Tuesday, January 6, 2009

Children & PTSD, Part 1: Who's At Risk?

As we begin this new year tackling our grown up PTSD problems, let’s not forget the little people! Since my experience with PTSD began on the cusp of adolescence (and went undiagnosed until over 25 years later), I don’t pay much attention to the ways in which children suffer from PTSD. But I’ve been thinking about them lately, those little people who seem resilient but are often as affected by trauma as adults. My friend, Maria, for example, has a son, Ian, who is now 6 years old. A year ago Ian suffered from the same illness I did. Today, he’s experiencing the same PTSD symptoms as the rest of us and Maria is doing a really terrific job finding and getting Ian the help he immediately needs so he does not spend years lost in the PTSD maze.

Watching her tireless and inspiring advocacy for her child got me thinking: What is specific to children with PTSD? Which made me think of this Licensed Professional Counselor I’m acquainted with, William Krill. I first discovered him in one of the online PTSD support groups I’m in; his voice was the sagest, wisest, most educated in the group. You’ll see why when you read our interview below.

Krill has been kind enough to shed some light on the topic of children and PTSD. The cool thing about his interview is that it’s so educational. Even for those of us who don’t have this situation in our lives, maybe we will one day. Or, maybe we’ll meet someone for whom the info we pass along will be critical. And if that doesn’t happen, we can spread the word that children need special attention after crises because they can develop very adult psychological complications.

My interview with Krill breaks down into two parts, the first defining the problem, the second exploring the solution.

Today we’ll tackle Part One, Children & PTSD – Who’s at Risk?:

Define the age category 'child' encompasses.

Generally, children are considered under the age of thirteen. It’s not uncommon for emotional development to be halted at the age of the first trauma. Interpersonal trauma treatment (i.e. PTSD) does need to be tailored not only to the age of the survivor, but also tailored to the individual. Adult treatment approaches do not work with children. Unfortunately, there is not a lot of material out there for survivors of interpersonal trauma in general, let alone materials specific to age. I’m currently working on a book outlining the treatment approach I have developed for working with children. It’s called Gentling: A Clinician’s Guide to Treating PTSD in Abused Children.

What types of situations induce PTSD in children?

Just about any situation can create PTSD, from natural disasters to direct physical and sexual abuse to neglect. In addition, there is research to show that children can develop PTSD in domestic abuse situations where they witness their mother (or other close relative) suffering abuse. We don’t yet fully understand why some individuals develop PTSD while others do not, even though they have experienced the same level of trauma. Recent research indicates that there may be a difference in people’s brain chemistry that accounts for a pre-disposition to PTSD.

About how long after a trauma does PTSD usually emerge in children?

Not everyone is effected long-term by a trauma. While it is likely that with enough intense trauma, everyone would develop PTSD symptoms eventually, all PTSD starts with the diagnosis of ‘Acute Trauma Disorder’. Acute Trauma is essentially the same as PTSD, but it may in fact end in a relatively brief period of time. It’s only after Acute Trauma does not ease that the diagnosis of PTSD is assigned.

In most cases, there will be identifiable signs of either of the stress disorders if there is a close enough observation of the child. The problem is that many of the signs of PTSD in children often look like a different diagnosis, like ADHD or ODD. It is not uncommon for these children to be misdiagnosed as Bi-Polar. In addition, most PTSD victims, especially children, tend to work hard at covering their symptoms and do not share the fact of experiences. So, a child could go for years, even decades, before anyone recognizes the behaviors seen and labeled as PTSD.

What symptoms should a parent look for in terms of recognizing PTSD in his child?

For me the key has been to start with any known traumatic events, such as abuse events. When difficult behaviors symptoms develop, a connection with the trauma(s) needs to be considered carefully. PTSD in children does not express the way that it does with adults. While there are general similarities, I have found that children tend to have unique expressions, like a high incidence of nighttime enuresis (bed wetting) that does not respond to medicine or behavioral interventions. In addition, many boys also have encopresis (fecal soiling after successful toilet training).

By far the biggest marker is that the child will have rapid mood changes from relative calm and happy to highly agitated. I describe this as being like a ‘light switch’. And just as quickly as the agitation starts, it can end. Often, the child cannot tell you what it was that they were upset about. The upsets are often accompanied by regressions in speech, and the child may begin to speak in baby-talk, cry uncontrollably, and refuse to be comforted or touched. This all may be accompanied by facial and chest flushing, body tenseness, pacing or looking panicked, and one very reliable sign: pupil dilation.

Often, parents describe these upsets as ‘tantrums’, but these are not really tantrums because they are far more intense than tantrums; tantrums are usually about manipulating to get something. Rather, these upsets are more accurately called ‘stress episodes’.

What is the best way to prevent PTSD from occurring in children?

There is a great deal of controversy over the idea of rapid response to trauma to prevent eventual PTSD. There is research on both sides that indicate it is effective or ineffective. There is even some research that demonstrates that ‘critical incident de-briefing’ can actually induce PTSD. So the jury is still out on the best time to begin treatment. In my opinion, the most important thing is to place the treatment time and speed into the hands of the person with the PTSD. “Forcing” someone to talk about their trauma before they are ready would likely not be effective. A trauma victim has already been forced during the trauma, I wouldn’t suggest repeating that situation to help them!
(Part 2 of this interview will post on Thursday, 1/8/09.)

(photo: **LYN**)


elizabeth said...


I love it when people see the value of helping others especially when it comes to something as important as PTSD. You are an angel with a blog.

Happy New Year!


krillco said...

Thanks Michelle, for helping me to spread the word of my passion: treating children with PTSD as a result of interpersonal trauma!

~bill krill