Post-Traumatic Stress Disorder (PTSD)

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KEY POINTS

• Post-traumatic stress disorder (PTSD) is a condition that can happen after your child sees or is involved in a very stressful event that involves actual or threatened death, serious injury, or sexual assault. Symptoms may start right after the stressful event or may start months or years later. When stressful events, such as abuse, keep happening, the symptoms may come on slowly and get worse over time.
• PTSD can be successfully treated with therapy, medicine, or both.
• Get emergency care if your child has serious thoughts of suicide or self-harm, violence, or harming others.

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What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a condition that can happen after your child sees or is involved in a very stressful event that involves actual or threatened death, serious injury, or sexual assault. Your child may have PTSD after learning of a stressful event that happened to a close family member or friend. The stressful event may be:

• Physical or sexual abuse, or seeing domestic violence
• Violence, such as war, shootings, terrorist attacks, or robbery
• A severe accident
• The death of a loved one
• A natural disaster, such as a flood, earthquake, hurricane, tornado, or fire

Most children and teens can get over PTSD with good treatment and family support. However, children have a greater risk for having PTSD later in life if they see or are involved in another stressful event.

What is the cause?

It is not known why one person will have PTSD after a trauma like a robbery, rape, battle, or severe car accident while another person may not. Things that increase the risk for PTSD after such an event include:

• A family or personal history of mental illness or substance abuse
• Long-term or repeated exposure to stressful events
• The severity of the stressful event
• Lack of family and social support after the event

The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals. People with this disorder may have physical changes in their brain.

PTSD can start at any age.

What are the symptoms?

Symptoms may start right after the stressful event or may start 3 or more months later. When stressful events, such as abuse, keep happening, the symptoms may come on slowly and get worse over time.

There are 4 types of PTSD symptoms.

1. Your child acts or feels like the event is happening again (flashbacks). Your child may:
   • Have distressing daydreams or have repeated thoughts, emotions, and images of the event
   • Have nightmares about the event
   • Have panic attacks when things happen that remind him of the stressful event
   • Feel like the event is happening all over again
2. Your child avoids things related to the stressful event. Your child may:
   • Try to avoid distressing memories of the event
   • Forget parts of the event
   • Avoid conversations, thoughts, or places that remind him of the event
   • Deny what happened
3. Your child thinks and feels negative. Your child may:
   • Feel hopeless about the future
   • Feel negative about himself and others
   • Blame himself for what happened
   • Be very distant and detached from others and activities
   • Not be able to feel happy or other positive emotions
4. Your child is extra alert and overreacts all or most of the time. Your child may:
   • Have trouble falling or staying asleep
   • Be very irritable or have angry outbursts
   • Have trouble concentrating or staying focused
   • Be startled or jump at sudden or loud noises
   • Feel very suspicious and be on guard all the time
   • Be extremely active and act recklessly, such as driving too fast or having unsafe sex

Anniversaries of the event can often cause a flood of emotions and bad memories

Some of these symptoms are normal after a stressful event. For most children, these symptoms stop within a month after the stressful event. If your child keeps having these symptoms, it’s called PTSD.

Children under age 6 may return to younger behaviors such as thumb sucking, bed wetting, or being clingy with parents. Having PTSD may also increase your child’s risk of having problems with depression, anxiety, eating disorders, and drug and alcohol use.

How is it diagnosed?

Your child’s healthcare provider or therapist will ask about your child’s symptoms, medical and family history, and any medicines your child is taking. Your provider will make sure your child does not have a medical illness or drug or alcohol problem that could cause the symptoms. Your child may be referred to a specialist who has experience working with children and teens who have PTSD.

How is it treated?

PTSD can be successfully treated with therapy, medicine, or both. It may take time for symptoms to improve.

Therapy is usually the first treatment for children. It may take time for symptoms to improve. Several types of therapy may help your child:

• Play therapy uses toys, games, and drama to help children learn to deal with their feelings. Play therapy helps children express their feelings without words.
• Cognitive behavioral therapy (CBT) is a way to make your child aware of unhealthy ways of thinking. It can also help your child learn new ways to handle the bad memories and feelings in more effective ways.
• Eye movement desensitization and reprocessing (EMDR) helps your child cope with feelings and thoughts about distressing past events. Your child moves his eyes back and forth, usually following the therapist's hand or pen, while he recalls the event. Over time, your child becomes less upset about the event.
• Exposure and response prevention therapy helps your child confront and control his fears by gradually increasing your child’s exposure to them. This process also involves learning ways to relax, such as breathing exercises. With help from the therapist, your child learns to overcome his anxiety.
• Family therapy is often very helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Medicine

Several types of medicines can help. Your healthcare provider will work with you to select the best one for your child. Your child may need to take more than one type of medicine.

What can I do to help my child?

• Let your child make simple decisions when appropriate. Because PTSD often makes children feel powerless, you can help by showing them that they have control over certain parts of their lives. For example, let your child decide what to have for dinner or how to spend the day.
• Check for books written for children who have been exposed to stressful events. Books are available for children of different ages and for different kinds of stressful events. Read and discuss the books with your child.
• Support your child. Encourage children to talk about whatever they want to talk about. Be a good listener. This helps your child know that their feelings and thoughts really do matter, that you truly care about them, and that you never stop caring. If your child shuts you out, be sure to let your child know that you are there for him whenever he needs you. Remind your child of this over and over again.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Be consistent. Understand that you are not responsible for your child's anxiety, even if something such as a car accident may have triggered it. Be firm and consistent with rules and consequences. Your child needs to know that the rules still apply to him. It does not help to teach children that they can avoid consequences if they’re anxious or if they act out.
• Help your child learn ways to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax--for example, by taking up a hobby, listening to music, watching movies, or taking walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach your child to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that your child takes. Make sure your child takes all medicines as directed by your provider or therapist. It’s very important for your child to take medicine even when feeling and thinking well. Without the medicine, your child’s symptoms may not improve or may get worse. Talk to your provider if your child has problems taking the medicine or if the medicine doesn't seem to be working.
• Learn about your child’s condition. Knowing how PTSD affects your child helps you better understand how treatments, medicines and lifestyle changes can help. Know what symptoms you should call your child’s healthcare provider or therapist about.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.
• Get emergency care if your child has serious thoughts of suicide or self-harm, violence, or harming others.
• You can get more information from:
  • National Institute of Mental Health
    866-615-6464
    https://www.nimh.nih.gov/index.shtml
  • Mental Health America
    800-969-6642
    http://www.mentalhealthamerica.net/
  • National Center for Post-Traumatic Stress Disorder
    (802) 296-6300
    https://www.ptsd.va.gov/