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Author: Dr Sabina DosaniConsultant Child & Adolescent Psychiatrist

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

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

What is PTSD?

PTSD is a very normal reaction to a traumatic event or situation. 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.
It can be very hard for children to communicate their feelings after a traumatic event, perhaps because they don’t have the words required, or the emotions are so overwhelming they don’t know how to talk about them. This can make it much harder for those around them to understand what is going on.

50%
Up to 50% of young people will go on to develop PTSD following a violent attack, abuse or trauma


Causes of PTSD in childhood

Terrorism Road traffic accidents
War Natural disasters and fire incidents
Assault, sexual or physica 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

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

Negative feelings

Loss of interest in social interaction
Feeling despair about the future
Being easily upset
Physical ailments that are not explained

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
Self harm
Depression

The therapist my son saw was amazing – M. never once refused to go (we were VERY surprised) and always came out looking ‘lighter’ and happier. We can’t thank them enough.

Vicki, Reading


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.

  1. Flashbacks are thought to help the brain prepare in case the event happens again.
  2. 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.
  3. Numbing and avoidance can be a mechanism for the brain to get some rest from constantly thinking about such upsetting events.
  4. 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.

Treating 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

  1. 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 symptoms.
  2. 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.
  3. 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.
  4. 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.
  5. 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 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.
  6. 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.

Parents might not know that children with PTSD can feel very protective of their parents. We know from research that children often withhold their emotions, if they feel that their parent might get upset when discussing the trauma. For this reason, when I am diagnosing PTSD in children, I will usually spend time alone with the child to understand their feelings, without their parents being in the room. This allows them to speak a bit more freely.
MBBS, MSc, MRCPsych

Consultant Child & Adolescent Psychiatrist
London

Dr Sabina Dosani is a highly experienced Consultant Psychiatrist currently working for the Anna Freud Centre looking after Children and Adolescents. She has a Bachelor of Medicine and Bachelor of Surgery as well as being a member of the Royal College...

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