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.