PTSD in children: approaches to diagnosis and treatment

Trauma can happen at any age. And trauma from war is even more so.

Therefore, PTSD in children is a common phenomenon. Approximately 15% to 43% of girls and 14% to 43% of boys experience at least one traumatic experience. Of those children and adolescents who have suffered trauma, approximately 3-15% of girls and 1% to 6% of boys develop PTSD.

Symptoms of PTSD in children

The main symptoms that signal the presence of PTSD in children include:

• Constant recalling of past events (obsessive memories about which the child may not talk openly with an adult), at the same time avoiding everything that reminds him or her of the past.
• Emotional tension, manifestations of aggression, or vice versa – apathy, depression, emotional detachment.
• Sleep disturbance, scary dreams that make the child wake up at night, while children of preschool and younger school age may cry at night.
• Increase of the anxiety level, expectation of events repeating.
• Memory loss, attention disorder, decline in the ability to learn.
• Constant reproduction of the past experiences in a game (for children of preschool and junior school age).
• Self-destructive behavior (in particular, in teenagers: self-harm, alcoholism, drug addiction).

Possible symptoms of PTSD in children

If new behavioral or emotional problems appear after a traumatic event and if they persist for more than 2 weeks, these may be the manifestations of post-traumatic stress disorder in children.

You should be alert to the following symptoms:

• appearance of permanent memories and experiences of a traumatic event;
• increased heart rate and sweating;
• the child is easily frightened;
• emotional numbness is present;
• the child is very sad or depressed;
• there were sudden changes in behavior, speech, use of words or strong emotions.

Causes of PTSD in children

Post-traumatic syndrome can appear in children if they have experienced a traumatic event. It can be:

• war;
• sexual violence;
• physical or psychological violence or other violent crimes;
• natural disasters (for example, floods);
• school shootings;
• car accidents or fires.

Risk factors for the development of post-traumatic syndrome in children

Why do some people who have experienced a traumatic event begin to suffer from PTSD, while others do not?

There are three groups of factors, the combination of which leads to the development of PTSD in children:

• The intensity of the traumatic event, its duration, suddenness and uncontrollability.
• The strength of personal protective mechanisms and the availability of social support.
• Personal risk factors: age at the time of injury, presence of traumatic and mental disorders in previous periods of the person’s life.

Children and adolescents are at risk of developing PTSD.

At the same time, every person affected by military actions has his own experiences and reactions, which are considered absolutely normal in response to an abnormal situation.

Posttraumatic stress disorder questionnaire (PCL-5)

Diagnosis of PTSD in children: methods

There are no laboratory methods for detecting PTSD. Therefore, methods of diagnosing PTSD in children are based on psychophysiological examination.

Pay attention to the above manifestations of the disorder. At the same time, take into account the age of the patient. Up to 6 years old – ask parents about the quality of the child’s sleep, his relationship with other children. Older than 6 years – based on the results of the interview and psychological testing of the child himself.

The key criteria for diagnosing PTSD in adolescents and children:

• unconditional fact of a traumatic event;
• the described symptoms are present for more than a month.

Correction of PTSD in children: approaches to therapy

The psyche of both adults and, especially, children and teenagers has huge reserves for recovery and self-regulation. Thanks to the support of relatives and, if necessary, the psychological support of specialists, a person indeed can return to normalcy after a traumatic experience. The first and main step in correcting PTSD in children is to provide the child with a safe environment and relieve him of his feeling of guilt. It’s necessary to convey to the children that they are safe, and that their reactions are completely natural.

Correction of PTSD in children is most often carried out with the help of cognitive-behavioral therapy, which is aimed at overcoming trauma.

It includes the following:

• Teaching parents the peculiarities of communication with the child. They must convey to the child how important he/she is for them, and give him/her faith in himself/herself.
• Teaching relaxation techniques to children.
• Training how to manage your emotions.
• Identifying and working with thoughts that prevent adaptation, for example, self-blame.
• Telling about the traumatic event and lowering the tension of emotional experience in the process.
• Exposure is a regular gentle reminder to the child about the traumatic event with a simultaneous explanation of how to manage one’s own reactions.
• Conducting family activities.
• Creating a stable sense of security for the child.

Children with PTSD have a higher risk of suicide. Therefore, for the treatment of PTSD in children with a tendency to self-destruction it may be possible to consider temporary inpatient psychiatric treatment.

Younger children should be introduced to trauma processing through a game. However, it is necessary to avoid transforming the game into a reconstruction.

Pharmacological therapy

In case psychological methods are ineffective, a pharmacological treatment is considered. Pharmacotherapy is aimed at combating critical symptoms: sleep disturbance, irritability, hyperarousal, etc.

The use of pharmacological therapy for children takes place under the supervision of a psychiatrist.

Post-traumatic stress disorder in children: advice for parents

In order to reduce the risk of post-traumatic stress disorder appearing in children and promote healing, if there are already signs of the disorder, parents need to take some measures.

You need to:

• Stabilize yourself psychologically. Only emotionally stable parents can support their children.
• Set up a schedule of a day and resume, if possible, routine daily affairs.
• Make sure you have support of your loved ones – do establish communication with important people, if this supports and uplifts you.
• Do physical exercises or, at least, walk in the fresh air, limit the viewing of news and filter the information received from emotionally brightly colored content.
• Seek help from a psychologist/psychotherapist who will help you master the technique of emotional stabilization of yourself and your loved ones and prevent or stop the development of PTSD.

Also take care of your child:

• provide (restore) a sense of security;
• encourage physical activity (physical education, dancing, regular walks in the fresh air, etc.);
• restore the regime of the day – this gives children a sense of security, a resource and the hope of returning to a normal, peaceful life;
• let the child feel a sense of unity and support (first of all, from the parents or their substitutes). He/she should know that close people are nearby and they love him/her; safe physical contact is also important here – hugs with close adults, holding hands, etc.
• listen to the child when he/she wants to talk, get answers to his questions;
• let them express their emotions and feelings;
• explain what’s happened: true information in age-appropriate words;
• encourage social activity: communication with peers, age-appropriate volunteering in society;
• steer the child’s aggression and form healthy behavioral frameworks,
• give the child access to professional psychological/psychotherapeutic help: specialists will tell you how to cope with emotions, learn to relax, control negative memories, etc., which will help prevent or stop the development of PTSD.

Where parents should seek help

If you or your children witnessed traumatic events, experienced a loss, drastically changed your usual life and location because of the war, do contact specialists for help.

Especially if after some time (several weeks) the child is still not able to come to his senses and perform usual tasks. First of all, you can consult a family doctor, who can give advice about the next steps that will help cure post-traumatic syndrome in children.

Remember, recovery takes time. And only calm parents, as well as professional psychologists, can help the child cope.

Sources:

1. https://www.ptsd.va.gov/understand/common/common_children_teens.asp
2. https://www.encyclopedia-deti.com/trevozhnost-i-depressiya/ot-ekspertov/posttravmaticheskoe-stressovoe-rasstroystvo-u-detey-mladshego
3. https://www.ptsd.va.gov/understand/common/common_children_teens.asp
4. https://www.unicef.org/ukraine/stories/about-post-traumatic-stress-disorder
5. https://gfmg.ua/news-medicine/posttravmatichnij-stresovij-rozlad-ptsr
6. https://acmc.ua/ptsr-ta-tryvozhnist-u-ditej-cherez-vijnu-shho-potribno-znaty-ta-yak-dopomogty-u-pershi-dni-j-tyzhni/