PTSD in Children

PTSD (Post Traumatic Stress Disorder) is a serious, upsetting condition affecting both adults and children.

It is the emotional response to a real or threatened traumatic event. The effects can be debilitating and long term if not treated.

PTSD in children was not a recognised condition until 1980, so we don't know as much about it as we do about adult PTSD. What we do know is that approximately 1% of children and adolescents have PTSD and it is a very common reaction following a traumatic event. Some estimate that up to 50% of young people will go on to develop PTSD following a violent attack, abuse or trauma¹.

What causes PTSD in children and adolescents?

PTSD can be caused by a single traumatic event, or series of events that have happened in someone's life.

It can be caused by suffering a trauma directly, but also caused by suffering from the threat of a trauma.

Common causes of PTSD in children are:

Terrorism	Road traffic accidents
War	Natural disasters and fire incidents
Assault, sexual or physical	Victim or witness to a crime
Childhood neglect	Diagnosis of a long term or life limiting illness
Childhood abuse	Death of a family member

What are the symptoms of PTSD?

Children aged 2 – 8 years: The symptoms of PTSD in young children are different to those in adults, partly due to how the immature brain processes information, but also because of the limited amount of emotional language available. Repeatedly re-enacting the event or drawing what happened, angry outbursts, disruptive behaviour and nightmares are all common symptoms of PTSD in children.

Young People older than 8: As children develop and mature, they start to display symptoms more similar to adults, including:

Intrusive memories Flashbacks and reliving the event Vivid memories Upsetting dreams about the incident Continuously thinking about the event Having physical reactions when thinking about the event, such as heart palpitations, anxiety or feeling sick	Negative feelings Loss of interest in social interaction Feeling despair about the future Being easily upset Physical ailments that are not explained
Numbing and avoidance Memory loss about the event Avoiding people or places that remind you of the event Feeling distant about the event when discussed with you	Emotional disturbances Feeling distressed and anxious Not being able to concentrate Sleep disturbances, trouble getting to sleep or waking Irritability Anger Feeling on edge all of the time

Other Symptoms of PTSD

Self harming, suicidal behaviour, personality changes and depression can be side effects of PTSD.

The symptoms of PTSD can take a few weeks to show and may only arise several years following the event.

Interesting research about symptoms of PTSD in children shows that many children will withhold their emotions, if they feel that their parent might get upset when discussing the trauma ². For this reason, when diagnosing PTSD in children, psychiatrists will often spend time alone with the child to understand their feelings, without the influence of their parents being in the room.

Why do we get PTSD?

PTSD is thought to be our way of coping with the stress that the body and brain have gone through and as a way of us coming to terms with the event.

Flashbacks are thought to help the brain prepare in case the event happens again.

The feeling of being on edge is due to increased adrenaline in the system, getting the individual ready to ‘fight or flight’. In normal daily life adrenaline can be a useful chemical, but after a trauma levels can become elevated and struggle to return to normal.

Numbing and avoidance can be a mechanism for the brain to get some rest from constantly thinking about such upsetting events.

The hippocampus is a part of the brain which is responsible for memory creation and storage. It can be adversely affected by the levels of adrenaline in the brain, released after the event. The increased adrenaline levels can stop memories from being processed as they should, resulting in flashbacks.

What treatment options are available for children and teenagers with PTSD?

Talking therapies are considered to be the most effective treatments for PTSD.

There are different types of therapy, which can be confusing, but we can help advise on which treatment would be best for your child, depending on their circumstances.

CBT (cognitive behavioural therapy) works by giving coping mechanisms to your child, to help them deal with the difficult emotions that arise after a trauma. Studies have shown CBT to be highly effective at alleviating PTSD symptoms³.

Trauma focused therapy work will work directly the event/s that caused the PTSD, with therapists who have specialist knowledge of trauma. It can be paired with CBT or carried out alone and may be better suited to some than CBT.

EMDR therapy can be particularly effective at working with complex, disturbing memories. It works by essentially ‘reprogramming’ some of the brain patterns and has very good outcomes for anxiety and trauma related conditions.

Family Therapy – research has shown that the most successful outcomes can be when the whole family receives help; even if the trauma was only experienced by the child themselves the repercussions will be felt across the other members of the family.

Parenting support – it is not easy caring for a child who has gone through traumatic experiences. Parent may feel incredible guilt, anger or frustration. A child’s behaviour can be challenging and difficult to know how to manage. Parenting support can be a lifeline – offering sensible, caring and useful help and support to make things are home much easier and less stressful.

Medication – Antidepressants and other psychotropic drugs can be useful for alleviating symptoms of PTSD, but more often than not talking therapies are recommended. Medications need to be carefully prescribed and managed in children and we would always advise seeking expert help when considering whether medication is an option.

How can Clinical Partners help?

If you are seeking help for your child or teenager, our team of nationwide psychiatrists, psychologists and psychotherapists will be able to help.

To start with, your child will meet with a psychiatrist, often some time will be spent with both you and your child and then with your child alone to determine the best treatment options.

Within 2 weeks you will receive a full psychiatric assessment, with any treatment recommendations. We can then help find a suitable therapist for you; you can choose to continue treatment with the psychiatrist if medication is prescribed, or you can choose to return to the NHS for further treatment if your GP supports it.

The process will be clearly explained to you by one of our clinical advisors and we are available to answer any questions you might have during the treatment.

¹ Yule et al (2000) The Long Term Psychological Effects Of A Disaster Experienced in Adolescence Journal of Child Psychiatry and Psychology 2000; 41:503-511
² Dyregrov, A and Yule, W. (2006) A Review of PTSD in Children Child and Adolescent Mental Health Volume 2, No. 4, pp 176-184
³ Dyregrov, A and Yule, W. (2006) A Review of PTSD in Children Child and Adolescent Mental Health Volume 2, No. 4, pp 176-184