by Julian Ford, Ph.D.
When children are exposed to psychological traumas they may develop problems managing stress reactions afterward. These problems often are called "post-traumatic stress disorder" (PTSD) because they occur after the trauma ("post-traumatic") and interfere with the ability to grow, learn, play, be healthy, and get along with people ("stress disorder").
Psychological traumas are a particularly severe form of stressful experiences that are terrifying or horrifying because they involve extreme violence (such as physical abuse or domestic or community violence), severe physical harm or death (such as life-threatening accidents, disasters, or the untimely death of a close friend or family member), or coercion and violation of privacy (such as sexual abuse or severe harassment/bullying). Trauma occurs in the lives of as many as 25% to 43% of children in the USA and internationally.
Most children who experience psychological trauma do not develop PTSD. Even very hardy and resilient children may develop PTSD if the trauma that they experience (such as sexual or physical abuse) is severe enough to overwhelm their coping abilities; if they experience several traumas; or, if they do not have help in managing their stress reactions and regaining their self-confidence and sense of trust and safety.
When children experience PTSD, they tend to have problems in emotional, behavioral, social, and intellectual development that show up in the a wide range of difficulties such as:
While these problems may be the temporary result of ordinary stressors, or may result from other psychiatric disorders (such as depression or ADHD), if a child has experienced traumatic stress, it is critical to carefully evaluate the child's ability to manage reactions to subsequent minor as well as major stressors to determine if he or she should be treated for PTSD.
PTSD involves four groups of symptoms : unwanted memories that are reminders of trauma experiences ("Intrusive Re-experiencing"); purposefully avoiding people, places, activities, or thoughts that are reminders of trauma experiences ("Avoidance"), feeling cut-off and detached from one's own feelings and from relationships ("Emotional Numbing"), and feeling watchful for any signs of danger ("Hyperarousal"). The common denominator is that the child is avoiding stress and emotional involvement because of unwanted memories.
The specific PTSD symptoms experienced by each child differs depending upon the child's trauma experiences, family and social support systems, and age and personality. When trauma occurs early in childhood, children may develop problems that are similar to PTSD but more severe.
Children younger than five often do not have the mental ability to communicate exactly why they feel anxious or frightened. They may "act out" by either appearing more fussy, clingy, irritable, or withdrawn. Or, while they are playing, they may "re-enact" traumatic events in play or creative arts, such as by having toys crash or drawing pictures of children or adults getting badly hurt or using weapons.
Somewhat older school-aged children may more directly express fears, self-doubt, distrust, or inconsolable sadness. They may avoid or become overly charged-up in peer-group or school activities, and are prone to blame themselves, to believe that they should have known that terrible things were going to happen ("omen formation"), and to feel guilty or hopeless because they couldn't have somehow magically prevented the trauma. They may act much younger than their age, and be "clingy" or forgetful or too easily trust strangers. They also may become defiant, negativistic ("oppositional"), irritable, impulsive, and aggressive outwardly toward adults or peers while feeling hopeless, depressed, and even suicidal.
Pre-adolescents and adolescents with PTSD tend to be consistently anxious, depressed, furious, "spaced out," or a combination of all of these states of inner turmoil. They may act out by violating social norms (such as using drugs, truancy, promiscuity, or other risky or illegal acts) or to withdraw into their own world. Either way, they often seem "unreachable."
As adolescents and adults, children who do not receive therapy for PTSD are at risk not only for chronic PTSD but also for persistent problems in school, work, relationships, and with the law, as well as psychiatric (anxiety, affective, addictive, psychotic, and personality) and medical illnesses (diabetes, cardiovascular and lung diseases, immune disorders), and re-victimization (repetitive or new traumas).
On the other hand, timely and effective therapy for PTSD can enable children who have experienced severe psychological trauma to once again feel safe and calm enough to think clearly and enjoy and succeed in activities and relationships. Therapy should provide guidance to the child and to the parents or other caregivers to enable them to know that troubling memories of past traumas are "old business," and that they can feel confident either won't happen again or that they can handle them without feeling too shocked and helpless to cope effectively and regain a safe healthy life.
The two PTSD psychotherapies for children that have the strongest scientific evidence base currently are Trauma Focused Cognitive Behavior Therapy (TF-CBT); and Child-Parent Psychotherapy (CPP); Several other promising therapy approaches also have been developed for children with particularly severe PTSD.
More information about children and PTSD and more detailed descriptions of the most effective therapies for children with PTSD, as well as other for resources for parents, teachers, therapists, and other adults who want to help children recover from trauma, are available from the National Child Traumatic Stress Network and the National Center for PTSD.
Julian D. Ford, Ph.D. is a clinical psychologist and Associate Professor of Psychiatry at the University of Connecticut Health Center. He has developed TARGET (Trauma Affect Regulation: Guidelines for Education and Therapy) for youth and adults with co-occurring psychiatric and addictive disorders and complex post-traumatic stress disorder, and is conducting research studies on this model with funding from the National Institutes of Health, National Institute of Justice, Department of Justice, and Connecticut state agencies.