue for years following the trauma or,
in some cases, may subside and return later in life if another
event triggers memories of the trauma. In fact, anniversaries
of the event can often cause a flood of emotions and
unpleasant memories.

Sometimes, symptoms are easy to identify — they often
resemble symptoms of stress, anxiety and depression. It
is also usual for a person to have a period of adjustment
following an unpleasant event in their lives, so during this
time, it's important to offer support and love and monitor
your youngster carefully.

The following signs and symptoms are characteristic of PTSD
if they have lasted for about a month or more, following the
event:

Re-experiencing the event:

• acting or feeling as though the event were happening again
(flashbacks)
• distress and fear when reminded of the event
• distressing dreams or nightmares of the event
• physiological reactivity (feeling jumpy, startled or anxious)
when reminded of the event
• recurrent and intrusive (unwanted) memories of the event

Persistent avoidance of any reminders of the event:

• avoiding activities, places, or people that are reminders of the
event
• avoiding thinking about or talking about the trauma
• feeling detached or estranged from others
• lack of interest and participation in activities (due to wishing
to avoid cues of the event)
• limited range of emotions
• no memory of an important aspect of the event
• sense that they will not live to graduate college, get married,
have kids, etc.

Persistent feelings of anxiety or physical reactivity:

• cranky, irritable, or angry
• difficulty falling or staying asleep
• exaggerated startle response
• overly aware of noises or other cues that remind them of the
event (smells, visual cues)
• problems paying attention or concentrating

People with PTSD often don't seek professional help because
they may not recognize the link between their symptoms and
the trauma they experienced. They also may want to continue
avoiding discussing the problem because it makes them feel
anxious.

Treating PTSD—

Many people recover from experiencing a
traumatic event after a period of adjustment.
However, if your youngster or teen has
experienced a traumatic event and has experienced symptoms
listed above for over a month, it's time to get help from a
professional.

Your youngster's teacher, doctor, friends, and other family
members who know your youngster well can play an important
role in recognizing PTSD. Other mental health professionals
who can help include:

•        bereavement specialists
•        licensed clinical social workers
•        licensed professional counselors
•        licensed trauma professionals
•        psychiatrists
•        psychologists

Therapy can be extremely supportive and helpful, particularly
if the trauma was unusually severe or life threatening.

Cognitive-behavioral therapy has been shown to be very
effective for people who develop PTSD. This type of therapy
helps someone to adopt new thoughts (called cognitions) and
behaviors in place of destructive or negative ones, while safely
revisiting aspects of the trauma.

In some cases, medication may be recommended to help
alleviate serious symptoms of depression and anxiety, which
can help your youngster cope with school and other daily
activities while being treated for PTSD. You can tell your
youngster that medication is often used as a temporary
measure to help until people with the disorder feel better.

Finally, group therapy or support groups can be beneficial
because they can help kids and teens understand they're not
alone. Groups also provide a safe atmosphere in which to share
feelings. Ask the therapist for specific referrals or suggestions
for a group.

Helping Children With Post
Traumatic Stress Disorder

Ask The Parent Coach—

Question: How do I choose a child therapist?

The task of finding a therapist for your youngster may
seem like an extremely difficult task, but here are a few
tips to make the process of choosing a therapist go more
smoothly. In the field of child anxiety, there are some
therapists who have been specifically trained in
implementing what we call “cognitive-behavioral”
techniques and skills.

Cognitive-behavioral techniques are essentially a set of
skills that kids can learn to help them change their fearful
thoughts, anxious behaviors, and to reduce their physical
feelings of tension. Cognitive-behavioral skills approaches
to treating child anxiety have been found to have high levels
of success when examined by clinical researchers. For
example, a youngster who is experiencing panic attacks
might learn how to identify anxious thoughts that trigger
panic attacks, learn how to change their anxious feelings,
and learn how to change anxiety-triggering behavior.

If you would like to find a cognitive-behaviorally oriented
therapist for your youngster, here are a few suggestions.
First, it might be helpful to consult the Association for
Behavioral and Cognitive Therapies (ABCT) website’s
directory of providers (www.aabt.org). Also, you could look
at the Directory of Providers on the ADAA website (www.
adaa.org). Both of these websites are conveniently listed
on our “links” page.

Question: Will my child’s anxiety go away naturally or
does she need treatment?

This is an excellent question, and one that is commonly
asked by parents. Many childhood fears are normal
developmental phenomenon. Fears tend to rise and
dissipate at predictable ages in a youngster’s life. For
example, a youngster might develop a fear of the dark at
age 4, which dissipates by the time the youngster is 6. In
addition, it is normal for kids to feel fearful of loud noises
when they are very young. However, no matter how old your
youngster is, if he or she is experiencing a fear that is
beginning to interfere with aspects of his or her functioning,
such as academic functioning, social functioning, or family
functioning, then these fears may warrant treatment.

Very often, successful short-term therapy can help to
alleviate your youngster’s fears and help your youngster
return to healthy functioning. If you are unsure whether your
youngster’s fear is normal, or whether it is interfering in
his or her life, it may be a good idea to consult with a
psychologist to determine whether your youngster could
benefit from treatment.

Question: I'm an anxious person also. Is it possible that
I gave this anxiety to my child?

Although research has shown that anxiety may be heritable,
there are many other ways that fears may be acquired. For
example, your youngster may have a more anxious,
inhibited temperament, which may make him or her more
vulnerable to feeling anxious. Further, fears are often
acquired through the media, through modeling from others,
etc. Fears might also occur after kids have experienced
some form of trauma. So, although you may feel you are
anxious, it is not likely that you simply could “give” an anxiety
disorder to your youngster. There are ways that you may
interact with your youngster, however, that may function to
increase his or her anxiety. It is important to examine such
factors with a trained professional.

Question: What is the difference between cognitive-
behavioral treatment and other kinds of treatment for
anxiety?

Cognitive-behavioral treatment is focused on teaching
kids and parents specific skills for changing their fearful
thoughts, anxious, tense physical feelings, and avoidant
behaviors. Other types of therapy are more focused on
using play therapy techniques, using talk therapy
techniques, etc. to produce change. There is much
research evidence suggesting that cognitive-behavioral
techniques are quite successful with reducing anxiety in
kids. Other forms of therapy have less empirical support.

Question: How long will it take before I see a change in
my child?

This will depend on your particular youngster’s problems.
For example, at the Center for Anxiety and Related
Disorders at Boston University, kids are typically treated
within 7-12 sessions for treatment for difficulties such as
specific fears, panic disorder, generalized anxiety disorder,
obsessive compulsive disorder, etc. In some cases,
however, additional sessions are needed to help a
youngster make the maximum progress.

Question: I have one child who exhibits a lot of anxiety,
whereas my other child does not seem anxious at all.
Why did this occur?

It is very normal for different kids to have different
temperaments. Some kids are more outgoing, and seem
to be impervious to feelings of anxiety, whereas other kids
may always seem to be anxious. It is possible for more
anxious kids to learn skills to help manage their anxiety
better so that they can fully participate in all activities, do
well in school, and not be “held back” by their anxious
feelings.

Ask The Parent Coach—

Hi Mark,

My name is C___. Our situation is a little different. We lost
my husband of 17 years and the father of my 2 girls ages 15
and 17. In the beginning my older daughter hyper-ventilated
every morning …could not go to school …the younger
jumped out of the car and ran from the two of us crying our
eyes out. He was very successful and died suddenly of a
heart attack. I was not home but my girls were and were
diagnosed with post traumatic stress. We all were on meds
and in counseling.

My younger child always was the head-strong little strong
willed child. She is so angry …now the cruel and hurtful
things she says break my heart and I end up saying and
acting just like her at times. My husband and I use to get
sick just thinking of our children leaving for college and now
I count the days till their gone, that saddens me, I love my
girls. The youngest says she does not believe in God now.
The one only good thing I have going is my girls don't do
drugs and alcohol.

I have recently dated a bit and that has made my life a living
hell. It’s the only time I feel that I can escape. I would never
let a man come before my girls or jeopardize their future at
school. She is the model student …deans list …well liked
…but at home she turns into a totally different kid …says
she wish she were dead, I were dead and her sister. She
is totally disrespectful to whoever she wants to be. I have
taken her learners permit from her indefinitely and she will
not drive until I see a difference. She is enrolled in a
volunteer program at a local hospital this summer 2 days
a week. Please help me, I love her but cannot stand her.

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Hi C.,

It's helpful to understand that PTSD is an emotional
problem and that your youngster's traumatic experience
has left "emotional scar tissue." This means that first and
foremost your youngster needs your support and under-
standing. It's usually necessary to seek help from a
qualified therapist. Family and friends can also play a key
role in helping your youngster recover.

Here are some other things moms & dads can do to
support kids with PTSD:

•        Do not criticize regressive behavior (returning to a
previous level of development). If kids want to sleep with the
lights on or take a favorite stuffed animal to bed, it's perfectly
normal and can help them feel better.

•        Encourage them to get involved in a support group for
trauma survivors. Check with your pediatrician, school, or
the library to locate groups nearby.

•        Get professional help immediately if there's any
suspicion that a youngster has thoughts of self-harm.
Thoughts of suicide are serious at any age and require
prompt and effective intervention.

•        Let them make simple decisions whenever
appropriate. Because PTSD often makes a youngster feel
powerless, moms & dads can help their kids by showing
them that they have control over certain aspects of their
lives. Depending on their kids's ages, moms & dads might
consider letting them decide things like what's for dinner,
what to wear, or select a weekend activity.

•        Let them talk about the traumatic event when and if
they feel ready. It's important not to force the issue if kids
don't feel like sharing their thoughts. Praise them for being
strong when they do talk about it.

•        Reassure them that their feelings are normal and that
they're not "going crazy." Support and understanding from
moms & dads can help kids accept their most frightening
emotions.

•        Stay in touch with caregivers. It's important to talk to
teachers, babysitters, and other people who care for kids
with PTSD.

•        Take care of yourself so that you're well equipped to
help your youngster. Dealing with PTSD can be very
challenging and may require a lot of patience and support,
but just remember that getting good help for your family can
help everyone recover.

•        Tell them that the traumatic event is not their fault.
Encourage kids to talk about their feelings of guilt, but don't
let them blame themselves for what happened.

Mark