Symptoms of PTSD & C-PTSD in children and young adults
Everyone has different ways of responding to traumatic events. What one child finds traumatic another child may not find distressing. Children will react in a variety of different ways after a trauma. Many children who experience a trauma experience some avoidant, intrusive, or hyperarousal symptoms – or they may communicate their distress through their behaviours rather than the typical ‘symptoms’ you may see in an adult with PTSD – generally these dissipate after a number of weeks.
However if symptoms or behaviours continue for longer than a month, and are affecting a child or young adults day-to-day life, PTSD or C-PTSD may be present and then it is worth consulting with a mental health expert or GP.
Typically, symptoms tend to start within three months of the event – but in around 15% of people, there may be a delay of months or even years before symptoms even start to appear.
It’s important to recognise however 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, and so it’s vital that any parents, caregivers, teachers and anyone who comes into contact with children can understand more about the differences in symptoms that may show as a result of PTSD or C-PTSD.
Generally speaking, there are three main symptom clusters experienced by children and young adults 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 young adults are likely to display these core symptoms clusters in a variety of different ways depending on their age.
You can see more about these differences below by clicking on each age range.
- Demonstrate poor verbal skills
- Exhibit memory problems
- Scream or cry excessively
- Have poor appetite, low weight, or digestive problems
Typical Symptoms In Children Younger Than Six
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
- Have difficulties focusing or learning in school
- Develop learning disabilities
- Show poor skill development
- Act out in social situations
- Imitate the abusive/traumatic event
- Be verbally abusive
- Be unable to trust others or make friends
- Believe they are to blame for the traumatic event
- Lack self-confidence
Typical Symptoms In Children Ages 6 – 12
Children in this age range 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 and Young Adults
Young adults are likely to display similar symptoms to 6-12 year olds 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
Trauma specific symptoms
Some traumas lead to specific sets of symptoms too. For example, children or young adults who have been exposed to trauma and violence through bullying may be more likely to bully others, be more distressed by bullying or appear desensitised to bullying.
‘The impact of physical abuse on a child’s life can be far-reaching. It is especially devastating when a parent, the person a child depends on for protection and safety, becomes a danger. Some children develop traumatic stress reactions.
Children who’ve been physically abused may struggle with developing and maintaining friendships. They don’t trust authority figures. They don’t feel good about themselves or see themselves as worthy. They may blame themselves for the abuse and feel that they must keep what goes on in their families a secret. Reactions vary depending on the age of the child, the kind of abuse, and how long it continues.
Many physically abused children become aggressive themselves or have other behavioral problems. Aggression and “acting out” are very common, but there are a wide range of reactions. Some children show few, if any, reactions. They don’t seem to care anymore if they are hit; they’ve lost the normal fight or flight reactions built-in to protect us from danger. These children may also fail to react to other dangers. They may stop trying to make friends or succeed at school or plan for the future.
Some abused children become anxious and fearful rather than numb and withdrawn. This happens frequently when the abuse has no predictable pattern. A child who never knows when a caregiver will become physically violent, and never knows how far the caregiver will go, has no control. That child may become more anxious.’
Death of a loved one
‘Each child grieves the death of a significant person in his or her own way. Reactions can vary according to age, ability to understand death, and personality, and children in the same family may react differently. Any death can be difficult for a child, and a wide range of emotional and behavioural responses are common including changes in sleeping pattern or appetite; sad, angry, or anxious feelings; social isolation; persistent thoughts about the death; or feeling the person’s presence nearby. Children’s difficulties with grief vary according to a child’s age, developmental level, previous life experiences, emotional health before the death, and family and social environment.
Some children develop traumatic grief responses, making it harder for them to
- Remember or enjoy positive memories of the deceased person
- Cope with the many changes that occur as a result of the death, and
- Continue with normal development.
Any thoughts of the person—even happy ones—can lead to upsetting images or memories of the way that person died. These images may occur repeatedly in the child’s mind and—because they are so upsetting—the child may avoid thinking or talking about the person or even going places or doing things associated with the person or the death. Traumatic reactions may exacerbate existing mental health issues, disrupt learning, and be misinterpreted by parents, teachers, and others.
Difficulties specific to childhood traumatic grief that may occur across developmental stages include the following:
- Intrusive memories about the death: These can appear through nightmares, guilt, or self-blame about how the person died, or recurrent or intrusive thoughts about the horrifying manner of death.
- Avoidance and numbing: These can be expressed by withdrawal, the child acting as if not upset, or the child avoiding reminders of the person, the way she or he died, or the event that led to the death.
- Physical or emotional symptoms of increased arousal: These can include irritability, anger, trouble sleeping, decreased concentration, drop in grades, stomachaches, headaches, increased vigilance, and fears about safety for oneself or others.
In childhood traumatic grief, the interaction between trauma and grief symptoms is such that any thoughts or reminders, even happy ones, about the person who died can lead to frightening thoughts, images, or memories of how the person died.’
PTSD & C-PTSD can have physical symptoms too
‘When we feel stressed emotionally, our bodies release hormones called cortisol and adrenaline. This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze‘ response.
Studies have shown that someone with PTSD will continue producing these hormones when they’re no longer in danger, which is thought to explain some symptoms such as extreme alertness and being easily startled.
Some people also experience physical symptoms similar to symptoms of anxiety, such as headaches, dizziness, chest pains and stomach aches.’
These altered cortisol levels also cause other physical symptoms such as your skin scaring more easily, digestive issues, and cold hands & feet, find out more in our blog article, ’10 unexpected physical symptoms of PTSD’ here.
When should I get help?
The guidance from the NHS states ‘It’s normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturally over a few weeks.
You should visit your GP your child are still having problems about 4 weeks after the traumatic experience, or the symptoms are particularly troublesome.
Your GP will want to discuss your childs symptoms with you in as much detail as possible.
Your GP can refer them to mental health specialists if they feel they’d benefit from treatment.’
If you’re able to, let them know your child has experienced a traumatic event in the recent or distant past and tell them about the symptoms they’ve been having since – it may help to print out this page, and highlight or tick any of the symptoms they’ve been experiencing, to help you remember.
A note for parents and care givers
When talking about children, it can sometimes feel very impersonal to talk about ‘symptoms’ – but obviously they are simply important things to look out for, and will be used to help guide a diagnosis from medical professionals.
Young children often do not have the words or understanding to tell you what they are feeling, or symptoms they are experiencing. But, it is important to remember that despite this, they may be experiencing a range of different feelings.
‘Some typical feelings they may have include:
- Anger – that something terrible has happened to them. They may be angry towards the people involved or angry at themselves that they didn’t do something to change the situation.
- Guilt – that they believed they should have done something to prevent the trauma happening or they may feel they were responsible or to blame. They may feel guilty that they survived when others didn’t.
- Frightened – that the trauma could happen again or that they are not safe anywhere or with anyone. They may feel too scared to tell anyone about what happened.
- Sad – about the trauma or if someone died or was injured.
- Ashamed or embarrassed – by what happened and are worried about telling anyone in case they get told off.’
Children and young adults may be very 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 they find it easier to talk to other adults, in which case seeking professional help is often advisable, as this will help them rediscover normality, as well as reducing the likelihood of prolonged, harmful stress reactions. Receiving the appropriate type of support can help your child come to terms with what has happened so that it does not continue to affect them for the rest of their life. Find out more about how parents can help children and young adults here.
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 more about how to look after yourself in this time 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
- Trauma – a guide for parents
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Treatments for PTSD
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.