Post-Traumatic Stress Disorder Basics

Post-traumatic stress disorder (PTSD) is an anxiety condition brought on by exposure to a disturbing event. Symptoms include detachment, difficulty sleeping, irritability, dreaming about the traumatic event and reenacting it during playtime. Our guide explains how to recognize the symptoms of PTSD in children, how it's diagnosed and the best current treatment options.

PTSD: What Is It?

Post-traumatic stress disorder (PTSD) is a condition brought on by exposure to a traumatic event. While all children can be expected to be upset after a very disturbing experience—such as witnessing or being a victim of violence, physical or sexual abuse, a natural disaster, an accident, or extreme neglect—children with the disorder don’t bounce back. They develop a pattern of behaviors that includes dreams about the event, play that reenacts the trauma, difficulty sleeping, irritability, and detachment. PTSD can develop months after the event, and may seem oddly disconnected from it. Though PTSD-like symptoms are common among children and adolescents exposed to trauma, the disorder is rare in young people.

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PTSD: What to Look For

If a child has experienced a disturbing event or series of events, anxiety and some behavioral changes are a normal part of the coping process. PTSD might be considered if she becomes distant, recreates her trauma during playtime, regularly has nightmares about it, or experiences difficulty falling asleep. Young children may begin wetting the bed, become overly clingy with their parents, or even forget how to speak.  Some children with the disorder will also develop separation anxiety disorder.  Adolescents with PTSD may display self-destructive behavior and guilt.

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PTSD: Risk Factors

PTSD is brought on by closely witnessing or experiencing a traumatic event that puts the child or loved ones in danger of serious injury or death. Risk factors that a child exposed to a disturbing experience will develop the disorder include the severity and immediacy of the trauma, and prior exposure to trauma, neglect, or other childhood adversity. Strong social support in the aftermath of the event is a protective factor that can moderate the impact on the child.

PTSD: Diagnosis

For a child to be diagnosed with PTSD, she must have experienced a traumatic event either directly, by witnessing it happening to someone else, or by hearing of it happening to a close family member or friend. Since many children who are initially anxious and distressed in the aftermath of a disturbing event will recover in a healthy way without intervention, PTSD isn’t diagnosed until a few months or longer after the initial trauma occurs, although symptoms may manifest earlier or even several years later.

A child who meets the criteria for PTSD shows symptoms commonly grouped in three areas: intrusive memories, such as bad dreams and play that reenact the event; avoidance and numbing, such as difficulty maintaining relationships, difficulty concentrating, and disinterest in formerly significant activities; and increased arousal, such as irritability, guilt, trouble sleeping, or fearful behavior. Children with the disorder often have stomachaches and headaches. The symptoms will cause significant impairment to ordinary functionality.

PTSD: Treatment

Many practitioners recommend a combination of behavioral therapy and medication. As some PTSD symptoms are often found in young people who don’t develop the full disorder, a careful evaluation is necessary before a clinician decides how to intervene.

Behavioral: PTSD therapy sessions aim to create a safe and supportive environment for a child. Psychotherapy that helps children speak, draw, play, or write about their trauma has been successful. In other cases, a clinician might recommend behavior modification techniques and cognitive therapy to teach a child to cope with his or her fear instead of addressing the trauma directly. Therapy sessions for children almost always involve a parent, a family member, or another caregiver.

Pharmacological: Medication may be prescribed to help alleviate fear and anxiety, starting with antidepressants and anti-anxiety drugs. If a child has persistent bad dreams, a medication used to treat hypertension called Prazosin has proven effective in curbing them.