When Children Are Battled Scarred: Signs And Symptoms Of PTSD In Children

Medically reviewed by Andrea Brant, LMHC
Updated October 10, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

Upon hearing the term “post-traumatic stress disorder,” many of us likely think of combat-related PTSD, sometimes called shell-shock or battle fatigue. However, anyone of any age or situation—including children—can develop PTSD. While PTSD in children still occurs as a response to a traumatic event, the signs and symptoms of this disorder may present differently than they do in adults. However, just as with adults, it is possible to treat the symptoms of post-traumatic stress disorder in children.

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Caring for a child experiencing PTSD can be difficult

The symptoms of PTSD in children

According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic criteria for post-traumatic stress disorder are separated based on age. Children ages six and older and adults must exhibit one set of symptoms while children younger than six must display different symptoms in order for a diagnosis to be considered.

No matter the child’s age, the first criteria for a potential post-traumatic stress disorder diagnosis is exposure to a traumatic event, such as a threat of death, sexual assault or abuse, serious injury, war, or a natural disaster. The child may experience the event firsthand, witness the event occurring to others, or learn that the event has impacted a family member or caregiver. Children ages six years and older may also have experienced trauma through repeated exposure to details of a traumatic event.

Per the diagnostic criteria, all children must then experience one or more of the following symptoms:

  • Distressing memories of the event. In children, this may occur as seemingly calmly reenacting the experience through play.

  • Recurrent distressing dreams related to the event. For young children, the dreams may not contain content related to the event but may still be frightening and distressing.

  • Flashbacks of the event, which may occur as a reenactment during play for children

  • Intense or long-lasting psychological distress that occurs as a response to internal or external items that symbolize the event

  • Physiological reactions to reminders of the event, also referred to as “triggers”

Along with displaying at least one of the above symptoms, children must also noticeably avoid stimuli that remind them of the event in order to be diagnosed with post-traumatic stress disorder (PTSD). This may be evidenced by one or both of the following:

  • Avoiding memories or feelings related to the event

  • Avoiding people, places, items, and situations that serve as reminders of the traumatic event

What qualifies as noticeable changes in “arousal and reactivity” vary depending on the age of the child, but all children must experience at least two of these changes for a PTSD diagnosis. Children of any age may experience the following:

  • Trouble falling or staying asleep

  • Irritable behavior; angry outbursts like temper tantrums

  • Difficulty concentrating

  • Hyper-vigilance

  • Heightened startle response

Finally, the DSM criteria also state that changes in mood and/or cognition must be noted after the traumatic event or traumatic events. Children under six may experience:

  • Increased negative emotions such as fear, guilt, and sadness

  • Decreased interest/participation in activities such as play

  • Social withdrawal

  • Expressing fewer positive emotions

Children over six must exhibit two or more of the following:

  • Lack of memory regarding major aspects of the traumatic event

  • Negative beliefs or expectations about the world, oneself, or others

  • Blaming oneself for the occurrence of the traumatic event

  • Persistent feelings of negative emotions such as fear, horror, anger, guilt, and/or shame

  • Decreased interest or participation in major activities like school, sports, or play

  • Feeling removed from others

  • Persistent inability to feel positive emotions

The above symptoms must occur for at least a month. Additionally, they must harm relationships or the ability to function in school. If these criteria are met, a diagnosis of post-traumatic stress disorder (PTSD) may be considered. If not, a mental health care provider may consider other potential diagnoses.

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Diagnosing PTSD in children

As mentioned above, the symptoms of PTSD in children can be diverse and may present differently in children of different ages. For example, older children may experience flashbacks that cause them to dissociate from the world around them. However, when younger children experience flashbacks, they may reenact the experience through playing with toys or peers.

While children must experience a traumatic event in order to develop PTSD, other factors may increase the likelihood of the onset of PTSD. These include a poor support network, experiencing more than one traumatic event, and other psychiatric challenges. A mental health professional can take these factors into consideration when they are evaluating a child.

While parents and caregivers may notice signs of PTSD in their children, other adults should also be on the lookout for signs of trauma in children. Teachers, camp counselors, and doctors are all classified as mandated reporters. This means that if they suspect a child is experiencing abuse, they must report it to the authorities. While not all children who experience trauma will develop PTSD, connecting these children with professionals can help them get the assistance they need to move forward from their trauma.

Treating PTSD in children

Although PTSD is a serious disorder, its symptoms can typically be treated. Treatment often involves helping the child feel safe. This may allow them to explore the truth of what happened during the event and express their feelings about it. Depending on the situation, the child may meet with a mental health professional on their own or with caregivers.

Various psychotherapeutic approaches can be used to help treat the symptoms of post-traumatic stress disorder in children and adolescents. However, one of the most commonly used treatment approaches is trauma-focused cognitive behavioral therapy (TF-CBT). A recent review of studies involving treating PTSD in children suggests that psychological interventions like cognitive behavioral therapy and others can be an effective way to reduce symptoms of PTSD in children. It also indicates that there was little evidence to support the use of medication to improve PTSD symptoms in adolescents.

Supporting a child experiencing PTSD

When a child is living with PTSD, it often affects more than just them. Parents, caregivers, family members, and teachers can also be impacted. Oftentimes, adults wish they could remove the traumatic event from the child’s past or help remove their current symptoms.

The truth is that PTSD typically warrants the help of a mental health professional, not just the support of family and community. Therefore, one of the best ways to support the child is typically by connecting them with the help they need. 

Another way adults can support children with post-traumatic stress disorder is to receive help themselves. It can be taxing and stressful to care for a child who is experiencing social withdrawal, distressing dreams, emotional outbursts, or other symptoms of PTSD. Connecting with a licensed therapist may help you learn ways to cope with the child’s symptoms as well as understand how you can offer support.

Find support with online therapy

When you’re supporting a child with PTSD, it can be hard to find the time to commute to an in-person cognitive behavioral therapy session for yourself. Online therapy is an alternative way to get the professional support you may need. Not only can online therapy more easily fit into a busy schedule, but research suggests that it can offer similar benefits to in-person behavioral therapy in many cases.

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Caring for a child experiencing PTSD can be difficult

Takeaway

Post-traumatic stress disorder can occur in children of all ages, although the presentation of symptoms can vary depending on the child’s age. Connecting with a mental health professional may allow the child to receive the help they need. Additionally, it can be important for parents and other caregivers to receive support as well if needed so they can properly care for their child. Online Therapy can be a more convenient way for caregivers to receive mental health support for themselves.

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