Childhood Post-Traumatic Stress Disorder: Symptoms And Treatment

It’s widely believed that a safe, balanced childhood with loving parents or caregivers allows a person to grow into a balanced, healthy adult. Conversely, children who face difficult experiences growing up may develop mental health concerns in adolescence or beyond. One of these potential challenges is childhood post-traumatic stress disorder (PTSD), which can stem from witnessing or experiencing traumatic events during childhood. Though not all children will develop childhood PTSD from traumatic events, some will. Here, we’ll discuss what post-traumatic stress disorder can look like in children and what the key options are for treatment.

Possible causes of childhood post-traumatic stress disorder

Although what qualifies as traumatic and how such an event affects a child can vary depending on each individual and situation, there are several types of adverse early childhood experiences that may cause a child to develop post-traumatic stress disorder. These may include:

• Experiencing or witnessing emotional, physical, or sexual abuse or other forms of violence 

• Experiencing sexual abuse, incest

• Experiencing human trafficking or kidnapping

• Being impacted by war

• Being impacted by a natural disaster or witnessing one

• Becoming displaced because of a crisis

• Becoming a refugee or immigrant

• Living in a neighborhood where violence, drugs, and/or crime are present 

• Living through a severe injury or illness, such as cancer

• Witnessing the death of a loved one through violent or unexpected means

• Experiencing the death of a primary caregiver or parent 

• Being neglected or abandoned 

• Being adopted

• Being in the foster care system, institutionalized, or in a group home 

A singular event of these types may cause a child to develop PTSD. Repeatedly being exposed to or going through any of these events may cause them to develop complex post-traumatic stress disorder. Complex PTSD (c-PTSD) is a form of post-traumatic stress disorder stemming from repeated traumatic events or complex trauma. The chronic stress of these repeated experiences can have a negative impact on a child’s self-esteem, emotional responses, and overall well-being. 

What are the symptoms of childhood post-traumatic stress disorder?

Recognizing post-traumatic stress disorder (PTSD) in children can be difficult. Some of the signs and symptoms of PTSD may be attributed to the hormonal changes of a growing child. Or, in some cases, caregivers or professionals may not believe a child who reports traumatic events. Some children may also feel afraid to speak up about trauma like abuse, especially if it’s inflicted on them by someone they trust. For these reasons, learning the symptoms of PTSD in children and taking them seriously can be important, especially since untreated symptoms can cause significant harm and may worsen and/or trigger other conditions—such as depression, anxiety, eating disorders, and substance use disorders (formerly “substance abuse disorders”), in older children.

Adults and children may experience some of the same type of symptoms of post-traumatic stress disorder. However, children may be more focused on their caregivers to provide support and understanding, as they may not have words for what they’ve experienced or what they’re feeling as a result. Children often express themselves through play for this reason. Pay attention to what kind of games they play, what they roleplay with dolls, or the things they draw. 

In addition, some common signs of childhood PTSD to keep an eye out include: 

• Memories and flashbacks of the traumatic event

• Frequent nightmares

• Crying more often than usual

• Feeling nervous and “on edge,” especially when faced with something that reminds them of the trauma (for example, a child may become anxious or run away when a particular person enters the room) 

• Acting out or drawing the traumatic events that happened to them

• Having difficulty remembering details of the trauma

• Avoiding any places, people, or things that remind them of trauma 

• Losing interest in activities or interests that used to give them pleasure or joy 

• Becoming detached or isolated from the people around them

• Trouble concentrating at school or home

• Self-blame and guilt about what happened

• Displaying aggression or irritability

• Behaving in an impulsive manner

• Sleep problems

• Expressing a general sense of fear or anxiety

• For adolescents and teenagers in particular: conduct concerns, such as illegal behavior, substance misuse, or excessive risk-taking

These symptoms may begin as soon as a few weeks after the traumatic event, or they can take several months or years to first appear. Also, note that not every child who has gone through a traumatic event will go on to develop PTSD. Factors like a history of mental illness in the family, the type of trauma, the child’s personality, their support system, and their environment may all play a role in whether they might develop post-traumatic stress disorder. 

Diagnosing childhood post-traumatic stress disorder

At the first signs of PTSD symptoms, it can be important to consult a doctor or a mental health practitioner and have your child evaluated. A doctor may conduct various physical and psychological evaluations to rule out other illnesses or abuse. 

A diagnosis for PTSD will be typically made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Symptoms from four criteria will need to be met for children under six years of age. They are as follows:

• Criteria A: exposure to a traumatic event either directly (it happened to the child) or indirectly (they witnessed it)

• Criteria B: the presence of at least one intrusive symptom, like having flashbacks or nightmares of the event

• Criteria C: displaying symptoms of withdrawal and avoidance of places, people, occurrences, or activities

• Criteria D: displaying changes in behavior, such as aggression or irritability

If a child has one or more symptoms in each of the four categories and the symptoms have lasted for at least a month, the doctor may diagnose them with PTSD. A diagnosis of PTSD can feel scary or upsetting. However, because PTSD is considered to be a treatable illness, a diagnosis may be the first step toward getting support for your child.   

Treating PTSD

The first-line treatment for individuals of any age living with post-traumatic stress disorder is typically some form of talk therapy, though the type can vary depending on age. Psychotherapy may help the child address the trauma and their feelings about it so they can work toward healing. A mental health therapist may use various talk therapy techniques to treat PTSD. Some of the most commonly used, research-based methods used are as follows. 

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of talk therapy used to treat various mental health conditions and concerns, including PTSD. A therapist specializing in trauma therapy may work with the survivor to understand the trauma and how it affected them through guided discussion, behavioral coping skills, and more. CBT may help them understand that they are not to blame for their trauma(s) and could encourage them to let go of any irrational thoughts surrounding the traumatic event. Finally, the therapist may provide survivors with tools to cope with and manage their symptoms.

Play therapy

Through play therapy, a therapist may encourage a child to express what they have gone through using a creative approach, such as playing games, creating art, role playing, or playing with sensory toys. Younger children or children who do not possess the skills to communicate effectively may be able to communicate through these creative means and imagination. Through play therapy, the therapist may help the child process the trauma. 

Eye movement desensitization and reprocessing therapy (EMDR)

EMDR is a form of trauma-focused therapy that is gaining popularity in the mental health field. Studies suggest that it can be a safe and effective treatment for adults, adolescents, and children with PTSD.

EMDR typically involves combining eye movement exercises (guided by the therapist) with CBT where the survivor talks about what they remember from their trauma(s). The therapist can then work with the individual to address the emotions they experienced during and after the event. 

Other trauma therapies 

Depending on the situation and the type of trauma experienced by the child, a professional may also recommend support groups, group therapy, family counseling, or another treatment method to help a child understand and cope with what’s happening. 

Medication

In some cases, a mental health professional may also prescribe medication to treat some of the symptoms associated with PTSD caused by trauma, such as anxiety or depression. Managing these symptoms may enable a child to resume normal activities more efficiently. For many, medication is only a temporary solution. Note, however, that it’s rare for medication to be prescribed for PTSD in children—especially young children—since research suggests limited efficacy. Again, therapy is typically the focus of treatment for children with PTSD.

How to support a child experiencing PTSD

A child with a strong support system may feel safer and more open to treatment. If you have a child with PTSD, you might consider the following tips. 

Validate them 

Avoid dismissing the child’s PTSD symptoms or experiences. Validate their emotions by affirming that their experience was traumatic, they didn’t deserve it, and you’re here to support them and help keep them safe. 

Encourage them but don’t force a conversation

Encourage the child to talk about their emotions or experiences when they’re ready. Let them know they have a safe person to confide in if they want to discuss it. If they refuse, do not force them to open up. Studies suggest that trauma healing can be done without recalling traumatic events. Additionally, some children might only feel comfortable opening up with a mental health professional, so connecting them with resources can be important.

Help them with self-care 

You might help boost your child’s self-esteem and self-confidence after trauma by allowing them to participate in activities they are good at, considering their opinions, and allowing them to make decisions. You can also model healthy self-care by practicing it in your own life. 

Don’t be critical 

Try not to be critical of your child’s behavior, as they may be struggling to cope with difficult emotions related to their trauma. It may take time for a child’s PTSD treatment to reflect in their behaviors. Remaining supportive and gentle may help them on the path to healing.

Help for adults supporting children with PTSD

Supporting a child with PTSD can be challenging. It can be difficult to watch your child grapple with difficult memories, emotions, and symptoms, and there may be times when you’re not sure of how best to support them. In addition to seeking professional mental health support for your child, you might also seek it for yourself. A therapist can offer a space where you can discuss your own emotions related to what your child is going through and receive support and guidance on how to be there for them. 

If a busy schedule makes it hard for you to attend regular in-person therapy appointments for yourself, you might explore online therapy instead. With a platform like BetterHelp, you can get matched and then meet with a licensed therapist from home or anywhere you have an internet connection. Research suggests that, in many cases, therapy done virtually can be similarly effective to therapy done in person.