Trauma Support for Children

Your children are the most precious gifts in your life. But just like adults, children are greatly affected by trauma. Today, we know that kids are susceptible to developing Posttraumatic Stress Disorder (PTSD) just as adults are, but PTSD affects children differently. Find out more about children, trauma, and how Family Recovery Group can help you and your family by clicking below.

1. What events cause PTSD in children?
2. What are the risk factors for PTSD?
3. What does PTSD look like in children?
4. Besides PTSD, what are the other effects of trauma on children?
5. How is PTSD treated in children and adolescents?
6. What can I do to help my child?

What events cause PTSD in children?

A diagnosis of PTSD means that an individual has experienced an event that threatened one's own or another's life and that this person responded with intense fear, helplessness, or horror. Children and adolescents are also susceptible to these responses. They may be diagnosed with PTSD if they have survived natural and man made disasters such as floods and fires; violent crimes such as kidnapping, murder of a parent, sniper fire, and school shootings; and transportation accidents such as automobile and plane crashes.

What are the risk factors for PTSD?

There are three factors that have been shown to increase the likelihood that children will develop PTSD. These factors include the following:

In general, most studies find that children and adolescents who report experiencing the most severe traumatic experiences also report the highest levels of PTSD symptoms. Family support and parental coping have also been shown to affect PTSD symptoms in children. Studies show that children and adolescents with greater family support and less parental distress have lower levels of PTSD symptoms.

What does PTSD look like in children?

Researchers and clinicians are beginning to recognize that PTSD may not present itself in children the same way it does in adults. Criteria for PTSD now include age-specific features for some symptoms.

Very young children may present with few PTSD symptoms. This may be because eight of the PTSD symptoms require a verbal description of one's feelings and experiences. Instead, young children may report more generalized fears such as stranger or separation anxiety, avoidance of situations that may or may not be related to the trauma, sleep disturbances, and a preoccupation with words or symbols that may or may not be related to the trauma. These children may also display posttraumatic play in which they repeat themes of the trauma. In addition, children may lose an acquired developmental skill (such as toilet training) as a result of experiencing a traumatic event.

Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia about the trauma. However, they do experience "time skew" and "omen formation," which are not typically seen in adults. Time skew means that a child mis-sequences trauma related events when recalling the memory. Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas. School-aged children also reportedly exhibit posttraumatic play or reenactment of the trauma in play, drawings, or verbalizations. Posttraumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety. An example of posttraumatic play is an increase in shooting games after exposure to a school shooting. Posttraumatic reenactment, on the other hand, involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

PTSD in adolescents may begin to more closely resemble PTSD in adults. However, there are a few features that may differ. As discussed above, children may engage in traumatic play following a trauma. Adolescents are more likely to engage in traumatic reenactment, in which they incorporate aspects of the trauma into their daily lives. In addition, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors.

Besides PTSD, what are the other effects of trauma on children? Children who experience trauma often have problems with fear, anxiety, depression, anger and hostility, aggression, self-destructive behavior, feelings of isolation and stigma, poor self-esteem, difficulty in trusting others, and substance abuse. Children who have experienced traumas also often have relationship problems with peers and family members, problems with acting out, and problems with school performance. Along with associated symptoms, there are a number of psychiatric disorders that are commonly found in children and adolescents who have been traumatized. One commonly co-occurring disorder is major depression. Others include anxiety disorders such as separation anxiety, panic disorder, and generalized anxiety disorder; and externalizing disorders such as attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

How is PTSD treated in children and adolescents?

Although some children show a natural lessening of PTSD symptoms over a period of a few months, a significant number of children continue to exhibit symptoms for years if untreated. A review of the adult treatment studies of PTSD shows that Cognitive-Behavioral Therapy (CBT) is the most effective treatment approach. CBT for children generally includes the child directly discussing the traumatic event (exposure), anxiety management techniques such as relaxation and assertiveness training, and correction of inaccurate or distorted trauma related thoughts. Although there is some controversy regarding exposing children to the events that scare them, exposure-based treatments seem to be most relevant when memories or reminders of the trauma distress the child. Children can be exposed gradually and taught relaxation to make recalling their experiences easier. Through this procedure, they learn that they do not have to be afraid of their memories. CBT also involves challenging children's false beliefs such as, "the world is totally unsafe." The majority of studies have found that it is safe and effective to use CBT for children with PTSD.

CBT is often accompanied by psycho-education and parental involvement. Psycho-education is education about PTSD symptoms and their effects. It is as important for parents and caregivers to understand the effects of PTSD as it is for children. Research shows that the better parents cope with the trauma, and the more they support their children, the better their children will function. Therefore, it is important for parents to seek treatment for themselves in order to develop the necessary coping skills that will help their children.

Several other types of therapy have been suggested for PTSD in children and adolescents. Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other techniques to help the children process their traumatic memories. Psychological first aid has been prescribed for children exposed to community violence and can be used in schools and traditional settings. Psychological first aid involves the following:

Twelve Step approaches have been prescribed for adolescents with substance abuse problems and PTSD. Another therapy, Eye Movement Desensitization and Reprocessing (EMDR), combines cognitive therapy with directed eye movements and is effective in treating both children and adults with PTSD. Medications have also been prescribed for some children with PTSD. However, due to the lack of research in this area, it is too early to evaluate the effectiveness of medication therapy.

Finally, specialized interventions may be necessary for children exhibiting particularly problematic behaviors or PTSD symptoms. For example, a specialized intervention might be required for inappropriate sexual behavior or extreme behavioral problems.


What can I do to help my child?

You’ve already taken a big first step toward helping your child just by learning about the effects of trauma on children. Continue to gather information on PTSD and pay attention to how your child is functioning. Watch for warning signs such as sleep problems, irritability, avoidance, changes in school performance, and problems with peers. It may be necessary to seek help for your child. Consider having your child evaluated by a mental-health professional who has experience treating PTSD in children and adolescents. Many therapists with this experience are members of the International Society for Traumatic Stress Studies, which has a membership directory containing a geographical listing of therapists who treat children and adolescents. Family Recovery Group can help you and your family choose a practitioner with whom your child feels comfortable. But the most important thing your child needs from you now is love and support.

Contact Family Recovery Group to help the family find a therapist specializing in child trauma.

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