August 4, 2014

PTSD/trauma – children and adolescents

Children and adolescents suffer traumas the same as adults do, however there are confounding factors of development that create a more complex picture for them. Young people are not fully grown, which means distressing events play a part in determining their course of growth and development. And they may not be able to understand or even verbalize their experiences.

When a child or adolescent experiences an event or situation that is overwhelming for their coping abilities,  they may behave as an adult would: feel terror, freeze, run away, feel as though they will die, hide in shame. These reactions are naturally human ones, but for young humans, it alters their brain chemistry and produces a “stuck” state from which growth and development cannot continue naturally. Because young people lack experience and perspective, they are at risk for interpreting the event maladaptively, for example, feeling that the event was their fault, or that it is a normal part of life. Beliefs and self-assessments that are damaging can easily arise from traumas, and this change in brain chemistry, and faulty assessment of the meaning of the trauma puts young people who have experienced trauma at higher risk for developing other mental illnesses as well. For this reason, it is of the utmost importance to find help for young people if they have experienced traumatic events.

Young people could develop PTSD if they have lived through an event or situation that causes them to feel their survival is threatened or their ability to cope is overwhelmed. Examples of such events include knowing or witnessing someone else who is killed or badly hurt; sexual or physical abuse or other violent crimes; disasters such as floods, school shootings, car crashes, or fires; living in a war stricken country; a friend’s suicide; or witnessing violence in their community.

Studies show that about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma. Of those young people who have had a trauma, 3% to 15% of girls and 1% to 6% of boys develop PTSD. Rates of PTSD are higher for certain types of trauma survivors. (National Centre for PTSD).

Three factors have been shown to increase the chances that young people will develop PTSD:

  • The severity of the trauma (eg., witnessing bullying vs. witnessing a murder). Young people who go through the most severe traumas tend to have the highest levels of PTSD symptoms.
  • How parents react to the trauma (eg., stable vs. hysterical). PTSD symptoms may be less severe if the young person has more stable family support and if the parents show less upset about the trauma.
  • Proximity of the young person to the trauma (distant cousin’s suicide vs. brother’s). Young people who are farther away from the event report less distress.

Other factors also affect the likelihood of developing PTSD. Events that involve people hurting other people, such as rape and assault, result in higher incidences of PTSD for people of all ages. Also, experiencing multiple traumas creates a higher risk of developing PTSD in all people of all ages. And females are typically more prone to developing PTSD than males.

PTSD looks different in children of different ages. Children aged 5-12 may not have the same symptoms as adults, such as flashbacks or amnesia for parts of the trauma. However, they may confuse the time-line of traumatic events, and they may remember signs of the impending trauma that weren’t there.  As a result, they may become vigilant to detect these signs again in the future, as a way of avoiding further trauma.

Signs of PTSD may also show in younger children’s play. There is typically a repetition of themes related to the trauma. Play acting the trauma is not the same as play therapy and will not help alleviate their distress. For example, a child might always want to play shooting games after witnessing a school shooting.

Young people aged 12-18 are closer in development to adults and so some PTSD symptoms in young people this age begin to look like those of adults. However, adolescents are more prone to show impulsive or aggressive behaviours than younger children or adults.

Both younger and older children who have experienced trauma often develop other emotional or behavioural problems. For example, PTSD research shows that sexually abused children often have problems with fearfulness, worry, sadness, anger, feeling isolated, feeling judged, low self-worth, and mistrust for others. Older children who suffer these problems can also show behaviours such as aggression, inappropriate sexual behavior, self-harm, and abuse of drugs or alcohol.

There is no set template for what emotional or behavioural signs a child will show if they’ve experienced a trauma. If you are worried about a child you know and care about, contact a professional and get help. Play therapy, EMDR, Cognitive Behavioural Therapy and even some medications can help young people to cope with their feelings. If you have questions, call Stillwater Studio at 604-734-2779. Megan Hughes is available to answer your questions. She is fully trained and experienced in the use of EMDR, play therapy and sand tray therapy with children who have experienced trauma.