PTSD in Children and Adolescents

Reviewed Sep 20, 2017

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Summary

  • Childhood PTSD can have symptoms all its own.
  • Small children may not be able to talk about trauma, so adults need to watch for non-verbal signs.
  • Treatment involves both children and adults.

Trauma comes in many forms for children. It can be crime, family violence, a natural disaster, a family death, abuse, neglect, or the pain of illness or injury. And many children are exposed to trauma. In a 2011 national survey of children and adolescents, two out of five said they had been assaulted in the past year. One in 10 had been hurt by violence. One in five had witnessed family violence during their lives. Nearly 15 percent had been neglect by caregivers.

Such events can have lasting effects. In very young children, they can even change the development of the brain. They can lead to depression or drug use. They can also lead to post-traumatic stress disorder (PTSD).

As in adults, PTSD in the young is a failure by the brain to integrate painful memories. Experiences that should be viewed as in the past are re-lived in the present. Emotions well up and can’t be controlled. There are differences, too. Small children who can’t voice their fear in words will act it out. They may blame themselves for not stopping a painful event, as if they had control over it.

The National Child Traumatic Stress Network (NCTSN) says these are some signs of traumatic stress in children younger than 6:

  • excessive temper
  • aggressive behavior
  • startling easily
  • fear of adults who remind them of the hurtful event
  • fear of separation from a parent or caregiver
  • poor sleep habits
  • nightmares
  • acting withdrawn
  • regressive behavior, such as wetting the bed after being toilet trained

Traumatized children 2 years and younger may have a poor appetite and cry or scream excessively. Children up to 6 years may have learning disabilities. They also may imitate the event and have trouble making friends.

Adolescents also have their ways of showing traumatic stress. The NCTSN says these include:

  • feeling sad and alone
  • having an eating disorder or other self-harming behavior, such as cutting
  • use or misuse of alcohol or drugs
  • talking about the event in detail
  • becoming sexually active
  • taking too many risks
  • feeling different from others
  • feeling like they’re going crazy
  • avoiding places that remind them of the trauma
  • saying they have no feeling about the event

How do you know when a child needs treatment? When your own efforts fall short, says psychiatrist Judith Cohen, MD. “If your current caregiving is not serving to soothe the child,” she says, “you should get help.”

As for the type of treatment, Cohen says forms of cognitive-behavioral therapy (CBT) are probably most widely used. Medication might be used to reduce some symptoms, but does not get at the root causes.

CBT aims to change the negative thought patterns of PTSD. It draws on a tool kit of techniques involving both mind and body. Relaxation skills such as deep breathing can help children dial down their fear and anger. “Cognitive coping” teaches them to spot harmful thoughts and put healthy ones in their place.

Creating a “trauma narrative” can help a child give new meanings to past stressful events.

“Exposure” is another cognitive method. It might involve talking about a traumatic event in a way that does not upset a child. Or it may be “in vivo”: going to places where trauma occurred.

Adults play a key part in therapy for children and teens. For instance, Dr. Cohen works with parents to make sure they understand PTSD and have the skills to support the child. Through much of her therapy, adults and children meet with her separately. But they also have joint sessions.

Parents are crucial because they are the most important people in a child’s life. They can help children work on therapies at home and, most of all, teach them that the world is not as dark and unsafe as they think. Says the NCTSN: “parents can create the stable, consistent, and caring environment in which the child can learn that a traumatic experience doesn’t have to dominate life.”

Resources

The website of the National Child Traumatic Stress Network has information for parents and professionals. See especially:

“Effective Treatments for Youth Trauma”: www.nctsnet.org/nctsn_assets/pdfs/effective_treatments_youth_trauma.pdf

Types of Childhood trauma: http://nctsnet.org/trauma-types

“What is Child Traumatic Stress?” http://nctsnet.org/resources/audiences/parents-caregivers/what-is-cts

The federal Substance Abuse and Mental Health Services Administration has a website devoted to child traumatic stress at www.samhsa.gov/child-trauma

By Tom Gray
Source: National Child Traumatic Stress Network, http://nctsn.org; Judith Cohen, MD, Professor of Psychiatry, Allegheny General Hospital, Pittsburgh, PA; "Violence, Crime and Abuse Exposure in a National Sample of Children and Youth: An Update," by David Finkelhor, et al. Jama Pediat, May 13, 2013.
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

  • Childhood PTSD can have symptoms all its own.
  • Small children may not be able to talk about trauma, so adults need to watch for non-verbal signs.
  • Treatment involves both children and adults.

Trauma comes in many forms for children. It can be crime, family violence, a natural disaster, a family death, abuse, neglect, or the pain of illness or injury. And many children are exposed to trauma. In a 2011 national survey of children and adolescents, two out of five said they had been assaulted in the past year. One in 10 had been hurt by violence. One in five had witnessed family violence during their lives. Nearly 15 percent had been neglect by caregivers.

Such events can have lasting effects. In very young children, they can even change the development of the brain. They can lead to depression or drug use. They can also lead to post-traumatic stress disorder (PTSD).

As in adults, PTSD in the young is a failure by the brain to integrate painful memories. Experiences that should be viewed as in the past are re-lived in the present. Emotions well up and can’t be controlled. There are differences, too. Small children who can’t voice their fear in words will act it out. They may blame themselves for not stopping a painful event, as if they had control over it.

The National Child Traumatic Stress Network (NCTSN) says these are some signs of traumatic stress in children younger than 6:

  • excessive temper
  • aggressive behavior
  • startling easily
  • fear of adults who remind them of the hurtful event
  • fear of separation from a parent or caregiver
  • poor sleep habits
  • nightmares
  • acting withdrawn
  • regressive behavior, such as wetting the bed after being toilet trained

Traumatized children 2 years and younger may have a poor appetite and cry or scream excessively. Children up to 6 years may have learning disabilities. They also may imitate the event and have trouble making friends.

Adolescents also have their ways of showing traumatic stress. The NCTSN says these include:

  • feeling sad and alone
  • having an eating disorder or other self-harming behavior, such as cutting
  • use or misuse of alcohol or drugs
  • talking about the event in detail
  • becoming sexually active
  • taking too many risks
  • feeling different from others
  • feeling like they’re going crazy
  • avoiding places that remind them of the trauma
  • saying they have no feeling about the event

How do you know when a child needs treatment? When your own efforts fall short, says psychiatrist Judith Cohen, MD. “If your current caregiving is not serving to soothe the child,” she says, “you should get help.”

As for the type of treatment, Cohen says forms of cognitive-behavioral therapy (CBT) are probably most widely used. Medication might be used to reduce some symptoms, but does not get at the root causes.

CBT aims to change the negative thought patterns of PTSD. It draws on a tool kit of techniques involving both mind and body. Relaxation skills such as deep breathing can help children dial down their fear and anger. “Cognitive coping” teaches them to spot harmful thoughts and put healthy ones in their place.

Creating a “trauma narrative” can help a child give new meanings to past stressful events.

“Exposure” is another cognitive method. It might involve talking about a traumatic event in a way that does not upset a child. Or it may be “in vivo”: going to places where trauma occurred.

Adults play a key part in therapy for children and teens. For instance, Dr. Cohen works with parents to make sure they understand PTSD and have the skills to support the child. Through much of her therapy, adults and children meet with her separately. But they also have joint sessions.

Parents are crucial because they are the most important people in a child’s life. They can help children work on therapies at home and, most of all, teach them that the world is not as dark and unsafe as they think. Says the NCTSN: “parents can create the stable, consistent, and caring environment in which the child can learn that a traumatic experience doesn’t have to dominate life.”

Resources

The website of the National Child Traumatic Stress Network has information for parents and professionals. See especially:

“Effective Treatments for Youth Trauma”: www.nctsnet.org/nctsn_assets/pdfs/effective_treatments_youth_trauma.pdf

Types of Childhood trauma: http://nctsnet.org/trauma-types

“What is Child Traumatic Stress?” http://nctsnet.org/resources/audiences/parents-caregivers/what-is-cts

The federal Substance Abuse and Mental Health Services Administration has a website devoted to child traumatic stress at www.samhsa.gov/child-trauma

By Tom Gray
Source: National Child Traumatic Stress Network, http://nctsn.org; Judith Cohen, MD, Professor of Psychiatry, Allegheny General Hospital, Pittsburgh, PA; "Violence, Crime and Abuse Exposure in a National Sample of Children and Youth: An Update," by David Finkelhor, et al. Jama Pediat, May 13, 2013.
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

Summary

  • Childhood PTSD can have symptoms all its own.
  • Small children may not be able to talk about trauma, so adults need to watch for non-verbal signs.
  • Treatment involves both children and adults.

Trauma comes in many forms for children. It can be crime, family violence, a natural disaster, a family death, abuse, neglect, or the pain of illness or injury. And many children are exposed to trauma. In a 2011 national survey of children and adolescents, two out of five said they had been assaulted in the past year. One in 10 had been hurt by violence. One in five had witnessed family violence during their lives. Nearly 15 percent had been neglect by caregivers.

Such events can have lasting effects. In very young children, they can even change the development of the brain. They can lead to depression or drug use. They can also lead to post-traumatic stress disorder (PTSD).

As in adults, PTSD in the young is a failure by the brain to integrate painful memories. Experiences that should be viewed as in the past are re-lived in the present. Emotions well up and can’t be controlled. There are differences, too. Small children who can’t voice their fear in words will act it out. They may blame themselves for not stopping a painful event, as if they had control over it.

The National Child Traumatic Stress Network (NCTSN) says these are some signs of traumatic stress in children younger than 6:

  • excessive temper
  • aggressive behavior
  • startling easily
  • fear of adults who remind them of the hurtful event
  • fear of separation from a parent or caregiver
  • poor sleep habits
  • nightmares
  • acting withdrawn
  • regressive behavior, such as wetting the bed after being toilet trained

Traumatized children 2 years and younger may have a poor appetite and cry or scream excessively. Children up to 6 years may have learning disabilities. They also may imitate the event and have trouble making friends.

Adolescents also have their ways of showing traumatic stress. The NCTSN says these include:

  • feeling sad and alone
  • having an eating disorder or other self-harming behavior, such as cutting
  • use or misuse of alcohol or drugs
  • talking about the event in detail
  • becoming sexually active
  • taking too many risks
  • feeling different from others
  • feeling like they’re going crazy
  • avoiding places that remind them of the trauma
  • saying they have no feeling about the event

How do you know when a child needs treatment? When your own efforts fall short, says psychiatrist Judith Cohen, MD. “If your current caregiving is not serving to soothe the child,” she says, “you should get help.”

As for the type of treatment, Cohen says forms of cognitive-behavioral therapy (CBT) are probably most widely used. Medication might be used to reduce some symptoms, but does not get at the root causes.

CBT aims to change the negative thought patterns of PTSD. It draws on a tool kit of techniques involving both mind and body. Relaxation skills such as deep breathing can help children dial down their fear and anger. “Cognitive coping” teaches them to spot harmful thoughts and put healthy ones in their place.

Creating a “trauma narrative” can help a child give new meanings to past stressful events.

“Exposure” is another cognitive method. It might involve talking about a traumatic event in a way that does not upset a child. Or it may be “in vivo”: going to places where trauma occurred.

Adults play a key part in therapy for children and teens. For instance, Dr. Cohen works with parents to make sure they understand PTSD and have the skills to support the child. Through much of her therapy, adults and children meet with her separately. But they also have joint sessions.

Parents are crucial because they are the most important people in a child’s life. They can help children work on therapies at home and, most of all, teach them that the world is not as dark and unsafe as they think. Says the NCTSN: “parents can create the stable, consistent, and caring environment in which the child can learn that a traumatic experience doesn’t have to dominate life.”

Resources

The website of the National Child Traumatic Stress Network has information for parents and professionals. See especially:

“Effective Treatments for Youth Trauma”: www.nctsnet.org/nctsn_assets/pdfs/effective_treatments_youth_trauma.pdf

Types of Childhood trauma: http://nctsnet.org/trauma-types

“What is Child Traumatic Stress?” http://nctsnet.org/resources/audiences/parents-caregivers/what-is-cts

The federal Substance Abuse and Mental Health Services Administration has a website devoted to child traumatic stress at www.samhsa.gov/child-trauma

By Tom Gray
Source: National Child Traumatic Stress Network, http://nctsn.org; Judith Cohen, MD, Professor of Psychiatry, Allegheny General Hospital, Pittsburgh, PA; "Violence, Crime and Abuse Exposure in a National Sample of Children and Youth: An Update," by David Finkelhor, et al. Jama Pediat, May 13, 2013.
Reviewed by Cynthia Scott, MD, Physician Advisor, Beacon Health Options

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