Post-traumatic stress disorder
Child; youth; stress; psychological; post-traumatic; trauma; emotions; post; traumatic; disorder; nightmares; memories; flashback; fears; anxiety ;
When children are faced with a very frightening situation they may become very distressed, cry and shake with fear. They may 'shut down', go into 'shock' and not respond to people around them for a while.
Usually when the danger passes, there is a slow return to normal, but sometimes children go on being distressed and frightened. They may 'see' what happened over and over again, and want to avoid anything that reminds them of what happened.
If a child's reactions seem to be getting worse, or not showing signs of getting better after a few weeks, it is important to get professional help. If your child is behaving in ways that are likely to harm him or he is unable to do normal things, such as going to school or spending fun times with friends, get help sooner.
What is post traumatic stress disorder?
- Post traumatic stress disorder (PTSD) is the name given to the psychological and physical problems that can sometimes follow threatening or distressing events.
- These events could be:
- a major disaster (such as an earthquake or bushfire)
- rape or sexual, physical or emotional abuse
- witnessing a violent death
- a serious accident
- other situations in which the person was very afraid, horrified, helpless, or felt that his or her life was in danger.
- The trauma can be a single event, or a series of events taking place over many months or years (such as repeated physical or sexual abuse).
- PTSD can start soon after the event, or it can come some time later (after several weeks, or months, or even years).
- PTSD may affect the person directly involved in the situation, but it can affect family members and people providing emergency services.
- PTSD is quite common. Up to a third of people who have a very distressing experience can develop PTSD, and it is estimated that about 8% of people will experience PTSD at some time in their life.
Symptoms of post traumatic stress disorder
- One of the most common symptoms of PTSD is having repeated and intrusive memories of the event.
- There may be a feeling of 're-living' the event through 'flash-backs' or nightmares.
- There can be physical reactions such as shaking and sweating.
- Because the memory is so intense and upsetting, the person may avoid people or situations which remind her of the trauma, and be unwilling to talk about what happened.
- Some people also forget significant parts of the event, while others think about it constantly. They may repeatedly ask themselves why it happened and what they could have done to prevent it, and feel guilt and shame, or they may feel that they do not deserve help. This stops them coming to terms with the event.
- They may feel very anxious or irritable, and find it difficult to concentrate and sleep.
- Ordinary things like going to school or work, or going out with friends can become very dificult.
It is quite common to have upsetting and confusing feelings in the first few weeks after a traumatic event, but if they persist for more than a month after the event the person may have PTSD.
- refuse to do things which remind them of what happened, for example refuse to get into a car if it was a car accident
- have sleep problems - find it scary to go to sleep, and have lots of nightmares
- have separation problems - not wanting to leave their parents, wanting their parents to be with them at night (even older children and teenagers)
- 'regress' in their behaviour, losing skills they recently learnt (such as having toileting accidents, wetting the bed, not being able to talk)
- be irritable, easily upset, easily startled and have panic attacks
- always be on the watch for something bad to happen. This is called hypervigilance (being over watchful) and it can be like 'hyperactivity'.
In the first few weeks after such a traumatic event it is very common for children to feel like this, so it is important not to be too anxious. If the feelings and symptoms are not getting better, seek expert advice and treatment. Your family doctor would be able to help you to start with, and if necessary refer you to a therapist such as a child psychologist, psychatrist or psychiatric nurse.
Children and young people do best with trauma focused cognitive behavioural therapy (CBT).
- This therapy focuses on memories, thoughts and feelings associated with the event.
- The therapist will encourage and support the child to gradually recall what happened and develop ways of coping with the distress.
- It would be normal to see the therapist between 8 and 12 times (at least once a week).
Some of the things that are not likely to be helpful for PTSD are relaxation therapy, play therapy, art therapy and family therapy. Single sessions, including 'de-briefing', are not helpful, and may be harmful.
- Closeness, extra hugs and talk can help - just letting your children know that you are there for them is very important.
- If the child does not want to talk it is important that she knows you are available to talk when she does want to.
- You can ask older children how they would like you to help or support them. Sometimes they cannot tell you, but often they can.
- Remember to talk to brothers and sisters about what is happening/has happened and listen to their feelings as well. They may feel they have lost your love, while you are busy attending to the child in most need at the time.
- Sometimes stories about a child or animal in a similar situation, read over and over again, can help children feel more in control.
- Being able to have some control of the situation may help, eg helping to see that the windows and doors are locked each night to prevent a burglary.
- Keep the child's normal routine going as much as possible, this provides a feeling of safety. Encourage her to keep up her friendships.
- Protect children from adults who are insensitive or do not understand, for example people who are blaming or want to push the children into situations which are frightening for them.
- If you feel sad or angry yourself about what happened, tell your children how you feel. They will sense it anyway.
- Be patient if your child cries or gets angry easily for a while.
- Don't expect too much too soon.
- Very young children and babies who cannot understand what has happened need lots of loving and holding and care. Even when babies are very young, explain gently what is happening when you do things for them. They will get to feel safe from the sound of your voice and words.
- Remember to let your child's teacher or child care worker know what has happened so they can be ready to support your child.
Note: It may be helpful to minimise the amount of extra stress your child has to deal with, eg from television, newspapers.
- bedtime routines (eg story, cuddles in bed, tuck up with special toys etc) will help a child relax, as will leaving the light on, the door open, etc, if the child wants it. Allow children to come into your bedroom in the night if they are afraid. You could keep a sleeping bag on the floor near your bed that they could get into, if you do not like to have children in bed with you.
- during the night comfort the child, and for children who can understand you can remind them that, scary as it is, it is only a dream. Let them talk about it the next day. Things are always less frightening in the light of day.
If your children go backwards
- some children need to be more babyish for a while. It won't hurt to let them do this and at the same time let them know that when they feel better they will be ready to move on again.
- children need to be held and reassured that you are for them and that the trauma is over now. Try to interest them in the real world and what is happening here and now.
You may have been involved in the same trauma as your child, or have seen your child go through something that frightened you a great deal. You may also experience the feelings, thoughts and memories that are part of PTSD.
If you are feeling this way, you need support for yourself as well as your child. Seek professional therapy soon, rather than putting it off until everyone else is fine.
Refugee children will often have experienced considerable trauma, including witnessing violence and torture, loss of family members and being forced to flee. A very high proportion will experience ongoing mental health problems, including post-traumatic stress disorder.
- Children, Youth and Women's Health Service - Parent Helpline
24 hours a day, every day of the year.
Phone 1300 364 100
- Trained staff available at all times at:
- Flinders Medical Centre - Ph: 8204 5511
- Women's and Children's Hospital - Ph: 8161 7000
- CAMHS (Child and Adolescent Mental Health Service)
- Northern Ph: 8161 7389
- Southern Ph: 8204 5412
National Institute for Health and Clinical Excellence 'Post-traumatic stress disorder (PTSD): the treatment of PTSD in adults and children' March 2005
Yule W, 'Post-traumatic stress disorder' Archives of Diseases in Childhood 1999;80:107-109 (February)
Fazel M, Stein A 'The mental health of refugee children' Archives of Disease in Childhood 2002;87:366-370
Australian National University 'Australian Child and Adolescent Trauma, Loss and Grief Network - Information and Resources'
Australian Centre for Posttraumatic Mental Health (ACPMH)
After the injury (USA)
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your child's sex.