From the Guidelines
Post-traumatic stress disorder (PTSD) in young children manifests differently than in adults, primarily due to developmental differences, and requires a tailored approach to diagnosis and treatment, as highlighted in the most recent study by Forkey et al 1.
Key Differences in PTSD Manifestation
- Children with PTSD often display regression in developmental milestones, such as bedwetting after being toilet trained, or losing language skills.
- They frequently exhibit trauma through repetitive play that reenacts the traumatic event rather than through verbal expression.
- Sleep disturbances are common, including nightmares that may not directly relate to the trauma.
- Children may develop new fears seemingly unrelated to the traumatic experience, such as fear of the dark or separation anxiety.
- Physical symptoms like stomachaches and headaches are more prevalent in children with PTSD.
Treatment Approaches
- Treatment approaches differ from those for adults, with play therapy, art therapy, and family-focused interventions being more effective for children, as noted in the study by Forkey et al 1.
- Medications like SSRIs (such as fluoxetine 10-20mg daily for children over 8) may be prescribed but are used more cautiously in children, with lower dosages and careful monitoring for side effects, as recommended by the American Academy of Pediatrics 1.
- Early intervention is crucial for both groups but especially for children, as untreated childhood PTSD can significantly impact brain development and emotional regulation skills.
Importance of Trauma-Informed Care
- Trauma-informed care is essential in addressing childhood trauma and promoting resilience, as emphasized in the study by Forkey et al 1.
- Pediatric clinicians play a critical role in providing trauma-informed care and should be aware of the signs and symptoms of PTSD in children, as well as the importance of early intervention and treatment.
- A trauma-informed approach acknowledges the biological effects of adversity without suggesting that childhood adversity is destiny, and requires a compassionate approach that does not suggest blame, as noted in the study by Forkey et al 1.
From the Research
Effects of PTSD on Young Children
- Young children who suffer from posttraumatic stress symptoms (PTSS) need treatment to prevent adverse long-term effects 2
- PTSD can occur in a minority of children and young people exposed to trauma, with factors such as cognitive and social factors distinguishing those who develop chronic PTSD from those who do not 3
- The introduction of developmentally adapted criteria for PTSD has improved the identification of children with clinical needs, with a prevalence of acute PTSD in young children of 8.6% in the first month post-trauma and 10.1% at 3 months 4
Differences in PTSD Effects between Children and Adults
- While evidence-based treatments for PTSD are recommended as first-line interventions for both children and adults, the specific approaches may differ 5
- Trauma-focused cognitive behavioral therapy (TF-CBT) is an established treatment for children with PTSS, whereas prolonged exposure and cognitive processing therapy are commonly used for adults 5
- Children may require developmentally adapted treatments, such as cognitive-focused therapy, which has shown promise in reducing PTSS in young children 4
Treatment of PTSD in Young Children
- TF-CBT and eye movement desensitization and reprocessing (EMDR) are effective and efficient in reducing PTSS in children 2
- Cognitive-focused therapy, such as CBT-3M, has shown a strong signal of putative efficacy for young children treated for PTSD 4
- Treatment moderators, such as age, gender, and parent/caregiver involvement, may influence treatment response in children with PTSD 6