Keywords: Post traumatic stress disorder, shell shock, neurochemicals, traumatic events, dissociation, regression, oppositional deviant disorder (ODD), conduct disorder, separation anxiety, trauma-focused cognitive behavioral therapy (TF-CBT).
Post Traumatic Stress Disorder in Children. Can post traumatic disorder occur in children? What triggers post traumatic stress disorder in children? How does the symptoms of post traumatic stress disorder in children look like? Are there complications of post traumatic stress disorder in children? How is post traumatic stress disorder in children treated?
Post traumatic stress disorder (PTSD), is a psychiatric illness that comes about after one has experienced a terrifying event. It usually starts within one to six months after the terrifying or life threatening event. In the olden days, it was called shell shock, because it was first noticed among soldiers. But today, we know that anyone male, female, young, old, and in any profession, can suffer from PTSD.
Can post traumatic disorder occur in children?
Children of all ages can suffer from PTSD, which was once known as shell shock.
Post traumatic stress disorder is a very serious disorder in children of all ages. This is because of the deep suffering it brings upon the children and the adverse effects it has on them. If these children are not treated, they can suffer for years. This will put the children at risk of developing other mental health disorders, and impairing their functioning, even up to adulthood.
Traumatic events that may elicit PTSD in children include traumatic events that involve serious harm to the child or others. These others are usually, the parents or the care givers. Such traumatic events include serious accidents, natural disasters, sexual or physical abuse and violence.
Children being exposed to traumatic events in Nigeria is quite common. These include community clashes, terrorism, kidnapping, wars, destruction of properties, suicide bombings, flooding, house armed robberies, sexual violence, etc.
Because children of all ages have limited coping means, they are more vulnerable to traumatic events than adults are. This means that PTSD is more likely in children globally. unfortunately PTSD is under diagnosed in children because they don’t speak out.
What triggers post traumatic stress disorder in children?
A child with post traumatic stress disorder could have inherited it from one or both parents. That means that different forms of the genes that are responsible for these neurochemicals can be inherited from the parents. These neurochemicals include dopamine, serotonin, corticosteroids, GABA (gamma amino butyric acid), etc.
Certain chemicals in the brain increase, while some decrease. Those that increase are the noradrenaline, dopamine, etc. The ones that are deceased are the serotonin, cortisol, GABA (gamma amino butyric acid), etc.
The prefrontal areas of the brain of children suffering from PTSD, are usually smaller in size than in other children.
Hippocampal brain area, which is responsible for memory, is usually larger in size in children with PTSD.
When a child is directly affected to a threat to his or her life, then that child can get PTSD. A child directly witnessed the loss of a family member, caregiver or properties, then the risk of PTSD is there.
Poor parent cum child relationship and poor parenting methods are risk factors to the child experiencing PTSD. The way parents respond after a trauma event affects the child’s judgment about the event. Also the way parents cope with the trauma, so will the child imitate. Not having adequate family support can be a risk factor for the child to have PTSD.
If a child already has a preexisting mental health issue, then PTSD is very likely if exposed to extreme trauma. Preexisting mental health issues include depression, anxiety or developmental disorder like autism, etc.
Usually, since children cannot appraise well most traumatic events, they end up with mental confusion. This could be one of the predicting factors to PTSD in children.
Gender and age issues:
Girls tend to be more at risk of having PTSD than boys. This is due to some factors such as these written here. Girls or females are more exposed to high impact trauma events such as sexual trauma, than men. Emotional focus coping are more practiced by the female gender. Females have a very sensitive hyper arousal system than males. This means that the female hypothalamic pituitary axis is more sensitive than males. There are also hormonal issues.
Age issue is also a risk factor. The younger the age of the child when the traumatic even took place, the more likely the risk of PTSD.
How does the symptoms of post traumatic stress disorder in children look like?
In children 6 years old and younger, the symptoms of PTSD is a bit different from those seen in adults. But for children above 6 years, the symptoms are like those of adults.
Symptoms of PTSD in children 6 years and under:
Intrusive thoughts and dreams –
The child has recurrent, intrusive distressing memories of the traumatic event. This means that the memories of the event keeps finding its way into the child’s mind. The child doesn’t want such thoughts and he or she keeps removing the thoughts, yet it keeps coming back.
Such a child will frequently have recurrent distressing dreams related to the traumatic event. Despite the fact that these children don’t want reminders of the event, some may act it out in plays or put it into drawings.
And there are times that the child will feel or acts as if the traumatic event is recurring all over again. This comes with the feeling of things not being real, called dissociative reactions.
Physical reactions –
Cues resembling any aspect of the traumatic event, will elicit distress in the child that may react with fear. There could also be tremors and palpitations, ie. fast heart beats.
Little things will make the child startle and will have problems with sleep.
The child will avoid every effort to get him or her to places, or things that will be a reminder to the event. He or she will also avoid people, conversations, etc. that will bring to mind the traumatic event. The child can react by crying, tantrum, running away, or displaying anger.
This child will prefer to stay alone and avoid playing with other children. He or she will remain sad and not showing any form of happiness.
Such children may even regress to behaviours that they have over grown. For example, the child who has stopped bedwetting, nay begin to bed wet. Some children may begin to suck their thumbs or cling to their mothers or caregivers. Then others may stop talking altogether.
Symptoms of PTSD in children 7 years old and above:
Children who are above 6 years show the same symptoms of PTSD as those of adults.
There are unwanted memories of the traumatic event that keeps intruding into the child’s mind. And there are also what is called flashbacks.
When the person goes to sleep, he or she has night mares concerning the event. And this can wake the person up in the middle of the night, leading to poor sleep.
The child will avoid the place the event occurred, and any other reminders. And the child may even not want to talk about the incident, because it will bring back the memory and pain.
There are also problems in remembering certain aspects of the traumatic events and will have poor concentration. And the child may blame himself or herself for the traumatic event. In teenage, they may become very disruptive and destructive in behavior.
Are there complications of post traumatic stress disorder in children?
Post traumatic stress disorder in children can negatively affects all aspects of the child’s life and into adulthood. This is most likely if treatment is not instituted.
Such children can suffer from depression and anxiety. They can also abuse substances and engage in antisocial behaviors. Because PTSD negatively affects brain development, academic performance also is negatively affected. The child’s grade will fall and the child may drop out of school.
For the children who are younger than 6 years of age, they may develop oppositional deviant disorder (ODD). Oppositional deviant disorder, is a behavioural disorder that occur in children younger than 6 year. The child will refuse to obey instructions, says no when corrected and may beat adults. The older ones will develop conduct disorder.
Such children suffering from PTSD, may also suffer from separation anxiety. This is an anxiety disorder, whereby the child cannot withstand being away from the primary caregiver, most often the mother.
How is post traumatic stress disorder in children treated?
Before writing about the treatment, it is important to know that PTSD in children is preventable.
It is well known that PTSD starts at least one month after the traumatic event. Within this one month, the child will go through what is called acute stress reaction. It is also known as normal stress response. From here, a child without resilience or support will then go into acute stress disorder. If not properly handled the child can then get into PTSD.
So, at any of the stages before PTSD, this disorder can be prevented. With good support from the onset of the traumatic event, prevention is very possible.
The child’s safety is paramount after the traumatic event, away from the scene. So get the child to a safe environment and provide food, clothing and shelter. If there is need for emergency medical care, this should be provided.
Friends and family members should be available to give emotional support to the child.
Psychological treatment is the first line of treating children suffering from PTSD. This treatment helps treats the problem and builds up the child’s resilience to enable the child cope with future stressors. Psychological treatment is rendered by a clinical psychologist.
For children, the first line of treatment when they have psychiatric issues is psychotherapy.
One treatment therapy is called trauma-focused cognitive behavioral therapy (TF-CBT). This type of talk therapy uses talking and learning activities such as play, drawing, and story activities. The parent or caregiver should be there during the therapy to support and help the child feel safe.
It is only when this is not enough, that medications are introduced, by a psychiatrist. The issue of social support is also very important in the treatment of PTSD. The most important social support should come from members of the family, especially the parents. Teachers can also help.
What can parents do on their own?
Spend more time with the child. This will help the child feel safe. And do things together like going outdoors, cooking music, etc. the major thing is to do things that the child enjoys. This will help the child reduce and build up resilience.
Reassure the child of your support at all times.
Help them do breathing exercise. Teach them how to breath in as you count up to 3 and out as you count up to 5. This helps to relax the child.
Let the teacher know about the traumatic event the child has gone through and request for help in his academics.
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