Post-Traumatic Stress Disorder (PTSD): Recognizing the Signs in Children
Dr. Cristina Davis
Children have many similarities to and yet many differences from adults when it comes to PTSD. Specifically, children’s language abilities such as the size of their vocabulary are often much more limited. Their insight may be less adequate than adults.
Identifying and understanding why children are experiencing symptoms may be difficult for them to comprehend. Self-awareness may also be limited as they may not be able to connect how their behavioral expression is related to their emotional state.
Post-Traumatic Stress Disorder (PTSD) is prompted by a real or perceived threat of death or serious bodily injury to the self or someone else. Various situations can cause PTSD in children including witnessing or experiencing violence, serious incidents such as a house fire or car accident, natural disasters, experiencing or witnessing an animal attack, or other incidents.
Children may have various symptoms that may not be easily understood by adults when they are triggered such as wetting themselves when exposed to triggers or reminders of the traumatic incident. In addition, hysterical meltdowns, avoidance of people, places, or things, recurring stomachaches or headaches, irritability, continuous fear and/or sadness, being easily startled, hypervigilance, and social withdrawal may be evident as well.
Children may appear distracted as they may be frequently preoccupied with flashbacks or thoughts about the traumatic incident. Children may relive the traumatic incident in thought or play. Bedtime may be especially difficult as the child may have difficulty falling asleep or staying asleep as well as may experience nightmares.
Unfortunately, children with difficulties maintaining attention often are labeled as ADHD, even when the providers that meet with them are well aware of the trials and tribulations the child has experienced. However, just because a child appears to have problems maintaining their attention does not mean that they have ADHD. So how do you tell if your child has PTSD, ADHD, or something else?
When diagnoses need to be differentiated, it is important to locate a licensed psychologist with experience in testing children or adolescents. Unfortunately, many people – even professionals in the psychiatric and medical field, at times – do not understand what a testing psychologist can do or what psychological testing is and so this option is often overlooked or not even considered.
Psychological testing is an important component of psychologists’ training because every individual, regardless of their profession, comes with their own flaws and perceptions which are influenced by their own life experiences. These flaws or differences in perceptions can lead to errors in our interpretation of what we see.
Therefore, a psychologist uses valid and reliable testing to answer questions and rule out diagnoses. The testing process usually involves a clinical interview where the psychologist gathers lots of information. In addition, they will review any available records from other medical professionals, therapists, social workers, school records, court records, or CPS records.
Afterwards, they will have a better understanding of what sort of diagnoses need to be considered and use the information to select a battery of psychological tests. Next, the psychologist will conduct the testing, interpret the results, and write up the report. The report will have all of the information gathered in it as well as the test results, interpretation, and summary of the findings.
In addition, the psychologist will provide the diagnosis, the evidence that supports this diagnosis as well as the reasons why it is not other specific diagnoses. The psychologist will also recommend a specific treatment that has evidence to support its use to treat the specific diagnosis identified during the testing process.
The benefit of using measures that have been backed by research in identifying an accurate diagnosis is that the tests often account for human error when developed. Therefore, it can be very useful to seek out a psychologist to do testing to narrow down and provide an accurate diagnosis as this may have great implications for treatment options.
If psychological testing is not used, the typical way a diagnosis will be made is by gathering all of the information, using behavioral observations, and additional records, and reading through the DSM to see if the criteria are met to make the particular diagnosis. The problem with this method of diagnosing is what can be observed may not be what it appears.
As noted above, problems with attention can often be written off as ADHD symptoms and further inquiry into potential other diagnoses that may account for the symptoms are not investigated.
What to do if you believe your child may have PTSD?
If you believe your child may have PTSD, you may want to consider contacting a mental health therapist or psychologist that works with children to begin the process of getting your child professional help. Establishing contact with a mental health provider may help you get your child set up with additional resources.
The therapist may have additional recommendations and may provide referrals for your child to meet with other providers. For instance, consultation with a psychiatrist may be helpful. The therapist may also recommend you take your child to meet with their medical provider as well. The therapist may also have a recommendation for a testing psychologist that can provide an answer to a specific question about the symptoms the child may be experiencing.
In the meantime, here are some helpful tips for how you can support your child when they may be experiencing PTSD symptoms.
Be careful about the effect you have on your child when they are having a strong emotional reaction. When your child is experiencing heightened or intense emotions, it is natural that you may have a physiological response as well. The stress you may be experiencing from your child’s outburst may be evidenced by your facial expressions and body language.
Be aware of your ability to regulate your emotional responses, specifically, furrowed brows and tense body language. These emotional expressions can convey judgment and this can be particularly unhelpful when your child is having an intense emotional response related to PTSD.
During times when your child is having a strong emotional response, take them to a quiet place and model and coach them on taking deep belly breaths. There is an important reason for this.
When someone is upset, their breathing is likely to change (short, shallow breaths), and as a result, an important part of the brain known as the prefrontal cortex may not be receiving enough oxygen. The prefrontal cortex is responsible for planning and following through on a plan.
Practice using coping skills such as deep belly breaths in addition to others when your child is calm. The reason for this is that if the child practices using coping skills when they are calm, it will be easier for them to retrieve that information and apply it during situations when they feel emotionally dysregulated.
Consider establishing a clear schedule in your household. This will help your child anticipate events and transitions throughout the day so there are few surprises throughout the day. You can increase the effectiveness of this by having the schedule displayed somewhere in the house.
Write out the times of transitions and/or events that are expected. Keep it simple. Too much writing will complicate it and make it difficult for your child to understand. Remember, this is to be used as a tool to help your child anticipate upcoming events and transitions throughout the day.
PTSD is real and children may experience various symptoms related to this disorder following experiencing a traumatic incident. Parents, remember you are your child’s greatest advocate. Nobody knows your child better or has more of a personal stake in your child’s emotional health and well-being than you do.
There are multiple ways that you can help your child including getting them formally assessed by a licensed psychologist, meeting with a child psychiatrist about potential medication options, and scheduling them to meet with their medical provider for a check-up.
If you believe your child has experienced a traumatic event, do not wait to get them help. Call Seattle Christian Counseling at 206-388-3929 and schedule an appointment for your child with me today.
“Rescue”, Courtesy of Johannes Blenke, Unsplash.com, CC0 License; “Tears”, Courtesy of Kat J, Unsplash.com, CC0 License; “Teddy Bear Patient”, Courtesy of Derek Finch, Unsplash.com, CC0 License; “Family”, Courtesy of John-Mark Smith, Unsplash.com, CC0 License