PTSD in children and adolescents
There has been increasing recognition that children and teenagers exposed to traumatic events are likely to develop post-traumatic stress disorder. Children and young adults may develop PTSD when they perceive an event or experience as either life-threatening or extremely dangerous, and respond to this event or experience with intense feelings of fear, horror, and helplessness.
It is therefore important to be aware of the signs and symptoms that may suggest a child or young adult you know is struggling with PTSD. Perhaps most significant is the fact that children and adults will experience PTSD differently. Adults are typically better able to verbalise how they are feeling and what they are experiencing, whereas young children will struggle to vocalise these emotions. Children and young adults may also find themselves unable to recognise that frightening thoughts and sensations experienced during flashbacks and memories of the trauma aren’t real. This can result in younger children physically reacting to these distressing moments – they might scream, hide, or fight, seemingly without obvious reason.
Applying the criteria by which adults are diagnosed with PTSD to children can therefore result in misdiagnosis, and research is still developing as to the effectiveness of different treatments for children with PTSD. However, this page will guide you through the symptoms to look out for and how PTSD might manifest itself, as well as potential treatment options.
PTSD Symptoms in Children and Young Adults
It is worth noting that not every child or teenager who experiences trauma will be diagnosed with PTSD. If symptoms last for less than a month, a diagnosis of acute stress disorder (ASD) will likely be made. If, however, they last for longer than one month, and have a notable negative effect on a child’s life and ability to function, then it is worth consulting with a mental health expert or GP. It is normal for children and young adults to display some avoidant, intrusive, or hyperarousal symptoms following trauma. Typically, symptoms tend to start within three months of the event – but they can begin months or years later.
There are three main symptom clusters experienced by children and adolescents with PTSD. They are as follows:
- Re-experiencing trauma – this can include intrusive memories and flashback experiences, and recurring nightmares.
- Avoidance of traumatic triggers – this can include people, places, and things. Typically, it will also result in numbing of emotional responsiveness.
- Chronic physiological hyperarousal – this can manifest as sleep disturbance, poor concentration, feeling irritable and grouchy, and hypervigilance to threat.
Traumatised children and teenagers are likely to display these core symptoms clusters in a variety of different ways depending on their age.
Equally, when PTSD symptoms persevere, they can result in the secondary effect of a child developing depression, and when the traumatic event involves losing a family member, children and young adults can present with complex grief and bereavement, such that the PTSD leads to a further diagnosis of mental health conditions.
Typical Symptoms In Children Younger Than Six
As discussed, very young children may lack the ability of adults to verbalise and vocalise their feelings and experience of trauma. It can therefore be a significant challenge diagnosing children younger than six.
Equally, younger children are particularly liable to express PTSD anxiety through hyperarousal, hyperactivity, excess distractibility and increased impulsiveness. These symptoms have a crossover with other conditions such as ADHD, and might therefore result in a misdiagnosis, so it is best to keep informed.
Other symptoms displayed by children in early childhood include:
- Re-enacting trauma through play or artwork
- Clingy or avoidant behaviour, and fear of strangers or situations
- High alertness and awareness
- Regression – for example, wetting the bed or sucking their thumb
- Physical complaints – headaches and stomach aches in particular
- Frightening nightmares – but note that these are not necessarily related to the traumatic event
Typical Symptoms In Children Ages 6 – 12
Children in this bracket might display the following:
- Fear of separation from caregivers – children may not want to sleep alone, for example
- Sudden negative change to worldview, seeing it as dangerous and unsafe
- Loss of trust in caregivers and family
- Replaying trauma, perhaps in artwork or role-play
- Loss of appetite
- Increased aggression and impulsiveness
- Loss of concentration
- Unusual mood changes – in particular, being depressed or distressed
- Loss of interest in activities that used to be enjoyed
- Physical complaints – headaches and stomach aches in particular
Typical Symptoms In Teenagers
Young adults are likely to display similar symptoms to the previous age bracket, but may also exhibit some more concerning behaviours that put their bodies at risk. These may include:
- Impulsive behaviour – for example, self-harm or substance abuse
- Suicidal ideation – teenagers may express thoughts of death, dying, or killing themselves
- Increased involvement in risky behaviour, such as unprotected sex, self-harm, or abuse of alcohol and drugs
If a child or young adult you know is displaying symptoms of PTSD, there are a number of treatment options that parents, guardians, and teachers can pursue.
Boston Children’s Hospital notes that a child’s recovery depends on a variety of factors, including the trauma’s severity and each individual’s resilience. Some children can recover within six months with treatment; for others, it may take longer. The important thing is that adolescents and kids feel supported and safe during treatment, particularly if they have been subject to abuse. Typically, children and young adults will be treated with psychotherapy, with medication as a secondary resource, but children and teens displaying depressive or panic symptoms alongside PTSD may be prescribed medication to complement psychotherapy.
Researchers generally agree that parents should be included in psychotherapeutic intervention for children and young adults with PTSD. This can include teaching parents and caregivers how to manage symptoms of stress and trauma in the child’s home environment. Equally, if caregivers and guardians are displaying emotional distress as a result of the trauma, they may also benefit from psychotherapy, so as to be better able to respond to the child’s needs.
Otherwise known as ‘talk therapy’, this treatment will equip children – and often their families – with coping strategies. Children and teenagers will typically be gradually exposed to the traumatic event and experience, and the consequent memories, thoughts and feelings associated with the same. This helps the child to develop a feeling of mastery over their symptoms and learn how to better handle overwhelming feelings. Children and teenagers will usually learn how to:
- Identify feelings of fear
- Manage fear and anxiety via relaxation techniques
- Talk – or, in the case of young children, play-act – the traumatic event. This helps release unconscious feelings related to the trauma
- Re-write distorted cognitive assumptions – children will learn how to think about the trauma in a way that avoids self-blame or guilt
- Restore trust in others and foster a feeling of hope for the future
Play therapy is particularly effective for children aged 2 – 11. It can be significantly helpful for those children and teenagers who experience trouble expressing their thoughts and feelings. It gives children a confidential, nurturing environment in which they can play in the knowledge that they are safe – both physically and emotionally.
Play therapy helps a child or young adult to handle emotional problems and increase self-awareness, express feelings and experiences, manage behaviour, develop social skills, cope with traumatic symptoms and stress, and restore a sense of overall wellbeing.
Play therapy can include art therapy, dance, storytelling, drama or role-play, creative visualization, and music.
There is very little empirical evidence as to the benefits of medication for children with PTSD. Some data suggests that citalopram, an SSRI, may be effective at mitigating the symptom clusters of PTSD in teenagers, so these may be prescribed in certain instances.
In combination with psychotherapy, medication can help ease a child if they are expressing severe anxiety, fear, or hopelessness. Medication is not, however, a ‘standalone’ treatment.
Children and teenagers will be distressed following a traumatic event. It is vital for caregivers and parents to recognise that this is totally normal. In fact, having a close figure offer a child support and love, perhaps in the form of talking about the trauma, can be helpful in helping a child to navigate their feelings and way of relating to the trauma. Sometimes kids find it easier to talk to other adults, in which case seeking professional help is advisable, as this will help them rediscover normalcy, as well as reducing the likelihood of prolonged, harmful stress reactions.
Equally, if you yourself are feeling distressed after a traumatic event or experience, it is best to recognise this and seek help yourself. Kids manage their emotions better if their families or guardians are feeling stable, content, and safe.
Support & information for Friends and Family
When someone you care about suffers from PTSD it affects you too.
The symptoms of PTSD aren’t easy to live with, and the changes in your loved one can be downright terrifying. You may worry that things won’t ever go back to the way they were before. At the same time, you may feel angry about what’s happening to your family, or hurt by your loved one’s distance and new emotions.
Your support can make a huge difference in your friend or family member’s recovery. But as you do your best to care for someone with PTSD, you also need to take care of yourself too.
PTSD UK Blog
You’ll find up-to-date news, research and information here along with some great tips to ease your PTSD in our blog.
Case Study: EMDR Treatment – Rachael Rachael was diagnosed with PTSD as a result of the horrific symptoms she experienced following a surgery. Unfortunately, Rachael had a few ‘false starts’ with EMDR, where the services provided had a specific timeframe
What is hyperbaric oxygen therapy and how can it help PTSD? Hyperbaric oxygen therapy (HBOT) involves breathing in pure oxygen in a pressurized chamber, to increase the amount of oxygen circulating in the blood. It works in a similar way