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There are many challenges and issues that associated with handling children and adolescents who get diagnosed with PTSD (Posttraumatic Stress Disorder). Most of the children and adolescents who present with symptoms of PTSD normally have been exposed at some point to chronic traumas arising from community violence, maltreatment and physical injury. Experiences and exposure leading to a diagnosis of PTSD influences a child's mental well-being, development and their ability to develop relationships. This paper discusses the disorder among children and adolescents focusing on the causes, symptoms, criteria for diagnosis and the related issues. Additionally, the paper will also at methods of treatment and the consequences of PTSD on the child's development.
Dwivedi (2000) asserts that every child and adolescent encounters stressful events at some point in their life which can have a negative impact on them both physically and emotionally. Their responses to stress are normally short-lived and they recover devoid of further problems. Children or adolescents who encounter a catastrophic occurrence can develop enduring difficulties referred to as posttraumatic stress disorder (PSTD). The traumatic or stressful occurrence entails a circumstance in which the life of someone has been threatened or they have sustained a serious injury, for instance, being a victim of or witnessing sexual abuse, physical abuse, automobile accidents, violence in the community or at home, natural disasters; earthquake, flood, fire and finally if they get diagnosed with a critical illness. The risk of a child or an adolescent developing PTSD depends on the trauma's seriousness, whether it is repeated, their relationship to the victim(s), and their proximity to trauma
PTSD Among Children and Adolescents Statistics
Several studies have been conducted among the general population to establish the rates of PTSD and exposure among children and adolescents. The outcomes of the studies almost agree in their findings and demonstrate that the percentage of girls and boys who have at least encountered one traumatic event through their lifetime is 15%- 43% and 14%- 43% respectively. Further, the findings establish that out of the children and adolescents who have encountered a trauma, 3%-15% and 1%-6% of girls and boys respectively might be diagnosed with PTSD. From this is crystal clear that within the group, children and adolescents, the rates of those exposed and diagnosed with PTSD is relatively higher in girls as compared to boys (Eth, 2001).
PTSD rates are more elevated among children and adolescents recruited from samples at-risk. Among these at-risk adolescents and children, the rates of PTSD range from 3%-100%. For instance, studies have revealed that strange as it may sound, as many as 100% of children witnessing sexual assault or parental homicides develop PTSD. Correspondingly, the percentage of children who are sexually abused who develop PTSD is 90%, that of children who are exposed to school shooting stands at 77% and 35% represents the urban youths exposed to violence of the community (Dwivedi, 2000).
In the United States of America, Child Protection Service receives about 3 (three) million reports involving 5.5 million children yearly. Out of these reported cases, there is almost 30% percent proof of abuse. Additionally among the cases, there is an idea on how different kinds of abuse happen. Those that occur due to neglect take up 65%, those as a result of physical abuse is 18%, sexual abuse is represented by 10% and occurrence due to mental (psychological) abuse is 7%. Furthermore, 3 to10 million children yearly, witness family violence. Out of these cases about 40% t0 60% entail child physical abuse. Most importantly, it should be noted that it is believed that almost two-thirds of cases involving child and adolescent abuse are not reported.
Today clinicians and researchers are appreciating the fact that PTSD might not present itself in a similar way among all the populations. It manifests itself differently across different population and the criteria for identifying PTSD currently comprise age-specific aspects for the same symptoms (Eth, 2001).
Very Young children (1-5)
Among this age group, very few PTSD symptoms may be presented. This could be due to the fact that eight of key PTSD symptoms need a verbal description on individual's feelings and experiences. Alternatively, more generalized fears may be reported in young children, they may include separation or stranger anxiety, sleep disturbances, avoidance of circumstances related or unrelated to trauma, and a concern with words or symbols or words which might be related or unrelated to the trauma (Silva, R. et al, 2004). On addition to that, children at this age might exhibit posttraumatic play by repeating ideas of the trauma. Lastly, they might lose a developmental skill they acquired (like toilet training) due to encountering a traumatic event.
Elementary School-aged Children (5-12)
According to clinical reports, children of elementary school-age might not encounter amnesia or mental flashbacks for traumatic aspects. Nevertheless, they go through what is referred to as "omen formation" and "time skew", which are not generally observed in adults. Omen formation refers to the belief that warning signs that foresaw the trauma were there. Consequently, children frequently believe that if they get alert or attentive, they will prevent future trauma through recognition of warning signs. On the hand, time skew is the child's mis-sequencing trauma associated occurrences at the time of memory recalling.
Reportedly, school-aged children as well show signs of reenactment of their trauma during play, verbalizations, or drawings or posttraumatic play. Reenactment differs from posttraumatic play because the latter is a literal demonstration of the trauma and it entails compulsively replicating some elements of the trauma and does not tend to ease anxiety. A good example of posttraumatic play is where children may increase getting involved in shooting games after being exposed to school shooting (Silva, R. et al, 2004). On the other hand, posttraumatic reenactment entails behaviorally recreating characteristics, such as carrying a weapon after being exposed to violence, of the trauma and is more flexible.
Adolescents and Teens (12-18)
Eth (2001) states that tt this stage PTSD might start to more closely look similar as among adults even though there are characteristics that have been demonstrated to differ. As aforementioned, children might engage posttraumatic play after a trauma. Conversely, adolescents have a more likelihood of engaging in traumatic reenactment, by integrating some aspects of the trauma in their day to day lives. Additionally, the likelihood of adolescents to exhibit aggressive and impulsive behaviors is more than adults or younger children.
If any individual is diagnosed with PTSD it means that they encountered an event involving a threat to their own physical integrity or life or to another person's and that they reacted to it with immense helplessness, fear, or horror. This takes us to the introduction bit where the paper explored some of the events that can cause posttraumatic stress disorder not only in children and adolescents but to the whole population at large (Mirza, A. et al, 2004). One can be diagnosed with PTSD if they have endured both man made and natural disasters like floods, earthquakes and violent crimes like parent's murder, kidnapping, rape , school shooting, and sniper fire. Other causes include motor accidents such as plane and automobile crashes; community violence exposure, severe burns, peer suicide, war, and physical and sexual abuse.
Risk factors for PTSD among children and adolescents
There are three main factors that have been indicated to increase the probability that children and adolescents will develop PTSD. The first factor is the severity of the traumatic occurrence, the parental response to the traumatic occurrence and thirdly the physical closeness of the traumatic event. Generally, many studies that have been carried out concerning the issue have established that children and adolescents who report encountering the most acute traumas also report PTSD symptoms' highest levels. Parental coping and family support have also been established to influence PTSD symptoms in children. Studies further reveal that adolescents and children with less parental grief and higher family support exhibit PTSD symptoms' lower levels. Finally, it has been established that children and adolescents who find themselves far from the traumatic occurrence exhibit less distress (Shannon, M. et al, 2005).
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Various additional factors affecting the severity and occurrence of PTSD exist. According to research, interpersonal traumas like assault and rape have a more likelihood of leading to PTSD as compared to other forms of trauma. Further more, when one encounters many traumatic occurrences in the past, these collective experiences elevate the risk for them to develop PTSD. When considering gender, as already pointed out earlier, girls have a more likelihood of developing PTSD as compared to boys. A few researches have attempted to examine the link between PTSD and ethnicity (Mirza, A. et al, 2004). Even though, some studies explain that there are higher reports among minorities, researchers argue that this is because of other factors like variations in levels of exposure. It is not apparent how the age of a child during exposure to a traumatic event affects the severity or occurrence of PTSD. There are some studies that have established a relationship while others have not. Differences that exist might be due to variations in the manner in which PTSD is demonstrated in children and adolescents of varied developmental levels or ages.
Criteria for diagnosis
Experiencing a traumatic event does not mean that one will necessarily have PTSD. A lot of individuals encounter traumatic events in their life and it is regular for strong anxiety feelings, tress and sorrow among them. Among other individuals, some PTSD symptoms may be experienced like memories of the event, nightmares, or difficulties in sleeping at night. Most of these symptoms similar to PTSD's are part of the body's usual reaction to stress (Bradley & Grinage, 2003). Due to this, mental health professionals designed particular prerequisites which have to be met for any diagnosis of PTSD to be done. These prerequisites are known as Criteria A-F as described below.
An individual must have encountered a traumatic event in which both of the following happened (Bellis et al, 2000):
At this point, an individual must be encountering at least one of below re-experiencing PTSD's symptoms:
According to Bradley & Grinage (2003), the individual must experience at least three of below avoidance PTSD's symptoms:
At least two of the below listed hyperarousal PTSD's symptoms are experienced by an individual (Silva et al, 2004):
All the above described symptoms must have been experienced for a period of not less than a month. Upon the symptoms last for a period less than one month, an individual may experience a different anxiety disorder referred to as Acute Stress Disorder.
The above illustrated symptoms have an immense negative impact on an individual's life, interfering with relationships and work.
Anyone feeling that they may be having PTSD as of the described symptoms, have to importantly seek for help from a mental health professional who is qualified in evaluating and treating PTSD (Bellis et al, 2000).
Wrong Diagnosis in Schools
There are some variations in the way different children in the same environment respond to a similar traumatic occurrence. For instance One may become withdrawn and depressed while the might become violent and angry. These symptoms may be similar to those experienced in a number of other psychological disorders like ODD, separation anxiety and ADHD among others. For this reason, counselors in schools end up being confused and giving wrong diagnosis for them when the real problem is PTSD (Bradley & Grinage, 2003).
Impacts on Development
Trauma impacts children in a different manner at each stage of development. For the purposes of understanding severity and constellation of symptoms of PTSD, it is significant to appreciate the age during which an individual encounters a traumatic event. Most studies addressing the connection of traumatic events and developmental have mainly been based on single episode trauma's victims like war and natural disasters. However it is of equal importance to observe this phenomenon among children having been exposed to shock on a chronic, continuous basis like child basis (Cohen, 2006).
There are two categories of effects of trauma or abuse on development: proximal and distal developmental consequences (effects). Proximal effects lead to interference with newly acquired developmental skills. On the other hand, distal effects might impact future developmental spots including danger's perception, personality, regulation of affect and cognition and representations of others and self. Furthermore, child's developmental level and age influences their reaction to risk, understanding and perception of traumatic occurrence, development of attention and cognition, self-concept, social skills, self-esteem, personality style and impulse control. Additionally, repeated victimization develops into a much more intricate impact on a child's development and they end up integrating their traumatic encounters into their day to day lives. Additional examination of how trauma is construed and comprehended among children is essential for correct treatment and diagnosis.
Children exposed to uncontrollable and unpredictable danger like child abuse have to be designated resources dedicated for their growth and development. This child's developmental resources' reallocation together with a lack of support and nurturance from their primary caregivers put them at a great risk for lack of ability to control their physical and emotional states and poorer development. This could present itself in a number of ways basing on the child. For instance, two children staying in an abusive household might react differently to a similar environment. One may become withdrawn and depressed while the might become violent and angry (Silva et al, 2004).
These variations in presentation of symptoms can partly be attributable the child's developmental stage during the trauma's time. Consequently, the aforementioned offers clarification why children exposed to traumatic occurrences at early ages faces risks for a number of psychiatric disorders. Due to this fact, children may get diagnosed particular psychiatric disorders such as separation anxiety, Attention -Deficit Hyperactivity Disorder (ADHD) or Oppositional defiant disorder (ODD) among others although the problem could be PTSD. This obviously contributes to wrong diagnosis and the successive treatment of children having PTSD.
Through adolescence, children normally experience the cognitive development's process that results to their capability to process abstract and complex ideas. Some of the findings of literature examining the trauma's cognitive effects on children are: lowered IQ, academic difficulties, confusion, learning disabilities, developmental delays and poor communication and language skills. Cognitive development is essential for learning of children and their functioning in social and academic contexts, specifically for the smooth transition to adulthood, from adolescence (Eth, 2001).
Self-awareness starts to in adolescence hence the involvement of adolescents with other and their capability to learn from prior experience might be affected by trauma during this stage. For children having been exposed to neglect and/or chronic abuse, this is very important as they grow an understanding of what has happened and what is happening within their surrounding. Lack of self-awareness development may make it difficult for an adolescent to understand and process experiences, that results to ineffective decision making and reasoning. This continues even as the adolescents attain adulthood they sustain utilizing ineffective reasoning skills and cognitive processing while interacting with others across the universe.
The repercussions are frequently much more disadvantageous in adulthood, often leading to the criminal justice system's involvement. Because of lack of completely developed judgment, adolescents and children will process experiences and information differently from adults. This aids in illustrating the reason behind PTSD manifesting itself in different ways at various levels of development (Shannon et al, 2005). Lack of ability among children to respond to and comprehend traumatic events properly may be due to their less developed emotional and cognitive abilities. Cognitive shortages might cover the underlying symptoms of PTSD hence they may need to be considered during examination of PTSD symptomatology among children.
Methods of Treatment
Even though children demonstrate a natural remission in symptoms of PTSD during a period of a few months, a considerable number of them sustain the symptoms for years if they fail to be treated. Few studies concerning treatment of have looked at measures that seem most effective for adolescents and children (Cohen, 1998). They are discussed as follows:
Cognitive-Behavioral Therapy (CBT)
Hawkins & Radcliffe (2006) observe that a review of PTSD's treatment studies among adults indicates that CBT is the most efficient approach in treatment of children. For children, CBT generally entails the child directly talking about the traumatic occurrence (exposure), techniques for managing anxiety like assertiveness training and relaxation, and correlation of distorted or inaccurate trauma related thoughts. Other than the existence of controversy concerning exposing children to occurrences which scare them, the most suitable treatments seem to be exposure-based, if reminders or memories of the trauma distress them. Children can be slowly exposed to the events and taught relaxation in order for them to gain knowledge of how to relax whenever they recall their encounters. By using this procedure, children learn the need of not fearing their memories. Additionally, CBT entails challenging the false beliefs of children for example the world being totally not safe. This approach is in most cases accompanied by parental involvement and psycho-education.
Young children experiencing PTSD and unable to handle the trauma in a more direct manner can use play therapy as an alternative form of treatment. Here the therapist will employ the use of drawings, games together with other techniques to aid them in processing the memories of the trauma (Cohen, 2006).
Psychological first aid
This approach is the best prescription for children who have been exposed to community violence. Psychological first aid can be engaged in traditional settings and schools. The Approach entails simplifying facts related to the trauma, normalizing PTSD responses of the children, teaching skills for solving problems, encouraging them to convey their feelings, and referring children with most symptoms for further treatment (Hawkins & Radcliffe, 2006).
Twelve Step Approaches
Twelve step approaches is the most suitable one for treating adolescents with who have problems to do with substance abuse and posttraumatic stress disorder.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is a form of therapy that combines directed movements of the eye and cognitive therapy. Even though EMDR has been indicated as being effective for treating both adults and children with PTSD, indications from research are that instead of the eye movement, the cognitive interventions are responsible for the change (Bellis, et al, 2000).
There area number of drugs that can be prescribed in some cases to treat children with PTSD. However, because of lack of research in this field, it is premature to evaluate the efficiency of medication therapy. Lastly, there might be a necessity for specialized interventions to deal with children exhibiting predominantly PTSD symptoms or problematic behaviors. For instance, a specialized intervention may be needed for severe behavioral problems or improper sexual behavior (Shannon et al, 2005).
Posttraumatic Stress Disorder (PTSD) is enduring difficulties developed by individuals who encounter traumatic events in their lifetime. Every child is believed to encounter a stressful event that could negatively impact on their physical or emotional well bell, at some point in their life. The causes of PTSD among children and adolescents include sustaining a serious injury, exposure to community violence, sexual or physical abuse, and natural disasters among other factors. The disorder negatively affects growth and development of children and adolescents but there are forms of treatment that can be used to control it. The available methods of treatment include cognitive-behavioral therapy, play therapy, psychological first aid, twelve step approaches, EMDR and medication. It should be noted however that family and parental support is very important for better and accelerated recover of children and adolescents exhibiting symptoms of PTSD.