Understanding Post-traumatic Stress Disorder (PTSD) in Children

Children and adolescents can endure post-traumatic stress disorder (PTSD) after a distressing experience. In the United States, more than two-thirds of children have experienced at least one traumatic event prior to the age of 16. Of those who experience trauma, approximately 16 percent will struggle with PTSD.

Common Traumatic Events in Childhood

• Sexual abuse/rape
• School violence
• Natural disasters
• Military-related stressors
• Sudden or violent loss of a loved one
• Neglect
• Severe accidents
• Life-threatening illnesses

Changes in PTSD Diagnosis for Children

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), now offers specific criteria for diagnosing PTSD in children, particularly for those six years old or younger. This adjustment recognizes that children, like adults, can be afflicted with PTSD and that symptoms in younger children may differ.

Diagnostic Criteria for PTSD in Children Ages 6 and Younger

• Criterion A: Exposure to an event involving actual or threatened death, serious injury, or sexual violence.
• Criterion B: At least one intrusive symptom, such as nightmares, flashbacks, or avoidance of trauma reminders.
• Criterion C: At least one avoidance symptom, such as shunning activities or places associated with the trauma.
• Criterion D: At least one change in arousal or reactivity, such as increased irritability, difficulty concentrating, or sleep problems.
• Symptoms persist for a minimum of one month and cause significant distress or impairment.

Signs and Symptoms of PTSD in Children and Adolescents

Behavioral Symptoms

• Increased crying or screaming
• Poor appetite or weight loss
• Nightmares or night terrors
• Fear of separation from parents or caregivers
• Difficulty concentrating in school
• Feelings of guilt or shame
• Anxiety or fearfulness
• Eating disorder behaviors
• Self-harm
• Depression or feelings of isolation
• Substance abuse or addiction
• Risky sexual behavior
• Impulsive and dangerous decisions

Cognitive and Emotional Symptoms

• Isolating behaviors
• Inability to concentrate
• Skipping classes
• Poor academic performance
• Dissociative tendencies
• Withdrawal from relationships
• Sleep disturbances
• Heightened awareness of surroundings
• Constant state of alertness
• Negative thoughts and emotions
• Avoidance of previously enjoyable activities

Risk Factors for PTSD in Children

• Life-threatening or physically harmful events: These are more likely to result in PTSD than non-life-threatening or non-physically harmful events.
• Previous traumatic experiences: Children with a history of trauma are more susceptible to developing PTSD after a new traumatic event.
• Gender: Girls are two to three times more likely than boys to develop PTSD after trauma.
• Mental health history: Children and teens with a prior diagnosis of a mood or anxiety disorder are more likely to develop PTSD after a traumatic event than those with no mental health history.
• Family dynamics: Children with parents who have PTSD are more likely to develop PTSD themselves. Children who lack social support are also more likely to develop PTSD.

Advice for Parents and Caregivers

• Educate yourself on the signs and symptoms of PTSD in children.
• Seek resources to support your child, such as a therapist or support group.
• Be supportive and understanding.
• Encourage your child to discuss their experiences.
• Medication may also be beneficial in treating PTSD in children.