Post-traumatic stress disorder (PTSD)

Children and young people may react immediately. They might find it hard to sleep, and have nightmares. They may keep thinking about the event or remembering it over and over again. Concentration can be affected. They often find it hard to relax and become very anxious, clingy and restless. Other reactions in young children include going backwards with toileting or other issues.

A child who is reacting in this way needs lots of reassurance and extra cuddles. A very calm and safe routine can really help, so that unexpected events are kept to a minimum. They may want to draw or talk about the event, which can help, but they may want to try and forget it. It can be difficult if you have also been involved in the event and are having your own reactions, but it is key to try and keep calm. Usually, the child is able to get over these reactions after a few weeks, as life begins to get back to normal.

If the child cannot get over their reaction, or if it starts to get worse, they may be experiencing post-traumatic stress disorder. This can include flashbacks. They may become oversensitive to danger and alert at all times. They may find it hard to do or think about things connected with the event, which can affect their routines and independence. They may also feel depressed, angry and anxious. These sort of reactions usually need professional help.

Signs and Symptoms

Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms include: Re-experiencing symptoms may cause problems in a person’s Monday to Saturday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

• Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts

Avoidance symptoms include: Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Staying away from places, events, or objects that are reminders of the traumatic experience Avoiding thoughts or feelings related to the traumatic event.

Do children react differently than adults? Children and teens can have extreme reactions to trauma, but some of their symptoms may not be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old), these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.