After the Emergency Is Over:
POST-TRAUMATIC STRESS DISORDER IN CHILDREN AND YOUTH
What Is Post-Traumatic Stress
There are three main categories of symptoms
After a frightening or distressing experience (any kind of
• Re-experiencing the Trauma. Upsetting thoughts, pic-
injury, a physical or sexual assault, car crash, fire, or other
tures, or feelings about the traumatic event just "pop"
natural disaster), a child or teen may suffer psychological
into his/her mind; may relive the traumatic event
stress in addition to any physical injuries. In the first few
through nightmares or through "flashbacks" when
days to weeks after a trauma happens, people of all ages
awake; reminders of the trauma may bring tears or
find that they have unwanted or upsetting thoughts or feel-
other physical symptoms such as sweating, heart
ings about the trauma, and that for a while they are more
pounding, or stomach upset.
"jumpy" (more on the lookout for possible danger). Often,
• Avoiding Reminders of the Trauma. Avoids (or wants
they want to avoid things that remind them of the traumatic
to avoid) situations, activities, or locations that might be
event that just occurred.
reminders; may feel emotionally "numb" or detached –
When these reactions last for more than a month and
shutting down emotions to protect from painful feelings;
are strong enough to affect a child's or teen's everyday func-
may feel less close to friends and family; can feel hope-
tioning, that child may be diagnosed as having Post-
less about the future.
Traumatic Stress Disorder or PTSD.
An estimated 70% of adults in the United States have
• Hyper-Arousal. Becomes jumpy or easily startled (e.g.,
experienced a traumatic event at least once in their lives; of
overreacts to sudden loud noises); may become hyper-
these, up to 20% go on to develop PTSD. Children's experi-
sensitive to signs of danger ("on guard"); may seem irri-
ence of traumatic events is not as well documented.
table or angry more than usual; may have sleep prob-
However, studies have found that about 30% of children
lems and trouble concentrating.
who experience a traumatic event develop PTSD. Children
can also develop PTSD symptoms when they witness or
What Can An Adult Do to Help A Child with PTSD?
hear about a traumatic event that happens to someone they
care about (for example, if a child witnesses a parent being
Observe. Be aware of changes in the child's behavior.
attacked or hears about a friend who is shot).
Talk. Speak with the child openly (and in a matter-of-fact
manner) about the traumatic event. Follow his/her lead but
What Are the Signs and Symptoms of PTSD?
don't avoid the topic. (If this is too upsetting for you, seek
Most children who experience a trauma will have at least a
support from other adults in coping with your own feelings).
few of the symptoms listed here, in the first few days or
Listen. Ask the child about his/her thoughts and feelings
weeks after the event. The majority resolve these reactions
regarding the event, and listen carefully to his/her words, tone,
with the support of their parents and families, but some chil-
and body language. Gently help to correct any misunderstand-
dren continue to have difficulties. (A child who appears to
ings. Sometimes children feel guilty about what happened
have little reaction to the trauma in the early stages is less
and mistakenly believe they are to blame; younger children
likely to develop symptoms of PTSD). Children or youth who
may have unrealistic or "magical" ideas about how the trau-
have had previous traumatic experiences, who have very
strong early reactions, or whose support systems (parents
and others) are very distressed by the event, appear to be
Support. Help your child to focus on his/her strengths and
at higher risk for later difficulties.
talents. Help him/her to develop and use strategies for
healthy coping with any fears or anxiety.
Take Care of Yourself. Parents and other caregivers need
American Psychiatric Association
to have support for themselves and their own reactions and
feelings after a child has experienced a traumatic event.
Association of America
International Society for
Ask for Help – Treatments for PTSD
Traumatic Stress Studies
National Assoc. of Social Workers
If a child continues to have symptoms that worry parents or
National Center for PTSD
caregivers, that bother the child or get in the way of his/her
National Institute of Mental Health
normal activities, or if a child has any behavior that endan-
PTSD Alliance Resource Center
gers himself or others, do not hesitate to get help from a
mental health professional. (See resources listed below.)
Look for a mental health professional (counselor, psy-
chologist, social worker, psychiatrist) with experience in
2000. Daviss WB, et al. “Predicting Posttraumatic Stress
helping children after trauma, and who can assess the child
After Hospitalization for Pediatric Injury.” J. Am. Acad. Child
and make a recommendation about treatment. Treatment for Adolesc. Psychiatry, 39:576-583.
PTSD in children and teens usually includes cognitive
1999. Horowitz, L, et al., eds. Psychological Factors in
behavioral therapy to help reduce avoidance behaviors and
Emergency Medical Services for Children: Abstracys of the
to change ways of thinking that can perpetuate the symp-
Psychological, Behavioral, and Medical Literature.
toms of PTSD. Treatment for children also generally involves
parents and other family members as well. Sometimes, chil-
1991-1998. Bibliographies in Psychology, Number 18.
dren or teens can participate in group therapy (or a support
American Psychological Association, Washington, DC.
group) with others who have also experienced a trauma.
1999. deVries APJ, et al. “Looking Beyond the Physical Injury:
Books On Children and Trauma
Posttraumatic Stress Disorder in Children and Parents After
Pediatric Traffic Injury.” Pediatrics, 104:1293-1299.
• Children and Trauma: A Guide For Parents and
Professionals by Cynthia Monahon, Jossey-Bass
1998. “Practice Parameters for the Assessment and Treatment
Publishers; San Francisco; 1997.
of Children and Adolescents with Posttraumatic Stress
Disorder.” Journal of the American Academy of Child and
• The Scared Child: Helping Kids Overcome Traumatic
Adolescent Psychiatry, 37:10 supplement, October 1998.
Events by Barbara Brooks, Ph.D., and Paula M. Siegel;
John Wiley & Sons, In.; New York; 1996.
1996. Fletcher K. “Childhood Post-Traumatic Stress
Disorder.” In: Mash E, Barkley R, eds. Child
• A Terrible Thing Happened by Margaret M. Holmes;
Psychopathology. New York, NY: Guilford: pp. 242-276.
illustrated by Cary Pillo; Magination Press; American
Psychological Association; Washington, DC, 2000.
1995. Boney-McCoy S, Finkelhor D. “Psychosocial
Sequelae of Violent Victimization in A National Youth
Sample.” J Consult Clin Psychol, 63:726-736.
• An extensive general bibliography on PTSD can be
1994. Diagnostic and Statistical Manual of Mental Disorders,
found at: www.sover.net/~schwcof/ptsd.html
4th edition (DSM-IV). Washington, DC: American
• A comprehensive resource with useful information and
links regarding trauma and PTSD can also be found at: 1994. Pynoos RS. Traumatic Stress and Developmental
Psychopathology in Children and Adolescents. In Pynoos
RS, ed. Post-traumatic Stress Disorder: A Clinical Review.
Professional Mental Health Associations and
Lutherville, MD: Sidran Press; pp.65-98.
1990. DiGallo A, Barton J, Parry-Jones WL. “Road Traffic
American Academy of Child
Accidents: Early Psychological Consequences in Children
and Adolescent Psychiatry
and Adolescents.” Br J Psychiatry, 170:358-362.
American Academy of Pediatrics
American Psychological Association
The EMSC Program is a federally funded initiative designed to reduce child and
youth disability and death due to severe illness or injury. the Program is jointly
administered by the Health Resources and Services Administration’s Maternal
and Child Health Bureau and the National Highway Traffic Safety
Administration. All 50 states, the District of Columbia, and five U.S. territories
have received funding through the Program.