Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

What is Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)?

Posttraumatic stress disorder, often called PTSD, is a mental health condition that can develop after a person goes through a shocking, scary, or dangerous event. This disorder can affect people’s thinking, feelings, physical sensations, and behavior. It’s important to know that kids can also get PTSD, and their symptoms might look different from those in adults. This makes treatment for kids distinct. PTSD can lead to long-term problems, it might occur with other psychiatric conditions, and it increases the risk of suicidal thoughts. In fact, PTSD can even affect children as young as one year old.

PTSD first appeared as a recognized disorder in the mental health field in a book called the “Diagnostic and Statistical Manual of Mental Disorders”, third edition, published in 1980. This book, also known as the DSM, lists and details all recognized mental health disorders. Including PTSD in the DSM showed the recognition of the big effect that scary or dangerous events can have on a person’s mental health. To be diagnosed with PTSD according to the DSM, a person has to have been through a shocking event and afterwards experience specific symptoms, like dreadful memories or nightmares, staying away from things or places that remind them of the event, negative mood and thinking changes, and an increased jumpiness or nervousness. Because of its inclusion in the DSM, the understanding, diagnosis, and treatment of people who have been through terrifying events have greatly improved. The most recent edition of the DSM now has special guidelines for diagnosing PTSD in children aged six and under.

PTSD is a complex to handle, because each traumatic event is unique, and the specific PTSD symptoms can vary from person to person. The main methods to prevent or treat PTSD in children involve therapies that focus on their mental well-being.

What Causes Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)?

People who go through traumatic events might develop long-term mental health problems. According to the DSM-5-TR, trauma is a key characteristic of Post-Traumatic Stress Disorder (PTSD). Trauma, in terms of PTSD, means being exposed to a threat of death, serious injury, or sexual violence. This could be from directly experiencing a traumatic event, witnessing someone else going through a trauma, or learning about a traumatic event that happened to a family member or close friend. Children, especially very young ones, are highly vulnerable to abuse and neglect, which can have a lasting psychological effect.

There are several theories aiming to explain how trauma can lead to PTSD. One such theory, called the shattered assumptions theory, suggests that traumatic events can change how children see themselves and the world compared to before the traumatic experience. It assumes that children believe the world is kind, meaningful, and that they are worthy. But after trauma, these beliefs can break down.

Another approach, psychodynamic psychology, explores how past experiences can influence current mental states and behaviors. Its supporters initially claimed that all mental illnesses stem from trauma. While this isn’t fully accepted today, it’s recognized that early life trauma can significantly contribute to mental illness development. This view especially focuses on trust; kids who have experienced trauma might have a hard time trusting that the world is safe or that people won’t hurt them.

Behavioral scientists also have theories describing how trauma can affect how we think. One of these includes the idea that repeated trauma can condition a person to react fearfully. This is commonly seen in PTSD.

Support after trauma also plays a significant role. Kids with a good support system are less likely to develop PTSD after traumatic experiences. On the other hand, kids who feel alone after trauma are more likely to suffer from acute stress disorder and possibly PTSD. Several factors can amplify the risk of PTSD after trauma, such as poverty, other adversities in childhood, gender, race, physical injury (including brain injuries), and the initial reaction to the trauma.

Risk Factors and Frequency for Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

The Post-Traumatic Stress Disorder (PTSD) is quite prevalent in life, with around 6.1% to 9.2% of adults in the United States and Canada experiencing it at some point. When we look at children, about one-third (31%) have experienced some form of trauma, with 7.8% developing PTSD by the time they are 18. Some studies even suggest that up to 60% of children and teenagers have come across a traumatic event. Over the course of a year, about 3.5% to 4.7% of people may experience PTSD.

In the Western Hemisphere, certain groups, like indigenous peoples and refugees, show higher rates of PTSD. However, Lower rates of PTSD have been observed outside the Western Hemisphere, particularly in the Eastern Hemisphere, though the precise reasons are not quite clear.

• Intentional trauma is more likely to result in PTSD than accidental or nonviolent trauma.
• The longer the trauma exposure or if repeated abuses occur, the higher the likelihood of developing PTSD.
• Although both males and females can develop PTSD after trauma, females are slightly more prone to it, with the level of susceptibility varying based on the type of traumatic experience.

Signs and Symptoms of Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

Post-traumatic stress disorder (PTSD) in children can vary in terms of the symptoms displayed and the history of the illness. The trauma that caused PTSD can be due to a variety of factors depending on the child’s age, gender, location, family status, and presence of any physical disability. Such factors could include sexual assault, political conflicts and forced displacement, exposure to military actions or combat, physical injury, or medical illness.

Understanding the child’s background and social situation is important due to the wide range of potential traumas. Typically, older children with PTSD have had early childhood trauma, which can be long before their clinical evaluation. The duration of symptoms after the traumatic event is important to distinguish PTSD from other psychiatric disorders.

Symptoms of PTSD can be dissociative, meaning that the person feels detached from reality. These symptoms must be differentiated from an existing dissociative disorder. Dissociative symptoms can manifest as:

• Depersonalization: The person may feel disconnected from their body or feel “lost” or like they’re “floating above their body”.
• Derealization: The person may feel like the world around them isn’t real, like they’re watching the world from a dreamlike state.

Before a psychiatric evaluation with children, consent from the parent or guardian must be obtained. Parents and guardians can provide important insights into changes in a child’s behavior, which can be the only initial sign of PTSD, especially in younger children. It is best practice to regularly screen children for abuse. If indications or verbalizations of child abuse are discovered, the clinician must immediately report the abuse to their local reporting agency.

Discussing trauma in patients being evaluated for PTSD requires sensitivity. Some patients, particularly those who have survived sexual assault, may have difficulty being alone with a healthcare professional of the same gender as their abuser. And some patients can discuss past trauma easily – others cannot talk about details without experiencing acute symptoms.

It’s crucial to respect the patient’s boundaries when discussing trauma and to ask them how much they want to discuss the topic. The specific details of the trauma usually aren’t necessary for diagnosing PTSD. Specifics are only needed for some types of psychotherapeutic treatments, to which the patient and parent/guardian must agree before initiation. Usually, in a first diagnostic interview, general questioning about symptoms related to trauma is the optimal approach.

Examples of general questions include:

• “Do you think about the traumatic event more than you would like to?”
• “Do you have nightmares or flashbacks related to the trauma?”
• “Do you avoid people or triggers associated with the trauma?”
• “Are you struggling with feelings of persistent sadness?”

The mental status examination, conducted during psychiatric evaluations, is key in assessing individuals with PTSD. The specific elements and findings in this examination will differ for each case of PTSD. The investment may include changes in appearance, attitude, behavior, mood, thought content, thought process, and insight.

The physical examination is generally not a significant part of the evaluation of PTSD. However, if the child is given medication for PTSD that affects blood pressure, monitoring blood pressure regularly is important to gauge the need for any adjustments to the medication. Also, a child’s heart rate may be elevated when talking about their trauma or when having flashbacks.

Testing for Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

To diagnose Post-Traumatic Stress Disorder (PTSD), a psychiatric evaluation is essential. However, doctors can also use validated questionnaires to identify and diagnose PTSD, particularly in situations where psychiatric specialists are not readily available. Examples of these screening tools are the PTSD Checklist for DSM-5 (PCL-5) and Trauma Symptom Checklist-40 (TSC-40). There’s also an interview-format tool, the Clinician-Administered PTSD Scale (CAPS-5).

Apart from these, other reliable screening tools are frequently used in clinical settings. These include the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA-PTSD-RI), the Trauma Symptom Checklist for Children (TSCC), and the Screening Tool for Early Predictors of PTSD (STEPP).

A formal PTSD diagnosis follows the criteria set in the DSM-5-TR – a manual for psychiatric diagnoses. The process involves a thorough evaluation considering various information sources like personal history and an overall health review. This thorough check allows doctors to assess the person’s symptoms and general mental health condition in relation to the standard diagnostic criteria.

The DSM-5-TR criteria for PTSD in children over 6 years old include experiencing a traumatic event, intrusion symptoms following the event (such as recurring thoughts or nightmares about the event), persistent avoidance of reminders about the event, negative changes in mood and cognition, and alterations in response and arousal to stimuli. Any disturbance caused by PTSD should persist for more than a month and cause significant distress or impairment in various life areas like social or occupational. Similarly, the diagnosis should not be attributable to substance use, medication, or another medical illness.

For children under 6, the criteria vary a bit. They also need to experience a traumatic event but may show more negative emotional states, socially withdrawn behavior, irritable behavior and angry outbursts, problems with concentration, and sleep disturbances following the event. The same duration and elements regarding significant distress or impairment in life and exclusion of substance use, medication, or other medical illness apply.

Treatment Options for Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

Treating children with PTSD requires a careful, tailor-made treatment strategy. It’s important to get the agreement of both the child and their parents before starting any treatment. However, some children with PTSD may not want to receive treatment, and others may have symptoms that don’t respond to conventional treatments. Generally, medications that alleviate PTSD in adults are not as effective in children. For this reason, the American Academy of Child and Adolescent Psychiatry recommends psychotherapy as the main treatment for children with PTSD. Yet, if a child is dealing with intense symptoms or other illnesses at the same time, they might not be ready for therapy right away. In such cases, starting with medication might be a good option and therapy can be introduced later when the child is more stable.

One of the best treatments for PTSD is trauma-focused psychotherapy, which encompasses cognitive behavioral therapy (CBT), exposure-based therapy, and Eye Movement Desensitization and Reprocessing (EMDR) therapy. Studies have shown that patients who go through any of these therapies get more relief from their symptoms than those who don’t. Also, they usually work better in children than medications.

CBT helps children identify and correct harmful beliefs that might develop after a traumatic event. This therapy uses methods such as teaching about PTSD, relaxation exercises, and teaching coping skills and stress management.

Exposure-based therapy is often used for anxiety disorders. It’s based on the idea that fear is a learned response that can be unlearned through gradual exposure to what’s causing the fear. However, it’s not suitable for all PTSD cases as it involves a lot of work from the child and consent is needed before it’s initiated.

EMDR therapy, on the other hand, was discovered to reduce the impact of disturbing thoughts through specific eye movements. These movements can willingly be adjusted while remembering a distressing event, which can lower the connected anxiety. Despite its effects, how EMDR works on a neurological level remains unknown.

Supportive psychotherapy can assist individuals coping with a recent traumatic event or acute stress disorder.

In 2020, the FDA approved a device that uses regular smartwatches to track heart rate during sleep for individuals with PTSD. The goal is to find a connection between bodily reactions and PTSD-related nightmares.

As for medication, Selective Serotonin Reuptake Inhibitors (SSRI) such as sertraline and paroxetine are allowed for treating PTSD in adults by the FDA. They’re typically less effective in children and usually work as well as a placebo. They’re mostly used for severe symptoms and are an unofficial approach to treating PTSD in children.

For children struggling with sleep or experiencing nightmares due to PTSD, some off-label medications are used. Prazosin, a drug for high blood pressure, is commonly given on its own or with an SSRI. It’s believed that it reduces the sympathetic response, which can minimize the frequency or severity of nightmares. Yet, it has mixed results. Another high blood pressure drug, clonidine, is sometimes used for similar purposes. Anyone prescribed these medications for PTSD should have their blood pressure monitored regularly, and they should be slowly taken off the drug to avoid any sudden rise in blood pressure.

What else can Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury) be?

It’s very important to identify child PTSD (Post-Traumatic Stress Disorder) accurately so we can treat it effectively. Sometimes, it might seem like PTSD but could be something else as symptoms can overlap with other conditions, such as ADHD (Attention-Deficit/Hyperactivity Disorder), Conduct Disorder, and Reactive Attachment Disorder.

Here are few other conditions which might at times seem like pediatric PTSD:

• Acute Stress Disorder: The symptoms for this and PTSD are often similar. The key difference is how long the symptoms last. If they are present for less than a month, doctors usually consider it as Acute Stress Disorder. Whereas, if these symptoms persist beyond a month, it could be PTSD.
• Dissociative Disorders: These include dissociative identity disorder (DID), dissociative amnesia, and depersonalization/derealization disorder. For example, DID involves the presence of two or more distinct personality states. Dissociative amnesia involves inability to remember important personal information, especially related to traumatic or stressful events. Lastly, the depersonalization/derealization disorder also involves feelings of being detached from oneself, but unlike PTSD, it doesn’t have other symptoms of PTSD.
• Major Depressive Disorder: This condition may co-occur with PTSD and typically involves persistent low mood lasting for at least two weeks. Emotional changes are common in both conditions.
• Adjustment Disorder: This condition develops in response to a known stressful event (not necessarily a traumatic one) and symptoms usually appear within three months of the event. If these symptoms continue for more than six months, then it’s most likely another, more chronic mental health condition.

Overall, diagnosis of PTSD requires careful observation and consideration of all symptoms and their duration.

What to expect with Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

The recovery from Post Traumatic Stress Disorder (PTSD) differs widely from person to person due to various factors. People who participate in PTSD treatments generally have better recovery outcomes than those who don’t. It’s worth noting that chronic PTSD is quite common. It’s estimated that one-third of patients continue to experience symptoms one year after diagnosis, and an equivalent fraction still have symptoms ten years later.

A newer area of psychology, called positive psychology, focuses on the ability to recover and grow after traumatic experiences. The concepts revolve around the idea that individuals recovering from trauma and PTSD can see positive changes in how they see themselves, how they interact with others, and how they view their life. These changes can lead to increased self-awareness, self-confidence, openness, and appreciation for life. However, it’s important to know that growth after trauma is not guaranteed and may even be rare. Also, there hasn’t been a lot of research into how positive psychology can help children with trauma disorders, so more studies are needed in this area.

Possible Complications When Diagnosed with Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

Post Traumatic Stress Disorder (PTSD) symptoms can get better, but they can also cause other mental health problems. This is because experiencing trauma increases the risk of developing major depression, borderline personality disorder, anxiety disorders, substance abuse, psychotic disorders, and more. People who have PTSD are also more likely to think about suicide, so doctors need to regularly check on them for such thoughts.

Besides mental health issues, individuals with PTSD often face difficulties in school or work, resulting in higher disability rates compared to people without PTSD. People who have experienced sexual trauma often struggle with intimate relationships when they become adults.

The risks associated with PTSD include:

• Development of other mental health disorders such as major depressive disorder, borderline personality disorder, anxiety disorders, substance use disorders, and psychotic disorders
• Increased likelihood of suicidal thoughts
• Educational and occupational problems
• Higher rates of disability
• Difficulties in establishing intimate relationships for those with a history of sexual trauma

Preventing Posttraumatic Stress Disorder in Children (Stress and Anxiety in Children after Injury)

To avoid and combat post-traumatic stress disorder (PTSD) in children, it’s critical to employ a diverse range of strategies that focus on lessening the chances of traumatic experiences and building stress resilience in kids. The main action includes tackling the broader issues resulting in trauma, like encouraging safe surroundings, initiating policies that are mindful of trauma in schools and communities, and encouraging constructive parenting methods.

Identifying individuals who are at risk early on and giving them access to supportive interventions can act as another preventative measures. This approach includes teaching them about trauma and skills to handle their emotions. It’s key for healthcare workers to identify if their patients might need PTSD screening. It’s important to note that foster care children are specially prone to neglect and abuse. Family doctors should look out for sudden changes in behavior, anxiousness, fear, or sleep issues in children, as these could indicate trauma. PTSD in children is a frequent but complicated emotional and behavioral disorder that can show up in various ways.

Moreover, promoting a robust social support system and improving kids’ skills in regulating their emotions can increase their ability to handle traumatic events, thereby decreasing the likelihood of developing PTSD. By focusing on proactive steps at individual, family, and societal levels, we can aim to lower the cases of PTSD in children and support the welfare of vulnerable groups.