Letter to the editor
An overview of post-traumatic stress disorder in children and adolescents
When children and adolescents have experienced a frightening event, it can affect them in different ways. Some children recover immediately, while others may show a change in their behaviour for weeks or month afterwards. You may have noticed some of the following changes in your child since the traumatic event occurred.
If your child has displayed any of the above reactions, following the frightening event, then he or she may be suffering from a condition which is known as post-traumatic stress disorder, or PTSD for short. PTSD is a reaction to a very scary event, in which the person is in physical danger (e.g. a shooting, a car accident, or a rape). It is common among children and adults who have suffered a life-threatening trauma. It is the person’s way of trying to cope with a terribly frightening event.
PTSD is a psychological injury. It is different from a physical injury, like a broken arm, because you can’t always see that it is there - it is on the inside, not the outside. Like a broken arm, PTSD an prevent your child from participating in his or her usual activities. Like a broken arm, it needs to be looked after by a specialised doctor (called a psychiatrist or a psychologist) if it is to heal properly. And, like a broken arm, it takes time to mend, sometimes many month.
How can PTSD affect your child? Children with PTSD try very hard to avoid any reminders of the trauma (such as memories, people or places associated with the trauma). This can prevent them from participating in all their usual activities. For example, they may not want to walk down to the corner shop, or attend school, if the traumatic event happened near their places. When they are reminded of the trauma, they feel as if it was happening all over again - they feel this in their body (e.g. they become very tense) as well as in their mind (e.g. they may have a "flashback" - they "see" the event happening over again in their mind). Children with PTSD usualy also have a strong feelings of fear, sadness and helplessness, and not feel safe, even though the trauma is over. Some children also feel guilty that they did not do anything to prevent the trauma, or that they are somehow to blame for the trauma.
The symptoms of PTSD can occur soon after the event or many month later. PTSD can have a negative effect on your child’s performance at school and on his or her relationships with family and friends. If help is not provided, these difficulties can continue into adulthood . Is therefore very important that your child receive treatment and support as soon as possible.
Fortunately, there are several effective treatments for children who have PTSD. Firstly, it is vital that the child is given a chance to talk about what happened, in a safe environment. A psychiatrist or psychologist can help the child to do this. Sometimes parents want to protect their child by avoiding any mention of the trauma. But research has shown that in fact it is much better for the child to talk about what happened, preferably with a qualified doctor o psychologist - this gives children a chance to deal with their frightening memories and work out their feelings about what happened, so that they can put it behind them.
Secondly, certain medications have been found to help adults who suffer from PTSD. It is possible that these mediations will also be helpful for children. How can medication help? Medication may help to reduce your child’s anxiety, depression and sleeplessness, and to relieve the distressing effect of his or her traumatic memories. However, these mediations may take a few weeks to work, so don’t expect to see a change in your child immediately.
What you can do to help:
Your child’s feelings
The recognition and treatment of childhood and adolescence PTSD has not reached the same level of advancement as in adults. The treatment of PTSD in children and adolescents is largely based on clinical experience and borrowed treatments from other anxiety disorders. Current treatments include debriefing, cognitive behaviour therapy (CTB), play therapy, group therapy, family therapy, psychodynamic therapy, psychotherapy and pharmacotherapy. The core elements of all treatment intervention include talking openly to the child about the trauma, re-exposing the child traumatic cues under "safe" conditions, helping the child master faulty cognition which have attributed to the trauma and teach the child stress/anxiety management techniques.
Currently, there is little evidence that drug treatment has pivotal role to play in child and adolescents PTSD. There is no empirical support for the use o antidepressants in treating PTSD in this population, nor is there evidence for the appropriate duration of medication treatment. Pharmacotherapy, when it is used in clinical practice, is usually an adjunctive treatment for disabling co-morbid symptoms (depression, panic, attention deficit and hyperactivity)...
Soraya Seedat, D. Kaminer, R. Lochat and Dan J Stein
Seedat S, Kaminer D, Lockhat, Stein DJ. An overview of post-traumati stress disorder in children and adolescents. Primary Care Psychiatry 2000; 6 (2): 1-6.
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