The diagnosis of Post Traumatic Stress Disorder (PTSD) was formally recognized as a psychiatric diagnosis in 1980. At that time, little was know about PTSD in children. Today it is widely know that children and adolescents develop PTSD.
A diagnosis of PTSD means that an individual experienced an event that involved a threat to one’s own or another’s life or physical integrity and that this person responded A diagnosis of PTSD means that an individual experienced an event that involved a threat to one’s own or another’s life or physical integrity and that this person responded with intense fear, helplessness, or horror. There are a number of traumatic events that have been shown to cause PTSD in children and adolescents. Children and adolescents may be diagnosed with PTSD if they have survived natural and man made disasters such as floods; violent crimes such as kidnapping, rape or murder of a parent, sniper fire, and school shootings; motor vehicle accidents such as automobile and plane crashes; severe burns; exposure to community violence; war; peer suicide; and sexual and physical abuse.
The American Academy of Child and Adolescent Psychiatry (AACAP, 1998) suggests that a child’s reaction to a disaster, such as a hurricane, flood, fire, or earthquake, depends upon how much destruction is experienced during or after the event. Here is the order of events rated by level of severity:
The death of family members or friends is the most traumatic, followed by loss of the family home, school, special pets, and the extent of damage to the community. The degree of impact on children is also influenced by the destruction they experience second hand through television and other sources of media reports.
There are three factors that have been shown to increase the likelihood that children will develop PTSD. These factors include the severity of the traumatic event, the parental reaction to the traumatic event, and the physical proximity to the traumatic event. In general, most studies find that children and adolescents who report experiencing the most severe traumas also report the highest levels of PTSD symptoms. Family support and parental coping have also been shown to affect PTSD symptoms in children. Studies show that children and adolescents with greater family support and less parental distress have lower levels of PTSD symptoms. Finally, children and adolescents who are farther away from the traumatic event report less distress.
Generally, most children recover from the frightening experiences associated with a disaster without professional intervention. Most simply need time to experience their world as a secure place again and their parents as nurturing caregivers who are also again in charge.
Many children who have difficulty reconciling their feelings will engage in play involving disaster themes and repetitive drawings of disaster events. It has also been demonstrated that children as young as two or three can recall events associated with disasters. The child’s level of cognitive development will influence their interpretation of the stressful events. Some studies reviewed by Yule and Canterbury suggest that the intellectual ability of the child, their sex, age, and family factors influence their recovery. Girls experience greater stress reactions than boys, bright children recover their pre-disaster functioning in school more rapidly, and families who have difficulty sharing their feelings experience greater distress. As expected, there also appears to be a direct relationship between the degree of exposure to frightening events and the difficulty in emotional adjustment and returning to pre-disaster functioning.
Symptoms of PTSD
Children and adults express signs and symptoms to stressful events along four dimensions: cognitive, emotional, physical, and behavioral. Common reactions expressed by children along each of these dimensions include the following:
- trouble concentrating
- preoccupation with the event
- recurring dreams or nightmares
- questioning spiritual beliefs
- inability to process the significance of the event
- depression or sadness
- irritability, anger, resentfulness
- despair, hopelessness, feelings of guilt
- phobias, health concerns
- anxiety or fearfulness
- isolation from others
- increased conflicts with family
- sleep problems
- avoiding reminders
- crying easily
- change in appetite
- social withdrawal
- talking repeatedly about the event
- refusal to go to school
- arguments with family and friends
- repetitive play
- exacerbation of medical problems
- physical complaints with no physical cause
The loss of prized possessions, especially pets, is very difficult for children in this age group. As noted in the previous section, the school environment and relationships with peers is central to the life of latency age children. School problems begin to appear and may take the form of:
- refusal to go to school
- behavior problems in school
- poor school performance
- fighting withdrawal of interest inability to concentrate
- peer problems (e.g., withdrawal from play groups, friends, and previous activities or aggressive behaviors and frequent fighting with friends or siblings)
THE ROLE OF THE FAMILY
Since children live in family systems, both the experience of the disaster and recovery from its aftermath are most often mutually experienced. Consequently, children will share common aspects of the disaster event experience. The retelling of these experiences between the adults and children in the family can normalize the overwhelming rush of feelings associated with the disaster. For many families, the role of the outreach worker is simply to give them permission to share their feelings with each other and to communicate that having disaster related feelings is normal and sharing these feelings with each other is appropriate and healthy.
If the child’s symptoms persist, further treatment from a qualified mental health professional should be obtained.
(This information was made available by the U.S. Department of Health and Human Service, Substance Abuse and Mental Health Service Administration, Disaster Relief Information).