What Is PTSD?
The disorder looks different in children as they develop
When we think about post-traumatic stress disorder most of us probably picture a soldier who has been in combat. In fact anyone — including children — can develop PTSD, because anyone can experience trauma. But not everyone who experiences trauma goes on to develop PTSD, even if they are showing the early signs of what looks like the disorder.
“The symptoms of PTSD are quite normal to have right after experiencing a traumatic event,” explains Janine Domingues, PhD, a child psychologist who specializes in trauma at the Child Mind Institute. “Anyone can experience an event and have a natural recovery period. PTSD is diagnosed when a child is stuck in the recovery period.”
When children do develop PTSD, treatment depends on their development level, which affects how they perceive and process the trauma. And as they get older, they may develop different symptoms, which may call for more therapy. “You treat PTSD at the current developmental level the child is at,” explains Jamie Howard, PhD, director of the Trauma and Resilience Service at the Child Mind Institute, “and then it might recur as kids get older.”
What is a traumatic event?
An event that might be traumatic for one child might not be for another. For example, experiencing a natural disaster might be very frightening but a child might be fully recovered several months later, while her friend may still be struggling. That’s because trauma depends on many factors, including a person’s perception of an event and proximity to it, previous experiences, experiences after the event, and more.
In general, traumatic events are ones that expose a child to death, serious injury or violence. The child may have directly experienced the traumatic event himself or witnessed it or even just learned about something traumatic happening to a close family member or friend. Here are some examples of events that may lead to PTSD in children:
- Car accident
- Natural disaster
- School shooting
- Physical or sexual abuse
- Domestic violence
- Community violence
- The death of a family member
- Displacement from the home
A traumatic event may occur just once, like a car accident, or the trauma can be recurring, like violence in the community or the home.
After experiencing a traumatic event
It is normal for a child to struggle after a seriously frightening or upsetting event. Tantrums or moodiness, trouble separating from caregivers, or disturbed sleep right after experiencing a trauma are fairly common. But if a child is still struggling one month after a traumatic event, she may have post-traumatic stress disorder.
Dr. Domingues says that parents may come looking for help shortly after a traumatic event because they are worried by changes in their child’s behavior, or simply because they are concerned about its impact. Then it is the clinician’s role to perform an evaluation to discover how the child is coping. “It is not always the case that a child will have PTSD,” explains Dr. Domingues. “We may find that, actually, it seems like the child has a healthy narrative about what happened and is recovering just fine.”
On the other hand, for children who are struggling in the immediate aftermath of a traumatic event, a clinician may determine that he has something called “acute stress disorder.” This is a disorder with symptoms that are very similar to PTSD, but can be diagnosed from three days to a month after an event. Getting treatment with a mental health professional who will help them build strong coping skills may prevent them from going on to develop PTSD.
Symptoms of PTSD
Children with PTSD can have a variety of symptoms, including unwanted intrusive thoughts, persistent efforts to avoid things that remind them of the trauma, and negative changes in their mood and thinking.
Some of these symptoms will be easier for parents and teachers to notice, while others, like shifts in thinking, may be more subtle. Some common symptoms include:
- Unusual irritability
- Difficulty concentrating
- Being easily startled
- Difficulty sleeping
- Significant change in mood
- Significant change in the way she views the world, her relationships, or herself
- Feelings of guilt or shame
- Seeming detached or estranged from others
Re-experiencing the trauma is a common symptom of PTSD. Children of all ages might re-experience their trauma during nightmares, flashbacks or intrusive memories. In young children re-experiencing might happen during play, which parents may find off-putting.
Different symptoms at different ages
PTSD symptoms can look different at different ages. “At a younger age children might not be able to articulate exactly what they’re feeling, but as a parent you might notice more avoidance of cues that remind them of the event,” notes Dr. Domingues. Young children are also fairly concrete thinkers. So if the traumatic event happened on a Friday, for example, a young child with PTSD might start thinking all Fridays are bad.
“When kids get older, they might struggle more with symptoms around fairness,” says Dr. Domingues. “They might be wondering things like, ‘How could something like this happen if I’m a good person?’”
Understanding symptoms of PTSD and how they can change with developmental stages helps in getting a correct diagnosis, but it also helps inform treatment. In fact, as children mature developmentally, they sometimes find they are struggling with an element of their trauma that didn’t bother them before, and they may need another dose of therapy to help them deal with a new symptom.
‘They go from have associative logic as preschoolers, and then they have more concrete thinking, and then when they’re teenagers they have abstract thinking, so they can process it totally differently, explains Dr. Howard. “They might need a tune-up or another course of treatment based on their developmental level.”