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Posttraumatic Stress Disorder in Children and Teens
What events cause PTSD in children?
Children and teens could have posttraumatic stress disorder (PTSD) if they have lived through an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend's suicide, or seeing violence in the area in which they live.
Child protection services in the US get around 3 million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur: 65% neglect; 18% physical abuse; 10% sexual abuse; and 7% psychological (mental) abuse.
What Can You
Also, 3-10 million children witness family violence each year. Around 40-60% of those cases involve child physical abuse. (Note: It is thought that two-thirds of child abuse cases are not reported.)
How many children get PTSD?
Studies show that about 15-43% of girls and 14-43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3-15% of girls and 1-6% of boys develop PTSD.
Rates of PTSD are higher for certain types of trauma survivors. Nearly 100% of children get PTSD if they see a parent being killed or if they see a sexual assault. PTSD develops in 90% of sexually abused children, 77% of children who see a school shooting, and 35% who see violence in the area in which they live get PTSD.
What are the risk factors for PTSD?
Three factors have been shown to raise the chances that children will get PTSD: 1) how severe the trauma is; 2) how the parents react to the trauma; and 3) how close or far away the child is from the trauma. Children and teens that go through the most severe traumas tend to have the highest levels of PTSD symptoms. The PTSD symptoms may be less severe if the child has more family support and if the parents are less upset by the trauma. Lastly, children and teens who are farther away from the event report less distress.
Other factors can also affect PTSD. Events that involve people hurting other people, such as rape and assault, are more likely to result in PTSD than other types of traumas. Also, the more traumas a child goes through, the higher the risk of getting PTSD. Girls are more likely than boys to get PTSD.
It is not clear whether a child's ethnic group may affect PTSD. Some research shows that minorities have higher levels of PTSD symptoms. Other research suggests this may be because minorities may go through more traumas.
Another question is whether a child's age at the time of the trauma has an effect on PTSD. Researchers think it may not be that the effects of trauma differ according to the child's age. Rather, it may be that PTSD looks different in children of different ages.
What does PTSD look like in children?
School-aged children (ages 5-12): These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.
Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.
Teens (ages 12-18): Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.
What are other effects of trauma on children?
Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of what we know about the effects of trauma on children comes from the research on child sexual abuse. This research shows that sexually abused children often have problems with fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others. They also struggle with behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol.
How is PTSD treated in children and teens?
For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years if they do not get treatment. There are many treatment options, described below:
Cognitive-Behavioral Therapy (CBT): CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert him or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, "the world is totally unsafe."
Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD.
CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children.
Psychological first aid/crisis management: Psychological first aid (PFA) has been used with schoolaged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem-solving skills. PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe symptoms may be referred for added treatment.
Eye movement desensitization and reprocessing (EMDR): EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.
Play therapy: Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other methods to help children process their traumatic memories.
Other treatments: Special treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol.
This article first appeared in the May, 2012 Brown University Child and Adolescent Behavior Letter