Main symptoms of PTSD in children and teens
What is PTSD?
Post-traumatic Stress Disorder (PTSD) occurs when there is unresolved trauma in a person’s life. During a traumatic experience the brain initiates a “fight or flight” response which increases activity in all parts of the brain and stores memory of the stimuli, such as sights and sounds. After the trauma the amygdala and hippocampus are supposed to calm the physiological responses and produce calming thoughts so the “fight or flight” symptoms go away. With children and teens who develop PTSD the brain becomes unable to turn off these responses and dramatic symptoms can return and recur for long periods of time. Trauma and PTSD are not the same thing. PTSD is a result of trauma, but not everyone who has experienced trauma develops PTSD.
So what is trauma then?
Trauma is threat of physical harm which occurs in many different types of situations.
- Trauma can occur through neglect, physical or sexual abuse, or as a result of a medical intervention.
- Trauma also occurs during natural disasters or during accidents in travel or home-related accidents.
- The effects of war and displacement of home, as with refugees, is another common cause of PTSD.
- Occasionally PTSD can also surface after the death of a loved one or divorce.
The length and intensity of the exposure affects the prevalence and severity of PTSD. PTSD does not always occur through direct exposure of a traumatic event, but can also appear through indirect exposure as in the case of learning about a family member or close loved one who experienced trauma. PTSD cannot be diagnosed until 6 months after the trauma, but onset of symptoms could happens immediately or they may not surface for several months or years. Symptoms must be present for at least 3 months to classify as PTSD. Despite infants and young children’s verbal inability to express trauma, they still display symptoms of PTSD.
Symptoms of PTSD in children and teens
Although some symptoms are present in adults as well as children and teens, continued research shows that there are quite a few differences in the way children and teens manifest the same traumatic events.
Symptoms include:
1. Recurrent, involuntary memory of the trauma
This includes flashbacks and nightmares. The nightmares may not be related to the traumatic event, but continued nightmares cause a significant disruption of sleep. This symptom is also manifest through post-traumatic play and post-traumatic reenactment through play, drawings, and verbalizations. Post-traumatic play is seen more frequently with school-aged children and is a literal representation of the trauma through repeating certain aspects of the trauma or increased interest such as playing shooting games after being exposed to a school shooting or acting out sexual behaviors after being sexually abused. Post-traumatic reenactment is more likely to occur with adolescents as they incorporate aspects of the event into their daily lives, such as carrying a weapon after being exposed to violence or being sexually promiscuous after abuse, rather than actually acting out the event.
2. Unexplainable vague illnesses such as headaches and stomachaches
This symptom can often go unnoticed because it can appear that a child is making up excuses to avoid participating in social activities or talking about the event. However, these complaints are a very real symptom of PTSD and often occur when the event surfaces in their mind.
3. Hypervigilance and startling easily
Hypervigilance is an exaggerated perception of sensory activity that increases anxiety and often causes the child to continually check their surroundings for possible threats. This response is one part of the amygdala that was initiated by the traumatic event which can be protective during dangerous situations, however, with PTSD this part of the brain remains overactive long after the event. Children or teens may jump easily when hearing loud noises or when they are in situations that resemble the traumatic event.
4. Avoiding external and internal stimuli associated with the trauma
Sometimes children will go to great effort to avoid places, people, and conversations that have a connection to the trauma. They may also avoid internal thoughts or feelings and can go as far as completely denying that the event ever happened. Burial and avoidance of these emotions can amplify the symptoms of PTSD and help should be sought quickly for children with these symptoms.
5. Depressed mood
Whereas the amygdala and hippocampus are overactive in children with PTSD, the prefrontal cortex (which controls emotions, behaviors, and impulses) is less active resulting in reduction of positive emotions, irritability, and social withdrawal. Many children and teens diagnosed with PTSD are co-diagnosed with Major Depressive Disorder.
6. Trouble concentrating
Lack of concentration is often manifest in school performance. Children may be distracted by their recurrent thoughts, focused on their feelings of depression or anxiety, or may simply find something that produces fear so they quickly move on to thoughts that are safer.
7. Negative view of the world and loss of hope for the future
This symptom is specific to children and teens due to their shortened lifespan leading up to the trauma. They have a persistent, and often distorted, view that the world is a dangerous place and have a negative view of themselves as well. Some children may blame themselves for causing the event and the resultant consequences. Many children also cannot answer questions about what their plans are for the future because they expect to die young.
8. Impulsive, self-destructive, and aggressive behaviors
These symptoms are more prevalent in adolescents and has a direct connection to their foreshortened sense of the future. Since they don’t believe they have a future they don’t see the need to save money, develop lasting relationships, or avoid risky situations. As a result many teens turn to drugs and alcohol, sexual promiscuity, aggression, and other impulsive behaviors.
Treatment of PTSD for children and teens
Treatment for children and teens is very effective. The most common, and most effective, type of therapy is Cognitive Behavioral Therapy. Cognitive Behavioral Therapy (CBT) directly discusses the traumatic event and provides anxiety-reducing techniques, relaxation and assertiveness training, and correction of inaccurate or distorted trauma-related information. CBT also teaches techniques to overcome their overly negative view of the world and themselves, and can be used to reduce impulsive behaviors.
Play therapy is used with young children who cannot discuss the traumatic event directly. Therapists need to be trained in play therapy and use techniques such as drawings and games to help children process their emotions related to the event.
Some medications have shown to improve the symptoms of PTSD, although there are other side effects such as irritability and poor sleeping habits.
Eye movement and Desensitization and Reprocessing (EMDR) combines CBT with directed eye movements. Although this technique has been used with children, research has shown it not to be as effective with children as it is with adults.
Parental involvement is a great protective factor for children and teens on the journey to recovery from PTSD. If you observe these symptoms in your child and they persist for a long period of time, seek help from a trained professional. During treatment, parents can continue to participate in therapy and reinforce the skills being taught when negative stimuli arise. The sooner treatment is sought the faster the road to recovery.
References
1. National Center for PTSD, U.S. Department of Veteran Affairs (2015). DSM-5 Criteria for PTSD. Retrieved from http://www.brainlinemilitary.org/content/2014/06/dsm-v-tr-criteria-for-ptsd.html.
2. Philo, Jolene (2013, September 12). 8 Symptoms of Post Traumatic Stress Disorder in Children and Teens. Retrieved from http://www.friendshipcircle.org/blog/2013/09/12/8-symptoms-of-ptsd-in-children-and-teens/
3. Philo, Jolene (2013, January 8). 10 Causes of Post Traumatic Stress Disorder in Children. Retrieved from http://www.friendshipcircle.org/blog/2013/01/08/10-causes-of-post-traumatic-stress-disorder-in-children/
4. The Anatomy of PTSD (2013). Retrieved from http://www.brainlinemilitary.org/content/2014/06/the-anatomy-of-ptsd.html
5. U.S. Department of Human Affairs (2016, February 23). PTSD in Children and Adolescents. Retrieved from https://www.ptsd.va.gov/professional/treatment/children/ptsd_in_children_and_adolescents_overview_for_professionals.asp