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What is PTSD?

PTSD or post-traumatic stress disorder is an anxiety disorder that can emerge following exposure to a traumatic event.

 

Symptoms of PTSD are observed in children who have been victims or witnesses to a violent crime, children who have experienced a natural disaster or catastrophe, and children injured in serious motor vehicle crashes.

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The Diagnosis of Post-Traumatic Stress Disorder

A diagnosis of PTSD is typically made on the basis of a clinical interview conducted by a trained health or mental health professional.

Since children might have difficulty reporting the symptoms they are experiencing, the parents of the child will often be included in these clinical interviews. During the clinical interview, the health or mental health professional will enquire about details of the traumatic event to which the child was exposed, as well as the types of symptoms the child might be experiencing.

The Symptoms of PTSD

The symptoms of PTSD fall into three main categories: re-experiencing symptoms, avoidance symptoms, and symptoms of hyper-arousal.

Re-Experiencing Symptoms

Following exposure to a traumatic event, the child with PTSD will experience recurrent and distressing thoughts and images of the event. In the case of a motor vehicle crash, a child might have nightmares of the crash, or recurrent thoughts about the crash, and might have difficulty turning attention away from memories of the crash. This might take the form of the child retelling the story of the trauma over and over to friends and family. Images of the trauma might also be represented in the child’s drawings or imaginary play.

Avoidance Symptoms

Following exposure to a traumatic event, the child with PTSD  might feel the need to avoid situations that remind him or her of the traumatic event. Often, children with PTSD will try to avoid situations that might make them think or remember details of the trauma. In the case of a motor vehicle crash, children might feel distressed in response to travelling near the site of the accident. The mere anticipation of travelling in a motor vehicle might sufficient to elicit intense emotional reactions in the child.

Symptoms of Hyper-arousal

Following exposure to a traumatic event, the child with PTSD might be on alert for signs of danger or other impending disaster. This type of ‘hyper-arousal’ can interfere with a child’s ability to engage in activities of daily living. It can also interfere with sleep and contribute to problems of memory and concentration. In the case of a motor vehicle crash, children might feel overly anxious when travelling in a motor vehicle anticipating that another crash is likely to happen. Children might be easily startled by unexpected sights or sounds while travelling in a motor vehicle.

Duration of Symptoms

It is difficult to predict how long the symptoms of PTSD will persist. Some children might recover within a few months of the onset of PTSD. For others, the symptoms of PTSD might persist for a longer period of time. Children who have ongoing pain symptoms seem more likely to develop chronic symptoms of PTSD.

Disability associated with PTSD

When severe, the symptoms of PTSD can interfere with a child’s ability to engage in many activities of daily living. In some cases, PTSD can contribute to prolonged absence from school. In turn, prolonged absence from school can impact negatively on social, emotional and academic development.

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Other problems associated with PTSD

There are a number of additional health or mental health problems that can co-occur with PTSD. Children who have been diagnosed with PTSD often report experiencing symptoms of pain. Pain symptoms might be experienced in parts of the body that were injured in the crash, or they might be unrelated to bodily injury. Children who have been diagnosed with PTSD might also experience symptoms of anxiety or depression.

The Treatment of Post-Traumatic Stress Disorder

Several psychological and pharmacological interventions have been used to treat the symptoms of PTSD. Some of the more common treatments include:

  • Cognitive-Behaviour Therapy
  • Cognitive Therapies
  • Anti-depressant Medication
  • Anxiolytic Medication

While considerable research has been conducted examining the effectiveness of different treatments for PTSD in adults, relatively few studies have been conducted with children. Little is currently known about the effectiveness of different treatments for PTSD in children.

Psychological Interventions

Cognitive-Behaviour Therapy

The most commonly used psychological approach to the treatment of PTSD is called Cognitive-Behaviour Therapy, or CBT. This type of treatment proceeds from the view that the symptoms of PTSD often persist as a result of the way in which the child ‘thinks’ or ‘acts’ in relation to a traumatic event. By guiding the child to think or act differently in relation to a traumatic event, the goal of treatment is to reduce the severity of symptoms of PTSD and assist the child in resuming involvement in important activities of his or her life.

A particular form of CBT referred to as Trauma-Focused Cognitive Behaviour Therapy has been used extensively with children suffering from PTSD.

Trauma-Focused CBT incorporates a number of different techniques designed to reduce the severity of symptoms of PTSD and to promote recovery.  Narrative techniques (story telling) are used to help the child derive a sense of meaning from the traumatic event. The development of trauma narrative also provides the therapist with the opportunity to correct inaccurate beliefs the child might hold about the trauma (I will die if I travel in a car again). Finally, a number of emotional regulation techniques are used to assist the child in controlling his or her emotional reactions to stressful or trauma-related situations.

Creative Therapies

The most commonly used creative therapies for PTSD in children include Art Therapy and Play Therapy. These therapies proceed from the view that successful adjustment to trauma requires expression of trauma-related thoughts and feelings. It is only through expression and reflection that a coherent sense of the trauma can emerge.  Children however have limited communication tools to express the complex thoughts and feelings they might experience following trauma. In creative therapies, drawings, painting and imaginary play are used to assist the child in sharing his or her thoughts and feelings related to the trauma.

Pharmacological Interventions

There is no medication that is specifically designed to treat the symptoms of PTSD. However, since PTSD is often associated with symptoms of depression and anxiety, antidepressant and anxiolytic (anti-anxiety) medication is often prescribed. Medication to treat sleeping problems is also used in the treatment of PTSD symptoms.

Physicians try to avoid prescribing medication for emotional difficulties for very young children. The concern of many physicians is that psychoactive medication used in very young children might have a negative impact on development. Although concerns about potential negative impacts on development are warranted, such preoccupations can also lead to the under-treatment of mental health problems in children.

Anti-depressant Medication

The beneficial effects of antidepressants are not immediate; improvement might not be seen for one to two weeks after starting to take the medication. Some antidepressants will cause some unpleasant side effects such as dry mouth, nausea or drowsiness. The side effects usually begin to subside within a week to 10 days of starting the medication. One thing all anti-depressants have in common is that they work best if taken the way they have been prescribed.

There are a number of anti-depressants that have been developed to treat the symptoms of depression. One type of anti-depressant known as ‘serotonin specific reuptake inhibitors’ or SSRIs, are the most frequently prescribed anti-depressants for symptoms of depression that might co-occur with PTSD. Medications such as Zoloft, Paxil and Prozac are SSRIs that are often prescribed for individuals with PTSD.  In children, antidepressants might also be used to treat symptoms of anxiety that might be associated with PTSD.

Anxiolytic Medication

‘Anxiolytic’ is the term that is used to describe medication designed to reduce the severity of symptoms of anxiety. Anxiety and fear are experienced by many children with PTSD. Symptoms of anxiety and fear can be very distressing. In addition, these negative emotions can lead children to avoid or withdraw from many important activities of daily life. By reducing anxiety or fear, anxiolytic medication can reduce the emotional discomfort of PTSD.

A type of anxiolytic referred to as ‘benzodiapines’ is the most commonly prescribed anti-anxiety medication for PTSD.  Examples of benzodiazepines that might be prescribed for a child with PTSD include drugs such as alprazolam, clonazepam, diazepam, and lorazepam. Although these drugs can reduce the severity of symptoms of anxiety, the danger of addiction is high. As well, these drugs can cause side effects such as dizziness, drowsiness or mental clouding that can be more debilitating than the symptoms of anxiety itself.

There are some newer anxiolytic drugs, such as buspirone, that appear to be less susceptible to addition and might actually help in reducing some of the more troubling symptoms of PTSD such as intrusive thoughts and nightmares.

Treatment Options

Recover researchers have developed a PTSD treatment options resource. The resource is designed to assist you in your discussions with your healthcare provider about the treatment of your PTSD

Are you interested in participating in one of our research projects?

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