Children have not had the time or the cognitive brains to process stress and trauma in the same way as we do as adults. Therefore, they might need more help after being exposed to a traumatic event or situation.
Also, three to ten million children witness family violence each year. Around 40% to 60% of those cases involve child physical abuse. (Note: It is thought that two-thirds of child abuse cases are not reported.)Studies show that about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3% to 15% of girls and 1% to 6% of boys develop PTSD.
Posttraumatic stress disorder, or PTSD , is diagnosed after a person experiences symptoms for at least one month following a traumatic event. The disorder is characterized by three main types of symptoms:
- Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
- Avoidance of places, people, and activities that are reminders of the trauma, and emotional numbness.
- Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered (in children this would look like meltdowns or irritability for no obvious reason).
- Fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others
- Children might show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.
- Behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol
Diagnosis criteria that apply specifically to children younger than age six include the following:
Exposure to actual or threatened death, serious injury, or sexual violation:
- direct experience
- witnessing the events as they occurred to others, especially primary caregivers (Note: Does not include events witnessed only in electronic media, television, movies, or pictures.)
- learning that the traumatic events occurred to a parent or caregiving figure
The presence of one or more of the following:
- spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events (Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.)
- recurrent distressing dreams related to the content and/or feeling of the traumatic events (Note: It may not be possible to ascertain that the frightening content is related to the traumatic event.)
- reactions as if the traumatic events are recurring; the most extreme being a complete loss of awareness of present surroundings. (Note: Such trauma-specific reenactment may occur in play.)
- intense or prolonged psychological distress at exposure to internal or external cues
- marked physiological reactions to reminders of the traumatic events
One of the following related to traumatic events:
- persistent avoidance of activities, places, or physical reminders
- people, conversations, or interpersonal situations that arouse recollections
- diminished interest or participation in significant activities such as play
- socially withdrawn behavior
- persistent reduction in expression of positive emotions
Two or more of the following:
- irritable, angry, or aggressive behavior, including extreme temper tantrums
- exaggerated startle response
- problems with concentration
- difficulty falling or staying asleep or restless sleep
Also, clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior not attributable to another medical condition.
How do I know if my child needs help processing a traumatic event?
If your child has experienced a traumatic event and you are seeing any of the signs or symptoms mentioned above, your child might need extra help processing their fears and emotions regarding this event. As mentioned above, children can experience symptoms of PTSD even if they simply witnessed or even overheard the traumatic event being described.
How is PTSD treated in children?
PTSD in children is typically treated in one of 3 ways:
- Cognitive-Behavioral Therapy (CBT)-CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert himself or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, “the world is totally unsafe.” Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD. CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children.
- Eye movement desensitization and reprocessing (EMDR)-EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.
- Play therapy-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 methods to help children process their traumatic memories.
At MCFT, we will do an assessment to determine the intensity of the anxiety caused from the traumatic event as well as to identify support systems in place to help aid in treatment. We use the CAPS (Clinician Administered PTSD Scale for Children/ Adolescents) which is the gold standard for identifying PTSD.
We then determine based on your child/ teen’s age, developmental level & readiness to work directly on the trauma, whether we will recommend trauma focused cognitive behavioral therapy (TF-CBT) trauma focused play therapy or Eye Movement Desensitization Reprocessing (EMDR).
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