Criteria for PTSD now include age-specific features for some symptoms.
Very young children may present with few PTSD symptoms. This may be because eight of the PTSD symp- toms require a verbal description of one’s feelings and experiences. Instead, young children may report more generalized fears such as stranger or separation anxiety, avoidance of situations that may or may not be related to the trauma, sleep disturbances, and a preoccupation with words or symbols that may or may not be related to the trauma. These children may also display post-traumatic play in which they repeat themes of the trauma. In addition, children may lose an acquired developmental skill (such as toilet training) as a result of experiencing a traumatic event.
Elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trau- ma. However, they do experience “time skew” and “omen formation,” which are not typically seen in adults. Time skew refers to a child mis-sequencing trauma related events when recalling the memory. Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas. School- aged children also reportedly exhibit post-traumatic play or re-enactment of the trauma in play, drawings, or verbalization. Post-traumatic play is different from re-enactment in that post-traumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety.
Other Signs of Trauma in Children
Besides PTSD, children and adolescents who have experienced traumatic events often exhibit other types of problems... fear, anxiety, depression, anger and hostility, aggression, sexually inappropriate behavior, self- destructive behavior, feelings of isolation and stigma, poor self-esteem, difficulty in trusting others, and sub- stance abuse. Children who have experienced traumas also often have relationship problems with peers and family members, problems with acting out, and problems with school performance.
Along with associated symptoms, there are a number of psychiatric disorders that are commonly found in children and adolescents who have been traumatized. One commonly co-occurring disorder is major depression. Other disorders include substance abuse; other anxiety disorders such as separation anxiety, panic disorder, and generalized anxiety disorder; and externalizing disorders such as attention- deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder.
From PTSD in Children and Adolescents, A National Center for PTSD Fact Sheet by Jessica Hamblen, PhD. This article originally appeared in Adoption Parenting: Creating a Toolbox, Building Connections. EMK Press