PTSD in Children
Post-traumatic stress disorder (PTSD) is something most people easily attribute to war veterans or victims of accidents and disasters. PTSD is shockingly prevalent for many people, including children and teenagers. Presentations of anxiety, depression, trust issues, violent outbursts, phobias, avoidance, chronic “daydreaming” [dissociation], or poor concentration are some of the symptoms of trauma – symptoms that require trauma therapy. Medication and behaviour modification are often merely “band-aid” solutions that provide relief in the short-term but do little to get to the root cause of what is going on (such solutions tend to make things easier for the adults in the child’s life). However, untreated severe childhood trauma will almost always develop into PTSD.
Adults may think that young children do not have the capacity to explicitly recall traumatic events, and therefore escape negative, enduring effects. This is not accurate. Trauma lives in implicit ways in our bodies. Just because we may have been pre-verbal when we experienced trauma, it does causes lasting effects (such events can often hold the clues to our anxieties and phobias). Other contributing factors as to why trauma goes untreated in children is that parents respect medical practitioners’ authority (“your child has ADHD” is only half the story – the ADHD is a presentation of an underlying cause), and parents may also be contending with their own trauma issues. Being told by a medical professional that your child’s challenging behaviour presentations can be modified by taking medication also holds an alluring (albeit unrealistically simplistic) appeal.
Deciphering undiagnosed PTSD in children and youth can be tricky if you aren’t sure what to look for. More obvious symptoms include hypervigilance and discomfort or avoidance when discussing certain events, people, environments or periods of time. Nightmares, sleep problems and somatic complaints (tummy aches, headaches) are other good indicators of trauma manifestations.
The following symptoms are more likely to appear in children three years of age and older:
Flashbacks. Children who can express themselves verbally may start to recount intrusive and distressing thoughts of the original trauma. These occurrences are common for the first few months after a traumatic event has occurred. However, if these flashbacks continue, it could be a symptom of PSTD.
Physical Reactions. Older children may complain of stomach aches, headaches or other vague illnesses when reminded of the trauma. Even though the pain may feel very real to the child, there is no diagnosable cause. This sometimes causes adults to dismiss the child’s complaints as attention-seeking; however, this can be a very real symptom of PTSD and should be further explored.
Denial. Occasionally a child who is old enough to explicitly remember a traumatic event will adamantly deny that it ever happened. When individuals suppress/deny/numb their feelings it can develop into severe PTSD. A child exhibiting this symptom needs treatment as soon as possible.
Concentration difficulties. PTSD in children is often misdiagnosed as Attention Deficit Hyperactive Disorder (ADHD) or Attention Deficit Disorder (ADD). The symptoms attributed to these diagnoses are often responses to trauma triggers. The internal fear compels them to move to something that feels safer; this becomes a cycle every time they encounter something that triggers them.
Easily Startled. Children may become skittish, or jump when they hear loud noises, depending on the trauma they experience (such as witnessing violence or verbal assault). In a situation of physical or sexual abuse, a child/teen may flinch when an adult’s hand comes near.
Lack of Dreams for their Future. Children who have experienced life-threatening occurrences may not dream of their future because they expect to die young.
Self-Destructiveness. While impulsivity and risk-taking behaviour are the norms of adolescent development, youth with PSTD are prone to engaging in dangerous activities and do not consider long-term consequences of their decisions.
Depression, Sadness, and/or Hopelessness. This mindset is rooted in their sense of a lack of future. Disappointment and fear has created a feedback loop in the brain that contributes to a pessimistic outlook.
Dissociation. A teacher may label a child with PTSD as a “chronic daydreamer” or state the child is constantly “in a world of their own” or an adult may think a child is purposely ignoring them.
Violent Play. Children with PTSD may act out or create artwork/stories that may be attributed to scary memories. Destructive behaviour and violence (frequently diagnosed as Oppositional Defiant Disorder) is a common symptom of PTSD.
Clinginess. Children exhibiting signs of PTSD can present as clingy.
Bed-wetting. Older children with PTSD may revert to bed-wetting.
Most of what we deem to be physical and psychological pathology (autoimmune diseases such as IBS, fibromyalgia and rheumatoid arthritis, cancer, substance use, eating disorders, personality disorders, anxiety, depression, oppositional defiant disorder, ADHD, and a host of other labels and diagnoses) evolve from chronic stress attributed to trauma that dis-regulates the central nervous system causing dis-ease. To address this, our medical, and human & social services providers need to widen the lens of what defines “trauma”. Trauma is not only a catastrophic event or severe physical or sexual abuse. Long-term traumatic consequences can occur from a child not experiencing optimal attunement with a caregiver due to uncontrollable occurrences such as poverty, grieve and loss, isolation, or illness (physical and mental), or a child undergoing invasive medical procedures, or a child witnessing abuse in the home (including substance abuse).
Bruce Perry, senior fellow of the Child Trauma Academy in Texas asserts that the developing brain is more susceptible to damage and neuro-chemical imbalances than the mature brain. It is suggested that the term “Developmental Trauma Disorder” should replace the multiple diagnoses such as Attention Deficit Disorder, Obsessive Compulsive Disorder, Autism, Tourette’s, Attention Deficit Hyperactive Disorder (ADHD) that children often get from different health professionals. Trauma in children is most often obscured and minimized, with a lack of connections being made between disorders and antecedent emotional events.
With trauma, the primordial, somatic awareness of feeling safe, secure, and loved gets ruptured causing a fragmented sense of Self. If your child or teen is exhibiting symptoms of PTSD, a holistic approach to treatment is needed to address not just the behavioural symptoms, but also as a means of reconciling the underlying trauma that is impeding ongoing healthy development.
christine@blacksheepcounselling.com
References:
Banich, M. T., & Compton, R. J. (2017). Cognitive neuroscience (4th ed.). Belmont, CA: Wadsworth, Cengage Learning.
Gabor Mate (2004). When the body says no: The hidden costs of stress. Toronto, ON: Vintage Canada.
Jackson Nakazawa, D. (2016). Childhood disrupted: How your biography becomes your biology. New York, NY: Atria.
Perry, B. (2013, July 25). The impact of trauma on the developing child. Brain Development and Learning Conference. UBC Interprofessional Education.
Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York, NY: W. W. Norton & Company.
van der Kolk, B. (2104). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books
