How Common is Post Traumatic Stress Disorder in Children?

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Patient Presentation
A pediatrician was talking with a colleague who asked, “Maybe you know the answer to this question? I was evaluating a teenager yesterday and the problem list had PTSD also listed as one of his problems. I could see that there were several notes for counseling. I had another patient within the last month who also had PTSD listed as a problem. I know that adults certainly can get PTSD, but how common is it in kids?” The pediatrician said she wasn’t exactly sure but that kids like adults can have many traumatic experiences in their life and that usually, with a supportive environment, the kids work through the problem. “We’re recognizing these problems more and more, even in young children, because of the stressful environments that many kids live in. Even a single event could cause PTSD but most don’t thankfully. Suicide is also an increasing problem in the teen population with stress and trauma certainly playing a part,” he said.

Discussion
“Exposure to traumatic stress events including physical abuse, sexual abuse, violence, witnessing violence in the home or community, severe family dysfunction/psychopathology, natural disasters, severe accidents and/or their own or their caregivers’ life-threatening illness are not uncommon in children and adolescents.” It is estimated that up to 60% of teens age 16-18 have experienced at least 1 traumatic event.

Some children, teens and adults may experience transient psychological problems or distress which may cause physical complaints including pain, behavioral changes such as irritation or regression, sleep problems, etc.. Some children, teens and adults go on to experience more difficulties immediately after the event or later on.

Risk factors for having significant problems include multiple traumatic exposures, multiple trauma types (physical, emotional, sexual, etc.), trauma intensity, personal mental health problems, high risk social situations including poverty, isolation, delinquent peer affiliation, multiple out-of-home placements and family members with physical or mental illness including substance abuse. Resiliency helps to moderate the effects including having problem-solving skills, self control, positive interpersonal relationships, safe home and school environments, religious faith, success with school and peers, socioeconomic advantage, and being older when trauma occurred.

To review a case about resiliency to the effects of war click here.

To review a case about the effects of bullying click here.

To review a case about gun violence click here.

Learning Point
Post traumatic stress disorder (PTSD) is a psychological disorder in a group that also includes reactive attachment disorder, adjustment disorder, acute stress reaction and acute stress disorder. The DSM-5® has criteria for children > 7 years, teens and adults. There must be:

  • An exposure to a traumatic event by direct self-exposure, direct witnessing of the exposure, learning of the personal exposure by a close friend or relative, or exposure by repeated discussions of the exposure by others
  • Intrusive experiencing of the traumatic events such as intrusive thoughts or memories, nightmares, flashbacks, intense distress with reminders of the trauma, etc..
  • Avoiding of the stimuli that brings on the intrusive experiences such as avoiding people, places, conversations, etc..
  • Negative cognition and mood associated with the trauma such as believing the world is not safe, distorted blame of the events, detachment from interpersonal relationship, anhedonia or persistent negative emotions including fear, guilt or confusion, etc..
  • Arousal and reactivity alterations such as anger and aggression, self-harm, recklessness, easily startled, hypervigilance, problems falling asleep, etc..
  • Duration of symptoms must be at least 30 days
  • Causes clinical impairment in important areas of functioning or significant distress

There are other criteria for children < 7 years old, but they are similar.

“The reported overall lifetime prevalence of PTSD in the general youth population is 3-9%. Some studies show gender differences with 4% of males having PTSD and 7% of females. A meta-analysis showed a highly significant association between PTSD and suicidality and “…was associated with elevated levels [of] suicidality in adolescents in a wide range of circumstances.” Suicide is the 3rd leading cause of death in the U.S. so recognition of traumatic stress, PTSD and potential suicidality is important.

There are several traumatic screening tools that can be used and PTSD is considered highly treatable. Although treatment plans are individualized “…[c]ommon treatment elements include (1) psychoeducation about PTSD, (2) relaxation and coping skills, (3) affect monitoring and emotion regulation skills, (4) cognitive processing of reactions to trauma, (5) helping the child construct a therapeutic trauma narrative, (6) in vivo exposure to trauma reminders and practicing of coping skills, (7) conjoint parent-child sessions, and (8) monitoring and enhanced individual safety.”

Questions for Further Discussion
1. What mental health services are available in your community for PTSD?
2. What role does the media and social media play in traumatic stress?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: Post Traumatic Stress Disorder

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Stoddard FJ Jr. Outcomes of traumatic exposure. Child Adolesc Psychiatr Clin N Am. 2014 Apr;23(2):243-56, viii.

Martinez W, Polo AJ, Zelic KJ. Symptom variation on the trauma symptom checklist for children: a within-scale meta-analytic review. J Trauma Stress. 2014 Dec;27(6):655-63.

Panagioti M, Gooding PA, Triantafyllou K, Tarrier N. Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2015 Apr;50(4):525-37.

Connor DF, Ford JD, Arnsten AF, Greene CA. An Update on Posttraumatic Stress Disorder in Children and Adolescents. Clin Pediatr (Phila). 2015 Jun;54(6):517-28.

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital

Published