Young children are particularly vulnerable to trauma.  For instance, compared to other age groups, children younger than four years of age have among the highest rates of nonfatal injuries (e.g., falls, drownings, poisonings, burns).  Furthermore, over half of child maltreatment victims in the US are under the age of six years old.

In fact, by age nine, more than one-third of children have experienced at least one potentially traumatic event.  Some of these children develop a mental illness called post-traumatic stress disorder (PTSD).

The present article discusses the common symptoms of PTSD in children, as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  It concludes with a review of treatments for PTSD.

Symptoms of PTSD in children

The DSM-5 criteria for diagnosing PTSD in children six years and younger include:

  • Exposure to actual or threatened serious injury, sexual violence, or death.
  • Presence of intrusive memories, recurrent nightmares, flashbacks, intense distress, or physiological reactions associated with the trauma in children.
  • Negative changes in mood and thinking (e.g., intense fear, inappropriate guilt, inability to experience positive feelings).
  • Avoidance of reminders of the trauma in children (e.g., locations, activities, thoughts, feelings).
  • Negative changes in arousal, including increased reactivity (e.g., increased irritability, greater startle response, significant sleep difficulties).

Reactions to trauma in children vary greatly depending on a number of factors, such as the child’s age.  For example, younger children with a history of trauma may show reluctance to get involved in new activities at school, whereas adolescents with a history of trauma may show diminished interest in developmentally appropriate opportunities (e.g., dating).

Psychological trauma in children often interrupts biological, emotional, and social development. As a result, traumatized children have great difficulty managing life stressors as they grow older.  Even if they do not develop post-traumatic stress disorder, they experience other mental health issues, such as anxiety and depression.

Psychotherapy and medications for PTSD

Common psychosocial treatments for PTSD in children include the following components:

  • Education. Providing information to children and their caregivers regarding the trauma and reactions to trauma in children (e.g., avoidance behaviors, guilt, shame).
  • Parenting skills. Teaching parents effective communication and behavior management skills.
  • Coping and relaxation. Explaining the importance of relaxation and describing how/when to use relaxation techniques such as deep breathing, guided imagery, and mindfulness meditation.
  • Emotion regulation. Teaching patients (and their families) effective ways to identify, express, and manage difficult emotions.
  • Cognitive processing. Explaining how thoughts, emotions, and behaviors are interrelated, and why changing thoughts can change emotions.
  • Creating a therapeutic narrative about the trauma.  The goal is to help identify and correct inaccurate beliefs about the trauma and life (e.g., that the world is very dangerous or nobody can be trusted).
  • Real-life exposure to trauma reminders. Encouraging the traumatized child to gradually face his or her fears.  This means exposure to safe activities that have been avoided because they serve as reminders of the trauma in children.
  • Parent-child sessions. Facilitating open and positive communication between parent and child.
  • Enhancing safety. Teaching safety skills to prevent revictimization.

What about medications?  For PTSD in adults, antidepressants like selective serotonin reuptake inhibitors (SSRIs)—sertraline, fluoxetine, paroxetine, etc.—are first-line treatments.

There is limited research on the effectiveness of SSRIs in childhood PTSD; nevertheless, they have been shown to be effective in treating childhood anxiety and depression, which are often comorbid with PTSD.

Because mental health is inextricably linked with physical health, interventions targeting physical exercise, healthy nutrition, and improved sleep quality are also important and may enhance the effects of the other treatments discussed.