PTSD in Children and Adolescents

Many people think of post-traumatic stress disorder (PTSD) as something that only affects adults, especially soldiers or those exposed to war. But PTSD can impact people of all ages, including children and adolescents. Young people can develop PTSD after any experience that threatens their safety or well-being, whether it’s a one-time event like a car accident or an ongoing event like abuse or neglect. 

Children don’t have to be involved in an event to develop PTSD, either. Even witnessing something traumatic, like a violent event or accident, can trigger the disorder. If your child has experienced a distressing event and you’re noticing changes in their behavior or mood, it’s important to understand how PTSD affects children and teens and how you can support them. 

In this article, we’ll guide you through what PTSD looks like in kids and teens, how it can be treated, and what you can do to help. 

What is post-traumatic stress disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a psychological disorder that can develop in children and adolescents after they experience or witness a traumatic event. These events can range from natural disasters and accidents to acts of physical or emotional violence. Sometimes, even hearing or seeing images of traumatic events can trigger PTSD in young people. 

Children and teens living with PTSD can struggle to navigate daily life, from school to friendships and family interactions, but symptoms will vary depending on the child and their age. For example, some younger children won’t verbalize their distress but instead act it out during play or artwork. A child who has survived a car accident may crash toy cars or reenact violent scenes during playtime. Older children and teens might experience flashbacks, nightmares, or intense emotional and physical reactions when reminded of the traumatic event. 

According to the National Comorbidity Survey Replication- Adolescent Supplement, 5% of adolescents have met the criteria for PTSD in their lifetime.

What events can cause PTSD in children and teens?

Kids and teens can develop PTSD after any event that threatens their safety or causes significant harm, whether physically or emotionally. Some of the most common events that can lead to PTSD in young people include: 

• Abuse or bullying: Any form of abuse, whether physical, emotional, or sexual, can lead to PTSD. 

• Natural disasters: Experiencing or witnessing fires, floods, hurricanes, earthquakes, or other natural disasters. 

• Violent crimes: Events like kidnappings, shootings, or other violent attacks, even if the child is not directly involved. 

• Motor vehicle accidents: Car, plane, or train crashes are some of the most common causes of trauma. 

• Community and domestic violence: Exposure to violence at home or in the community, including domestic abuse, street violence, or gang-related incidents. 

• Serious health conditions: Being diagnosed with a life-threatening illness or undergoing invasive medical procedures, especially for children under six. 

• War or terrorism: Bombings, terrorist attacks, or living in a war-torn region can all cause PTSD. 

• Separation from parents or caregivers: Children who are suddenly and unexpectedly separated from their parents or caregivers may develop PTSD.

• Stressful situations: Scary or stressful events, like being bitten or attacked by an animal or trapped in a confined space, can all cause significant stress and lead to PTSD. 

Risk factors for developing PTSD

Certain factors can influence whether a child or teen develops PTSD after experiencing or witnessing a traumatic event, including the type of event and intensity of exposure. Generally, it’s believed that children who are closer to the traumatic event are more likely to develop PTSD than those who are further removed. 

For example, in one study following a fatal sniper attack at an elementary school, 77% of children who directly witnessed the shooting developed moderate to severe PTSD symptoms compared to only 26% of children who had already gone home for the day. 

Other risk factors that can increase the likelihood of children and adolescents developing PTSD include: 

• Gender: Females tend to be at a higher risk than males. 

• Previous trauma exposure: Children who’ve already experienced trauma are more vulnerable to PTSD.

• Pre-existing disorders: Mental disorders, like depression or anxiety disorders, can increase likelihood of developing PTSD. 

• Family history of mental illness: If parents have mental health disorders, especially PTSD, kids are at a higher risk of developing it. 

• Low social support: A lack of emotional or social support from family, friends, or the community can make it harder for kids and teens to recover from trauma. 

Is it common for children and teens to experience trauma?

Yes, it is common for children and teens to experience trauma, and numerous statistics point out how widespread these experiences can be – although these numbers might be vastly underestimated the true scope of the issue. For example, annual reports from the Department of Health and Human Services focus primarily on cases of child abuse and don’t account for other traumatic events, like natural disasters or community violence. On top of that, many cases of abuse go unreported, meaning the true number of children exposed to trauma may be significantly higher.  

While information is outdated, in 2011 alone, U.S. child protective services received 3.4 million referrals representing 6.2 million children. Of those, around 19% were confirmed cases of abuse. Here’s how those cases broke down:

• 78.5% of children experienced neglect
• 17.6% experienced physical abuse
• 9.1% experienced child sexual abuse.

 

When looking at older children, the National Survey of Children’s Exposure to Violence has shown that 60.6% of kids aged 0 to 17 have either experienced or witnessed some form of victimization in the past year. Specifically:

• 46.3% experienced physical assault
• 10.2% experienced child maltreatment
• 6.1% experienced sexual victimization
• 25.3% witnessed domestic or community violence.

 

As children grow older, their chances of being exposed to traumatic events increase. Among girls aged 14 to 17, 18.7% have experienced either a completed or attempted sexual assault, and more than a third have witnessed parental assault. Another national study found that nearly half of adolescents aged 12 to 17 had experienced sexual or physical assault or had witnessed violence during their lifetime. Specifically:

• 8% experienced sexual assault
• 22% experienced physical assault
• 39% witnessed violence.

The above statistics highlight how common trauma is in the lives of young people. This can have long-term impacts on their mental health, including the development of PTSD. 

PTSD symptoms in children and teens

Children and adolescents with PTSD experience three main symptom clusters: re-experiencing the trauma, avoiding traumatic triggers, and chronic hyperarousal. These symptoms can look different depending on the child’s age and developmental stage, but they all show that a child is struggling to process a traumatic event. 

Let’s take a look at each of these three primary PTSD symptoms in more detail.

Re-experiencing trauma

One of the main symptoms of PTSD is reliving the traumatic event. For kids and teens, this can manifest as intrusive memories, flashbacks, or recurring nightmares. Younger kids might re-enact the trauma through play or artwork, while teens can experience more vivid flashbacks or nightmares that make them feel like they’re reliving the event. 

Avoiding traumatic triggers

Kids and teens with PTSD might go out of their way to avoid anything that reminds them of the traumatic event. This might mean avoiding certain people, places, or situations that trigger memories of the trauma. Younger kids might become unusually clingy or fearful of new people or situations, while older kids and teens may isolate themselves from friends or family to avoid these triggers. 

Chronic psychological hyperarousal

This is when the body is in a constant state of alertness and tension, always on the lookout for danger. For kids and teens with PTSD, this can look like disturbed sleep, irritability, or difficulty concentrating. They might be easily startled or emotionally reactive to minor events. Younger children might show hyperactivity or impulsiveness that can be confused with other conditions, like ADHD, while teens are more likely to engage in risky behaviors like self-harm or substance abuse to cope with the stress. 

Age-specific PTSD symptoms in kids and teens

Besides the three primary symptom clusters, posttraumatic stress disorder can show up differently for children and adolescents of different ages. Let’s look at what PTSD looks like for different age groups: 

• Children under 6: Diagnosing PTSD in younger children can be difficult as they don’t always have the language skills to describe their feelings. Instead, they might express distress through physical symptoms like headaches or stomachaches, or by regressing to behaviors they had outgrown, such as bed-wetting or thumb-sucking. They might also show signs of hypervigilance and become excessively clingy or avoidant of new situations. 

• Children aged 6 to 12: When children in this age group have PTSD, they might view the world as being dangerous and unsafe, showing distrust in family members or caregivers. They might display aggression, mood swings, and a loss of interest in activities they once enjoyed. Children in this age group might also engage in traumatic reenactment through play or artwork. 
• Teens aged 13 and older: PTSD symptoms in adolescents resemble those seen in adults, however teens are more likely to engage in impulsive or risky behaviors like unprotected sex, substance use, or self-harm. Some with more severe symptoms might experience suicidal thoughts or a desire to die. They might withdraw from family and friends, and their symptoms can lead to a decline in academic performance. 

See More: Is TMS Appropriate for Treating Adolescents With Depression?

Treating children and adolescents with PTSD

For some children, PTSD symptoms can slowly reduce and disappear over time. However, if left untreated, many will continue to struggle with the effects of trauma for years afterwards. Below we look at the most common treatments for PTSD in children and teens. 

Cognitive-behavioral therapy (CBT)

Trauma-focused cognitive-behavioral therapy (TF-CBT) is one of the most effective treatments for children and adolescents with PTSD. This form of therapy includes:

• Exposure therapy: Where children gradually talk about their traumatic experiences.

• Anxiety management: Techniques including relaxation and assertiveness training.

• Cognitive restructuring: Where children learn to challenge and correct distorted trauma-related thoughts. 

 

Parental involvement is an important part of CBT. Psycho-education can teach parents about PTSD symptoms and their effects so they can better support their children. Research shows that when parents can cope with their own trauma, they’re able to provide more emotional support to their child so they can recover more successfully. 

Keep Reading: How to Find & Choose a Good Psychiatrist for You

Play therapy

Play therapy is a good alternative for younger children who aren’t yet able to directly process their trauma through traditional therapy. This approach uses games, drawing, and imaginative play to help children express their trauma in ways they can understand. By reenacting their experiences in a safe, guided environment, children can work through their emotions and gradually make sense of what happened to them.

Psychological First Aid (PFA)

Psychological First Aid (PFA) provides immediate support to kids and teens exposed to large-scale traumatic events like natural disasters or community violence. This is often administered in schools or community settings and involves providing comfort, validating the child’s emotional responses, and teaching coping strategies. 

Medications

Medications, such as selective serotonin reuptake inhibitors (SSRIs), are usually prescribed for children and teens with depression and obsessive-compulsive disorder (OCD). Some research suggests that these medications can also help treat PTSD in children, however they are usually only prescribed after other therapeutic options have been explored. 

Similar Reading: Do Antidepressants Work and How Effective Are They?

How can I support my child with PTSD?

Supporting your child through PTSD can feel overwhelming, but the love, patience, and care you show will make a difference in their healing journey. Below are some steps you can take to support your child or teen as they go through PTSD treatment: 

• Stay patient: Recovering from trauma takes time and your child might not feel better right away. While it’s natural to hope for quick relief, remember that healing follows its own timeline. Be patient and trust that with time and treatment, progress will come. 

• Provide reassurance: Kids and teens with PTSD might need constant reassurance of your love and support. Let them know that you’re there for them, and create a safe and nurturing environment where they feel secure. 

• Validate their emotions: Try not to minimize the trauma or suggest that your child will ‘get over it’ soon. Validate their emotions and reassure them that it’s okay to feel the way they do. Children need to know that they can express themselves without fear of judgment or criticism. 

• Respect their privacy: Older children and teens might struggle to talk about their feelings. It’s important to respect their need for space while letting them know that you’re always there when they’re ready to talk. 

PTSD support for children and teens

If you think your child or teen is struggling with PTSD, it’s important to seek professional support. As challenging as it may feel at the moment, healing is possible with the right care and attention. Our compassionate team at BestMind Behavioral Health is here to support you and your family with evidence-based therapies tailored to the unique needs of children and teens. Contact us today to learn more about how we can support your child’s healing journey.