School shootings. Bullying. Sexual assaults. Hurricanes. Flooding. Tornadoes. Car accidents. Fires. Physical and sexual abuse. Exposure to violence. These days, the traumas that our children face seem endless. Exposure to traumatic events such as these can lead to the development of Posttraumatic Stress Disorder or PTSD.
The DSM-5 Criteria: Posttraumatic Stress Disorder (PTSD)
Exposure to actual or threatened death, serious injury, or sexual violence
- directly experiencing the traumatic event
- witnessing, in person, an event as it occurred to others
- learning that traumatic event occurred to a close family member or close friend
- experiencing repeated or extreme exposure to aversive details of the traumatic events such as the exposures that first responders, police officers, and firefighters typically endure
Presence of one or more of the following intrusion symptoms associated with the traumatic event that begins after the traumatic event occurred
- recurrent, involuntary, and intrusive distressing memories of the traumatic event which can manifest as repetitive play in which themes or aspects of the traumatic event are expressed for children
- recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event (may be experienced as frightening dreams without recognizable content in children)
- dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event were recurring
- intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble aspects of the traumatic event
- marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event
Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred
- avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events
- avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event
Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred
- inability to remember important aspects of the traumatic event
- persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
- persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself/herself or others
- persistent negative emotional state – fear, horror, anger, guilt, or shame
- markedly diminished interest or participation in significant activities
- feelings of detachment or estrangement from others
- persistent inability to experience positive emotions
Marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred
- irritable behavior and angry outbursts, with little or no provocation, typically expressed as verbal or physical aggression towards people or objects
- reckless or self-destructive behavior
- hypervigilance
- exaggeration startle response
- difficulty concentrating
- sleep disturbance – trouble falling or staying asleep or restless sleep
What to Know
1) According to the National Center for PTSD, child protective services in the United States receive 3 million reports of trauma and abuse every year which impacts about 5.5 million children
2) Rates of child maltreatment – 65% neglect, 18% physical abuse, 10% sexual abuse, and 7% psychological or mental abuse
3) Anywhere from 3 to 10 million children witness family violence every year
4) Rates of trauma and PTSD in children – 15 to 43% of girls and 14 to 43% of boys experience at least one trauma; of those who were exposed to a traumatic event, 3 to 15% of girls and 1 to 6% of boys will develop PTSD
5) Risk factors for PSTD – severity of the trauma, repeated trauma, multiple types of trauma, reactions of parents and/or other caregivers to the traumatic event, proximity of the child to the trauma
6) Young children may regress (act younger than their age) behaviorally in response to trauma – clingier, difficulty separating from parents/caregivers, whiny, fearful of the dark, bedwetting, thumb sucking, stop talking
7) Young children with PTSD may re-enact trauma through their play – drawings, aggressive play, traumatic themes
8) Other symptoms of PTSD children may display include worries about dying at an early age, physical complaints such as headaches and stomachaches, irritability or anger outbursts, school avoidance, sleep changes, changes in appetite, difficulty concentrating, pervasive worry or dread
9) Successful treatment of PTSD incorporates both psychotherapy and psychotropic medications. Trauma-focused cognitive behavioral therapy (TF-CBT) is a specific type of evidence-based therapy uniquely designed to help children or adolescents and their parents process emotions and develop strategies to cope with the psychological impact of a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is another type of psychotherapy used to promote psychological healing in the face of trauma. Many psychiatrists also prescribe psychotropic medications such as antidepressants and anti-anxiety medications to ameliorate the mood symptoms, anxiety, and sleep issues that often plague youth with PTSD.
