AUGUST2002

What is post traumatic stress syndrome (PTSD) and how can parents and others help children cope with it?

Post Traumatic Stress Disorder is an anxiety disorder characterized by the development of specific symptoms following a psychologically traumatic event that can range from watching the attack on the World Trade Center to being chased by a pit bull. The symptoms can vary depending on the race/ethnicity, culture, age, and gender of the child. Symptoms usually occur shortly after the trauma but may go away and return again, even years later.

Diagnostic Criteria (DSM IV) for Post Traumatic Stress Disorder 

A) The person has been exposed to a traumatic event in which both of the following were present: 

1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. 
2. The person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. 

B) The traumatic event is persistently reexperienced in one (or more) of the following ways: 

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. 
2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. 
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma?specific reenactment may occur. 
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: 

1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma. 
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma. 
3. Inability to recall an important aspect of the trauma. 
4. Markedly diminished interest or participation in significant activities. 
5. Restricted range of affect (e.g., unable to have loving feelings). 
6. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span). 

D) Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following:

1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle response. 

E) Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. 

F) The disturbance causes clinically significant distress or impairment in social, occupational, academic, or other important areas of functioning.

A child's risk for PTSD is often dependent on how intense the stressor was (i.e., seeing a parent murdered) or how chronic (i.e., placement in multiple foster homes). The child's age also has a major impact on how the child will respond to the event. For example, six?year?olds may show their concerns about a catastrophe by refusing to attend school, whereas adolescents may minimize their concerns but argue more with parents and show a decline in school performance. It is important to explain the event in words the child can understand.

PTSD rarely appears during the trauma itself. Though its symptoms can occur soon after the event, the disorder often surfaces several months or even years later. 

Parents should be alert to these changes:

• Refusal to return to school and "clinging" behavior, shadowing the mother or father around the house.

• Persistent fears related to the event, such as fears about being permanently separated from parents.

• Sleep disturbances, such as nightmares, screaming during sleep, and bedwetting, persisting more than several days.

• Behavior problems, such as misbehaving in school or at home in ways that are not typical for the child.

• Physical complaints, such as stomachaches, headaches, or dizziness for which physical cause cannot be found; withdrawal from family and friends; listlessness; decreased activity; preoccupation with the event.

INTERVENTIONS: 
Parents/Guardians/Other Family Members/School Staff/Friends Can:

• Be a sympathetic listener.

• Encourage and help the child to get professional help, if symptoms persist.

• Continue to give your love and support, even if the child acts detached and tries to push you away.

• Share everyday chores without taking over all responsibilities.

• Educate others about Post Traumatic Stress.

• Be honest about and seek outlets for your own feelings.

Mental Health Professionals Can: 

• Use cognitive therapy to help child identify thoughts that cause anxiety and the physical symptoms that occur with the thoughts.

• Teach behavioral techniques including:

  • Relaxation training; 

  • Deep breathing; 

  • Guided imagery; 

  • Meditation; 

  • Muscle relaxation; and 

  • Role-play