A child with
Posttraumatic Stress Disorder develops symptoms
such as intense fear, disorganized and agitated
behavior, emotional numbness, anxiety or depression,
after being directly exposed to or witnessing
an extreme traumatic situation involving threatened
death or serious injury, or hearing about such
an event involving a family member. Victims
of repeated abuse or children who live in violent
environments or war zones may experience PTSD.
Treatment includes community and family support
Andrew which destroyed 75,000 homes in Florida,
9-year-old Stevie was at school. When he got
home he found that the roofs of most of the
houses on his street, including his own, had
been blown off. He could not find his parents
and his sister, who had been removed to a shelter.
He desperately searched the neighborhood and
after several hours was found by the police,
who reunited him with his family. The family
stayed in the shelter for two weeks until they
were relocated, and Stevie refused to eat or
speak for several days. Two months later Stevie
was still afraid to sleep alone at night, was
not concentrating in school, and was irritable
whenever there was a rain storm.
Jessica, a 7-year-old
girl, was withdrawn and quiet in the classroom
and somewhat distant from her peers. Although
she had previously been a top student, Jessica's
academic performance was faltering. On several
occasions, the teacher had observed her masturbating
while she was working at her desk. Jessica then
began to refuse to go to gym class because she
said she was afraid of the teacher, a male.
She also complained frequently that she was
tired, but she had trouble falling asleep at
night and was often awakened by nightmares about
strange men. When the school psychologist spoke
with Jessica, she learned that her mother had
recently remarried and on weekends Jessica was
left in the care of her stepfather while her
mother was at work. Jessica also stated that
when her stepfather had a "funny smell
on his breath" he would engage Jessica
in mutual genital stimulation.
of a trauma
situation is one involving an actual or threatened
death or serious injury. Sometimes when people
experience an event so terrible and frightening
that it is difficult for most of us to imagine,
they suffer from shock. This can happen after
a one-time natural catastrophe like a hurricane
or a flood or after an experience like seeing
a bomb attack or seeing someone shot. Sometimes
this kind of shock can happen when an unpleasant
experience occurs time and time again in a child's
life, like being beaten or sexually abused repeatedly.
Particular signs of stress can occur after experiencing
an event directly, from witnessing an event,
or even hearing about such an event in regard
to a family member. People who suffer from a
prolonged reaction to such shock may be diagnosed
as having Posttraumatic Stress Disorder.
are the symptoms of PTSD?
PTSD symptoms fall into the following categories:
- moments when a child seems
to replay the event in his or her mind
- intrusion of recurrent
memories of the event or repetitive play
about the event
- nightmares, scary dreams
- disorganized and agitated
- irritability or anger
- nervousness about everyone
and everything around the child, as when
people get too close
- jumpy when hearing loud
- avoidance of thoughts,
feelings, or places that remind the child
of what happened
- numbing, or lack of, emotions
- regression to earlier
behavior, such as clinging, bedwetting,
- difficulty sleeping or
- detached from others,
- excessive use of alcohol
or other substances to self medicate
To warrant a
diagnosis of PTSD, the reaction must be present
for more than one month and cause significant
impairment in the person's life and functioning.
is likely to have it?
traumatic events have been rare in the lives
of most children, each year three million children
are diagnosed as having Posttraumatic Stress
Disorder. Following a traumatic event such as
the attack on the World Trade Center in September
11, 2001, or a natural disaster or trauma, children
and teens most at risk for PTSD are those who
directly witnessed the event, suffered from
direct personal consequences (such as the death
of a parent, injury to self), had other mental
health or learning problems prior to the event,
and lack a strong social network.
does it happen?
who goes through the same experience responds
in the same way. People are born with different
biological tendencies in how they respond to
stress. Some are more adaptable, others more
cautious. Reactions and recovery are affected
by the length and intensity of the traumatic
is it treated?
is imperative. Parental support influences how
well the child will cope in the aftermath of
the event. Parents and professionals can help
- maintaining a strong physical
- modeling and managing
their own expression of feelings and coping
- establishing routines
- accepting children's regressed
behaviors while encouraging and supporting
a return to age-appropriate behavior
- helping children use familiar
- helping children share
in maintaining their safety
- allowing children to tell
their story in words, play or pictures to
acknowledge and normalize their experience
- discussing what to do
or what has been done to prevent the event
- maintaining a stable and
therapy has been shown to be effective for children
with PTSD. Cognitive training helps children
restructure their thoughts and feelings so they
can live with out feeling threatened. Behavioral
interventions include learning to face your
fears so children no longer avoid people and
places that remind them of the event. Relaxation
techniques are used with supervised retelling
of the child's story about the event to help
teach the child how to handle fears and stress
effectively. Training parents to help the child
with new coping strategies and teaching adult
coping strategies is often included.
child's parents separate or divorce, would the
child react with PTSD?
certainly stressful and the emotional health
of the child should be considered, but divorce
would not be considered a life-threatening traumatic
event, and thus the child would not be at particular
risk for developing PTSD. Divorce, however,
may increase the risk of PTSD for some children
exposed to traumatic events.
child's parent or close relative dies, would
the child suffer from PTSD?
is different from a PTSD response. Grief responses
may include intrusive thoughts about the person
who died or sadness about activities associated
with that person, but grief responses are usually
worked through with time. Childhood traumatic
grief is a separate condition in which traumatic
thoughts and images interfere with the ability
to enjoy positive memories and accomplish typical
type of trauma most often leads to PTSD?
have witnessed an act of violence or whose family
member has been reported missing or injured,
who have been the victim of a criminal act,
such as abuses or physical or sexual assault,
are at a higher risk than those who experienced
a natural disaster. This is possibly due to
the fact that the violence seems, and often
is, intentional in comparison to an unpredictable
is the most common age for a child to develop
the age of 11 are more vulnerable to developing
PTSD. However, it is difficult to diagnose in
very young children who have less developed
language. Therefore they cannot describe their
internal state well or report on whether they
are having intrusive thoughts or nightmares.
PTSD can develop years after an event, as we
have seen in the case of war veterans.
long does someone have PTSD?
reactions following a traumatic event may last
for weeks or months, but they often show a relatively
rapid decrease after the direct impact subsides.
It has been estimated that for adults and children
after natural disasters with community-wide
impact, there is often close to complete symptom
remission after eighteen months to three years.
In some cases PTSD can remit spontaneously.
But PTSD also can develop years after an event.
Some children may not develop PTSD until a year
or more after the event; this is known as the
"sleeper effect." Left untreated for
a period of time, such as two years, PTSD can
F. Goodman, Ph.D., is a clinical psychologist
specializing in bereavement issues.
Gurian, Ph.D ,Clinical Assistant Professor
of Psychiatry, NYU School of Medicine, Editor
of the NYU Child Study Center Letter and Executive
Editor of www.AboutOurKids.org.