POST-TRAUMATIC STRESS DISORDER
Helping Children and Adolescents Cope with Violence and Disasters
Some children and adolescents will have prolonged problems after a traumatic event. These potentially chronic conditions include depression and prolonged grief. Another serious and potentially long-lasting problem is post-traumatic stress disorder (PTSD). This condition is diagnosed when the following symptoms have been present for longer than one month:
Re-experiencing the event through play
or in trauma-specific nightmares or flashbacks, or distress over events
that resemble or symbolize the trauma.
The disorder may arise weeks or months after the traumatic event. PTSD may resolve without treatment, but some form of therapy by a mental health professional is often required in order for healing to occur. Fortunately, it is more common for traumatized individuals to have some of the symptoms of PTSD than to develop the full-blown disorder.
People differ in their vulnerability to
PTSD, and the source of this difference is not known in its entirety. Researchers
have identified factors that interact to influence vulnerability to developing
PTSD. These factors include:
Research has shown that PTSD clearly alters a number of fundamental brain mechanisms. Abnormal levels of brain chemicals that affect coping behavior, learning, and memory have been detected among people with the disorder. In addition, recent imaging studies have discovered altered metabolism and blood flow in the brain as well as structural brain changes in people with PTSD.
TREATMENT OF PTSD
People with PTSD are treated with specialized forms of psychotherapy and sometimes with medications or a combination of the two.
One of the forms of psychotherapy shown to be effective is cognitive behavioral therapy, or CBT. In CBT, the patient is taught methods of overcoming anxiety or depression and modifying undesirable behaviors such as avoidance of reminders of the traumatic event. The therapist helps the patient examine and re-evaluate beliefs that are interfering with healing, such as the belief that the traumatic event will happen again.
Children who undergo CBT are taught to
avoid "catastrophizing." For example, they are reassured that dark clouds
do not necessarily mean another hurricane, that the fact that someone is
angry doesn't necessarily mean that another shooting is imminent, etc.
Other forms of psychotherapy that have been found to help persons with PTSD include group and exposure therapy. A reasonable period of time for treatment of PTSD is 6 to 12 weeks with occasional follow-up sessions, but treatment may be longer depending on a patient's particular circumstances. Research has shown that support from family and friends can be an important part of recovery.
There has been a good deal of research on the use of medications for adults with PTSD, including research on the formation of emotionally charged memories and medications that may help block the development of symptoms.
Medications appear to be useful in reducing
overwhelming symptoms of arousal (such as sleep disturbances and an exaggerated
startle reflex), intrusive thoughts, and avoidance; reducing accompanying
conditions such as depression and panic; and improving impulse control
and related behavioral problems.
There is accumulating empirical evidence
that trauma/grief-focused psychotherapy and selected pharmacologic interventions
can be effective in alleviating PTSD symptoms and in addressing co-occurring
A mental health professional with special expertise in the area of child and adolescent trauma is the best person to help a youngster with PTSD.