Trauma in Children

Based on a lecture series by

Peter Ash, M.D.

For a review of posttraumatic stress disorder, the adult posttraumatic stress disorder file.

Posttraumatic stress disorder in children may present differently than in adults. In both instances, there must be a trauma, an overwhelming extraordinary experience, often one that is either life-threatening or gives the person a sense of losing control.

Amnesia for the event is uncommon in children, although distortions may be present.

Children may engage in numbingly repetitive play (reenacting the trauma) instead of classic flashbacks. The psychodynamic theory is that play is an attempt at mastery, but with posttraumatic stress disorder this often doesn't work.

Note that children may be withdrawn and inhibited, and most often will not talk about the trauma spontaneously.

Increased arousal may be present, similar to adults, with insomnia, irritability, and anger.

A naturalistic study of 26 children who survived a horrific kidnapping in which they were literally buried alive for a period of time before escaping shed some insight into childhood posttraumatic stress disorder. 26/26 of the children had moderate symptoms or worse. In studies of less severe trauma, only a portion had posttraumatic stress disorder.

The reaction of parents or others in a child's surroundings (calm v. anxious, supportive v. unavailable) may shaped a child's response. Studies of British children during the Blitz in World War II showed that those who spent the night in bomb shelters with calm parents had less symptoms than those who were with anxious parents.

There are few good predictors of who will develop posttraumatic stress disorder and who won't. One thing posttraumatic stress disorder is not is a function of "character" or "toughness."

Death and bereavement are other common childhood traumas. Separation from parents during hospitalization (less common today when parents can spend the night) may be more traumatic than the medical illness prompting the hospitalization). Gun violence is very prevalent, especially among urban kids.

Biological and Psychosocial Interactions: "no words but the body keeps score." Even if a child has no verbal memory of the trauma, the child has a physiological memory. There is little habituation to the startle response (it tends not to go away). Flashbacks are a sensorimotor phenomenon. Desensitization does not seem to work (although Virtual Reality studies in adult Vietnam combat survivors is showing some initial promise). Somatization is highly correlated with childhood trauma. The earlier the trauma, the greater the effect.