Editor’s Note: Always seek the advice of your child’s pediatrician or other qualified healthcare professional with any questions you may have concerning your child. Never disregard professional medical advice or delay seeking it because of something you have read in this article.
While military veterans often serve as the face of post-traumatic stress disorder (commonly referred to as PTSD), children may also be diagnosed. PSTD is a mental health condition triggered by a traumatic event that has been witnessed or experienced.
About 4% of children under the age of 18 are exposed to some sort of trauma in their life that leads to post-traumatic stress disorder. Of those children and adolescents who have experienced trauma, about 7% of girls and 2% of boys are diagnosed with PTSD.
It’s fair to say that the stress of the pandemic, racial and social justice concerns, and school shootings have prompted many parents to wonder whether their children may suffer from PTSD.
To help parents, we talked to Dr. Abena Brown-Elhillali, a licensed clinical psychologist at Kennedy Krieger Institute’s Center for Child and Family Traumatic Stress. Dr. Brown-Elhillali shared guidance on detecting signs of PTSD in children, the difference between PTSD and stress, and appropriate treatments to consider.
Signs of PTSD in Young Children
For younger children, PTSD can be difficult to identify. Dr. Brown-Elhillali said that the key is noticing subtle changes in your child’s temperament and behaviors and being aware that your child may have experienced trauma.
Although PTSD is difficult to recognize in younger children, there are some critical signs to help identify a child experiencing trauma-related symptoms. Dr. Brown-Elhillali offered the following examples. (Note that the presence of one of these changes does not indicate trauma exposure, but a combination of these changes should prompt further investigation.)
- Regression of previously learned skills: Younger children may struggle with using the toilet after making progress or even mastering toileting skills. There may be more day or night-time accidents. Sitting still and concentrating on a task, even for short periods of time, may have been achievable for your little one. A common marker of a trauma-related diagnosis is newly-emerged difficulty concentrating and focusing, as well as hyperactivity.
- Unexplained fears or anxieties in situations or settings that children were previously comfortable in: Children may have been happy and confident going to school or another familiar place and later have unexplained avoidance and fears in these settings.
- Difficulty sleeping, nightmares, and other sleep disturbances: Children may have more anxiety and avoidance at bedtime, refuse to sleep, or refuse to sleep alone, have more night waking, and have more disturbing dreams. Sometimes the content of the dreams may be similar to the traumatic experience, but often the dreams are just scary and anxiety-provoking in nature.
- Unexplained irritability: Children can be moody when there are changes to their environment or routines. Irritability that is out of the ordinary for your little one can look like sadness, withdrawal, or being very easily upset.
- Re-enacting trauma: Young children often re-enact trauma in their play activities. Witnessing violence in their environments can result in children imitating similar violent themes in their play.
The Difference Between PTSD and Acute Stress
PTSD refers to the complete diagnosis of post-traumatic stress disorder. “This diagnosis is exactly what it sounds like: a stress-related disorder that results after a child experiences a trauma,” explained Dr. Brown-Elhillali. “PTSD is essentially the manifestation of our body and brain responding to significant levels of stress that exceed our ability to cope. Everyone experiences some stress, even small children starting daycare for the first time or adjusting to the arrival of a new sibling. Trauma is different because the stress is so extreme that it feels life-threatening.”
The symptoms of PTSD are similar to those of Acute Stress Disorder, and both result from extreme stress levels. Dr. Brown-Elhillali noted that the main difference between the two diagnoses is when the symptoms appear and how long they last. “Acute Stress Disorder is typically diagnosed if a child experiences a trauma and exhibits symptoms within one month of a trauma exposure, the symptoms last for at least three days, and symptoms resolve within a month. A diagnosis of PTSD is typically given if the symptoms persist for longer than a month following a child’s exposure to a trauma.”
Misconceptions About PTSD in Children
One of the biggest misconceptions is that hyperactivity and difficulty concentrating equate to an ADHD diagnosis. Many parents are familiar with the signs of ADHD in kids and know how to respond with behavioral or pharmacological treatments. But Dr. Brown-Elhillali pointed out that if a child is showing hyperactivity and inattention, as well as other signs consistent with a trauma diagnosis, it’s a good idea to pay attention to the possibility that this could be PTSD, not ADHD.
“Another common misconception is that trauma will resolve on its own. Symptoms of PTSD may decrease over time, but it’s best to seek professional help rather than waiting it out. This is because a diagnosis of PTSD is related to the development of other disorders later in life, and the adoption of maladaptive coping strategies (alcohol and drug misuse), especially when left untreated.”
How Children are Diagnosed with PTSD
Dr. Brown- Elhillali said that children are usually diagnosed with PTSD as a result of an assessment by a licensed mental health professional. Licensed psychologists, psychiatrists, and social workers are among the professionals qualified to provide a PTSD diagnosis.
“This is usually done through the process of a diagnostic interview that the child and adult caregiver(s) participate in. Very young and nonverbal children are observed in their play and in their interactions with others—both people they know, like their parents, and new people, like the office staff. The evaluator may also use questionnaires to help make an appropriate diagnosis. The bulk of the information used to provide a diagnosis is often coming from the parents’ report, which is why paying attention and being aware of changes in your little one is so valuable.”
Treatment for PTSD in Children
The most important part of PTSD treatment in children is parental involvement in treatment, said Dr. Brown-Elhillali. “Children heal best with parental support. If birth parents are not available—or in cases where they were involved in the trauma, and therefore their involvement in treatment would not be therapeutic—the presence of a caring, stable adult is highly recommended and will enhance PTSD treatment progress and effectiveness.”
The most important part of PTSD treatment in children is parental involvement in treatment.
Dr. Brown-Elhillali said it’s good to consider evidence-based treatments—those are treatments that scientific data have proven to be effective in treating trauma-related diagnoses in children. One of the principal treatments backed by evidence, and proven effective for children of different cultural backgrounds, is Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This treatment is effective and beneficial for children ages age 3 and up.
Child-Parent Psychotherapy (CPP) and Parent-Child Interaction Therapy (PCIT) integrate play, psychoeducation about trauma, and parenting skills to address and treat trauma-related symptoms in young children. CPP is effective for children ages 0-6, and PCIT is often recommended for children ages 2-7.
When seeking trauma treatment for your child, it’s a good idea to ensure sure your provider is experienced in treating trauma for young children and certified in providing a particular treatment model. You can learn more about trauma in children and different types of trauma treatment at The National Child Traumatic Stress Network.