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
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
Find out about treatment options for PTSD for children and young people here.
- Kaminer, D., Seedat, S., & Stein, D. J. (2005). Post-traumatic stress disorder in children. World psychiatry : official journal of the World Psychiatric Association (WPA), 4(2), 121–125.
- Post-Traumatic Stress Disorder
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It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.