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PTS3398 - SECTION 4: PTSD IN CHILDREN

 

The National Institute of Mental Health (NIMH) reports that in the United States there are a substantial number of children and adolescents who experience trauma in any given year. “Twenty million (or more) children with PTSD are among the least understood and inconsistently served [people] in the United States.” (National Institute for Mental Health, n.d.)

In addition, according to National Center for PTSD, a small number of studies of the general population have been conducted that examine rates of exposure and PTSD in children and adolescents.

Results of these studies indicate that up to 43% of girls and boys have experienced at least one traumatic event in their lifetime. Limited studies have shown that the prevalence of PTSD is much higher in children and adolescents who are already are considered at-risk. (Hamblen, n.d)

STATISTICS

The rates of a PTSD diagnosis for these at-risk children and adolescents varied from 3-100%.

“For example, studies have shown that as many as 100% of children who witness a parental homicide or sexual assault develops PTSD. Similarly, 90% of sexually abused children, 77% of children exposed to a school shooting, and 35% of urban youth exposed to community violence develop PTSD.” (Hamblen, n.d.)

Traumatic events can be the same for adults and children, but for children and adolescents, trauma can be caused by a parent or caregiver’s physical or emotional abuse or by a physical or emotional assault by anyone else, including neighborhood or school bullies.

Scary movies and real-life tragedies aired by the media and viewed by millions, including children, can also be considered traumatic events.

In the U.S., recent examples of mass media exposure include the media footage of the tragedies at Virginia Technological University, the media footage of the Iraqi and Afghanistan Wars, media footage of the current Piracy Standoffs, and living through or watching video footage of natural or manmade disasters.

When children develop severe symptoms and remain untreated or undiagnosed, they may be misdiagnosed with:

- Attention deficit disorder
- Attention deficit hyperactive disorder
- Oppositional defiant disorder

The Cyclic Effect

As stated earlier, the symptoms of PTSD in one family can span generations. We call it the cyclic effect, because the learned patterns of behavior can cycle from one generation to the next. Children may experience secondary trauma because of the actions or inactions of a caregiver who has untreated or ill-managed PTSD symptoms.

Dysfunctional family environments may occur when one or both of the parents display chronic or ongoing symptoms of PTSD. There have been several studies that have shown that parents with a history of PTSD can have a negative impact on the child-parent relationship. (Lauterbach et al., 2007)

Additionally, these studies documented the association between individuals with PTSD and marital discord. (Lauterbach, et al, 2007) With this information, one might conclude that these issues will likely have at least some impact on the wellness of family functioning and successful childrearing.

Children also can have learn from their environment that trauma may emerge at any time, and from this they can develop PTSD symptoms in response. For example, a parent whose mood is constantly changing due to alcohol or substance abuse may leave the children guarded. That is, they may feel like they are “walking on eggshells,” not sure when the “angry parent” will appear, or what will trigger the “angry parent” to emerge.

These children are also at elevated risk for dropping out of school and failing to maintain meaningful employment. They can end up relying on the welfare system. If their PTSD arose from childhood abuse, they are likely to also abuse their children, and the cycle continues as they become adults who are predisposed to anti-social or criminal behavior.



Case Scenario

Consider the following abbreviated scenario:

A mother returns from serving in the military. While she was away, the father remained at home with their five-year-old daughter. The girl was doing very well in school until her mother returned from her tour of duty. The mother witnessed several traumatic events while she was on tour, and she recounted these experiences almost daily to her family and friends.

According to family members, the mother has not been the same since she came back two years ago. Family members describe her as depressed and angry; she often throw fits, hits her husband, screams at her child, drinks heavily, and no longer engages in family or other social functions. In addition, the mother has not been able to maintain employment because she frequently calls in sick.

As a result of his wife’s behavior, the husband feels stressed and unable to cope. He begins drinking heavily; they yell at each other constantly and physically fight, and neither of them spends any significant family time with their now seven-year-old daughter.

The seven-year-old child’s grades fall significantly; she reports to the nurse almost daily for a stomach ache and/or headache and stays home from school on many occasions for such psychosomatic pains.

She becomes withdrawn and no longer engages with her classmates, except to occasionally belittle and berate another classmate. The child is counseled about her poor academic performance, offered a tutor, and is even been suspended for a belittling/bullying incident.

The parents are also counseled, and they assure school officials that their child would be punished at home. Yet their daughter’s grades, mood, and behavior continue to deteriorate. Neither parent nor child has been diagnosed or treated for any mental health condition.

The parents take their child to their family pediatrician, but he cannot find any physical etiology that would account for the child’s physical complaints. No follow-ups are provided.

In this scenario, once the family history was known, one might conclude that all three members of this family suffer from some degree of PTSD. Clinicians might agree that at least a portion of the child’s recent behavior was learned by observing her parents’ behavior.

However, questions remain regarding the child: her bullying, her poor performance in school, her avoidance of school, and her lack of socialization. Is she merely exhibiting bad and/or learned behavior, or is the child suffering from PTSD due to the neglect and abusive behavior of her parents or from secondary PTSD due to exposure to her mother's experiences?


 

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