Yes, Children Can Have PTSD Too

When we hear or think of post-traumatic stress disorder (PTSD), our thoughts immediately think of veterans or adults who have gone through something very traumatic. PTSD is a very specific mental health disorder. It is the one mental illness diagnosis that requires a direct etiology, meaning a single source or direct cause responsible for the person's distress and signs and symptoms. According to Dr. Michael Scheeringa (2011) for a person to receive a diagnosis of PTSD they have to meet at least 17 of the possible signs and symptoms as outlined by the DSM-IV criteria. The person needs to also be able to vocalize and/or recall the traumatic event or events in which their symptoms can be attributed to. Adults find it difficult discussing those events, let alone a school-aged child. Whether adults talk about their experiences or not, signs and symptoms can be observed much easier in them than in a child (Hamblin and Barnett, 2019; Scheeringa, 2011).

According to Hamblen and Barnett (2019), 19% of cases referred to the Department of Human and Health Services (DHS) were children who suffered or experienced a traumatic event. Out of that number, 75% were from neglect, 17-18% from physical abuse, and less than 10% from sexual abuse (Hamblen and Barnett, 2019). Events that place children at risk for developing PTSD include but are not limited to:

• Sexual abuse/violence
• Physical abuse including neglect
• Natural/man made disaster
• Violent crimes - whether witnessing or a victim of
• Motor vehicle accident or plane crash, etc. 
• Witnessing community violence, school shootings
• Domestic violence
• War

Signs and symptoms that can be seen in children with PTSD who may have experience one or more of these events include:

• Reports of unwanted or persistent memories
• Avoidance type behaviors, especially anything that may remind them of the event
• Constant worries and beliefs the world is an unsafe place
• Trouble falling asleep and/or staying asleep
• Negative thinking or mood
• Feeling jumpy or edgy
• Younger children tend to be fearful and may regress to an earlier form of behavior like bedwetting, thumb sucking, etc. 
• Problems paying attention
• Withdrawing from people
• Defensive, always on the look out for danger
• School-aged children tend to get the order of events out of sequence when recalling memories
• A belief they can recognize warning signs of impending trauma

These signs and symptoms are not an exhaustive list. They can also vary depending on the developmental age of the child, the severity of the trauma, type of trauma, and the duration of the trauma (Centers for Disease Control, 2020; Hamblen and Barnett, 2019; Peterson, 2016; Scheeringa, 2011). 

In adolescents (children aged 12-17 years) PTSD symptoms are very similar to adults and can be easily recognized. In very young children it is not always as obvious. The signs and symptoms displayed by very young children are often dismissed as ADHD, oppositional defiance disorder (ODD), obsessive compulsive disorder (OCD), and/or general anxiety disorder (GAD) (Peterson, 2016; Scheeringa, 2011). Treatment for symptoms ranges from cognitive behavioral therapy to play therapy to medications and sometimes a combination of treatment modalities. These symptoms can be short-lived only a few months to years or can last a lifetime depending on the child. 

I recently learned that our son J showed signs of PTSD. Like many people, I never associated PTSD with young children; teenagers and adults, but not children. I knew J's first two years of his life were very traumatic. He lived in a house full of violence, drugs, and alcohol. The police had been to the home on numerous occassions. He entered the foster system after he was found wandering around the streets at 2 am in the morning. There is no telling what else he went through or witnessed. 

My husband and I were told that he suffered from night and day terrors. He could not sleep nor stay in any room with the door closed. It was difficult to get him to go to bed at nights. He did not communicate except for screaming and throwing himself around, etc. While we were meeting J for the first time, we witnessed some of his behaviors. However, it did not keep us from making him a part of our family. 

Over the past 6 years we have been struggling trying to find help for J. We were told he has ADHD, ODD, and GAD. We were also told that he is just defiant. We have been in countless therapy sessions. I retold the story of his beginnings numerous times - at least what we knew, and still the diagnoses remained the same. These diagnoses were based on an hour long evaluation by a psychologist and paperwork I completed. Never once, did it cross my mind that J would have PTSD. What is even worse, I taught mental health to nursing students. But in my defense, the focus was on adults not children. 

When I heard the diagnosis of PTSD, I felt a tremendous amount of guilt. I should have known better! All the times I yelled out of frustration, sent him to his room, took away privileges, spanked (open hand), and allowed the school to paddle him if necessary, and trying all the techniques the therapists said to try, and so on, I could have been responding better. What have I done?! I cried. The doctor tried to reassure me that I am not to blame. She stated J needs a lot of help and there is no way we would be able to handle him without help. It didn't make me feel any better. I treated J as this defiant child who needed structured discipline. Although I tried to temper that with hugs and kisses and affirmations, I still responded to his negative behaviors with punitive actions. 

Today I was reminded by a family member how far we have come with J. Within 6 months after coming to us, he could stay in his room with the door closed. I could get him to bed at a decent and regular time. He has become a loquacious talker and reads at a 5th grade level. He has a desire to help others. He does not have as many nightmares as he once did. J is willing to try new things. He is not the same child that came to us 6 years ago. 

Knowing what we know now, my family and I can respond better or at least do our best to respond appropriately. We are still going to make mistakes and that is okay. I am only human. One thing is certain, the Lord does not make mistakes. He chose me to be J's mom and all I can do in my limited capacity as a human is to love J with all my heart whether I make mistakes or not. 

References:

Centers for Disease Control (2020). Posttraumatic Stress Disorders in Children. CDC: Children's Mental Health. Retrieved from www.cdc.gov/childrensmentalhealth/ptsd.html . 

Hamblen, J. & Barnett, E. (2019). PTSD in Children & Adolescents. Retrieved from www.ptsd.va.gov. 

Peterson, J. (2016).  PTSD in Children and Adolescents: Symptoms, Causes, and Effects, Healthy Place. Retrieved from: https://www.healthyplace.com/ptsd-and-stress-disorders/ptsd/ptsd-in-children-symptoms-causes-effects-treatments#:~:text=The%20effects%20of%20PTSD%20in%20school-aged%20children%20can,behavior%202%20Sexual%20acting-out%203%20Aggression%204%20tantrums.

Scheeringa, M.S. (2011). PTSD in Children Younger Than the Age of 13: Toward Developmentally Sensitive Assessment and Management. Journal of Child Adolescent Trauma, September; 4(3): 181-197. Retrieved from PubMed. 

I'm Just Telling You My Perspective

Since J came into our lives, we have had many ups and downs. To be honest, more downs than ups. My husband and I have had to readjust our parenting techniques many times over; little to no direction, going in circles, pulling our hair out readjustments. We did not know if we were coming or going. With the unpredictable chaos of emotions, it is hard to remember the good days, the good occasions, the moments of laughter and love. 

Currently, J is in the hospital getting treatment. A program that I am hoping and praying will help him and by extension us. My house has been quiet these past couple of weeks. The lack of sound is almost deafening. There is no screaming, fighting, being woken up at 6 am to a child demanding milk, no slamming of doors, banging on the walls - well, I think you get the picture. While he is in the hospital, the atmosphere in the house is calm and uneventful. However, my thoughts are on J. 

The amazing thing about silence and stillness is what one learns; or better yet, remembers. I was reminded of the quiet times we had with J: the mornings of sleeping in, the uneventful nights when he put himself to bed, and so on. I was reminded of the times he tried to help around the house. I even remembered times of laughter and fun. The main thing I learned was how a build up of negative moments can hide positive moments and experiences. It is easy for a person to lose sight of those little moments, especially when there is so few of them. In the past couple of weeks I was reminded of one particular moment. 

The three of us were eating lunch at a restaurant when a discussion ensued about the color of their paper napkins. I was stating they were tan. J insisted they were light brown. Yes, it is a tan color. J continue to insist they were light brown. After several exchanges back and forth, I asked J why he was arguing with me. He promptly stated "I'm not arguing with you. I'm just telling you my perspective. They are light brown" With that, my husband got up from the table and walked away stifling a laugh. I responded with "My perspective says it is tan." J just started laughing. In the grand scheme of things, J's perspective wasn't wrong. 

In the stillness of these past couple of weeks, the Lord has been reminding me about perspectives. How J sees and views the world is different and unique. I should not force a perspective but rather take the time to listen to his. His perspective is bound to change as he grows older. I can only hope that mine will grow and change as well. 



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A Damaged Child

How does someone handle a damaged child? Yes, I said it - damaged. 'Damaged' is not an adjective we like to use when describing children, let alone your own. Children are meant to be sweet, whole, innocent, precocious at best, whimsical and other good adjectives that can be applied; but damaged is not one of them. If I am being honest with myself, it is the best word I can use to describe our youngest son. 

My husband and I made the fateful decision 6 years ago to make J a part of our family. Our two oldest sons were in their late teens and taking on a two-year-old would be like starting over. However we prayed about it, well I mostly prayed about it, and it was placed on my heart to have J become a part of our family. Although it was placed on my heart, we did have a family meeting to discuss it before proceeding to move forward. My husband and I even flew out to another state to meet J to be sure if we really wanted to pursue it. 

As a registered nurse with a master's degree and having taught several classes on mental illness, I knew J could possibly have some issues. Little did we know. What I knew about mental illness mostly applied to adults, very little (except for Erickson life stages - for all you nurses out there) did I know about children. However, we are learning. 

J did not come to us whole. Despite his outward appearance- bright blue eyes, long dark brown eyelashes and freckled cheeks, J was broken. Now, I may get flack for stating such a thing about a child. After all, who wants to admit their son or daughter is broken? Knowing what I know - thank you Erickson, I felt I could fix him - my family could fix him. I felt his brokenness could be fixed with as much love and care as I could give him. If I just hugged him enough, bought him things, met his needs, etc., he would be healed, be whole again. I was wrong. It has been a tremendous learning process for myself and my family. Needless to say, I have prayed a lot and others have prayed for us. 

The use of the adjectives 'damaged' and 'broken' is not to convey that J is a terrible child. He is not. There are many children just like him - full of potential and a desire to be kind. There are many parents full of love for their child, biological or otherwise, that are as frustrated, angry, and tired as we are. It is difficult and challenging dealing with a child who has been damaged and has mental illness as a result. 

There are no magic words or processes that work for every child. The purpose of this blog is to share our experiences and allow a place for others to share theirs as well. This blog is dedicated to my son J.