PTSD in Children: Symptoms, Causes, & Treatments

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after a person experiences a traumatic event.^1,2 A traumatic event is an experience that involves violence, death, or danger. It can be an isolated event, like a natural disaster or car accident, or a recurring experience, like abuse, which can lead to complex PTSD.

The person may experience the event themselves, witness it happen to someone else, or hear of it happening to a loved one. This condition can affect people of all ages.

How Many Children Develop PTSD?

Studies have found that between 14-43% of children and teens have experienced at least one instance of childhood trauma.³ Between 3-15% of girls and 1-6% of boys go on to develop PTSD after trauma.

Does Trauma in Childhood Always Cause PTSD?

Experiencing a traumatic event does not guarantee that your child will develop PTSD. Some people can experience trauma and not show signs of PTSD. Having a good support system and getting treatment early on may help children cope more effectively with and reduce the likelihood of them developing PTSD.^4,5 Conversely, if there is ongoing trauma, like recurring domestic abuse, a child may develop C-PTSD instead of PTSD.

PTSD Symptoms in Children

PTSD is a reaction to trauma. Children with PTSD re-experience the traumatic event in some way, engage in avoidance, and experience anxiety and mood changes.^1,2 While people of all ages can develop PTSD, it can present differently in children versus adults.⁴

Childhood PTSD symptoms can include:^4,5

• Difficulty remembering details of the traumatic event
• Confusion around the sequence of events
• “Omen formation,” which is a belief that the child could have predicted or foreseen the trauma and possibly prevented it
• Post-traumatic play, where children act out the trauma
• Fear and helplessness
• Depression
• Anger
• Aggressive behavior
• Nightmares
• Difficulty sleeping
• Avoidance of people, places, or things that remind them of the traumatic event
• Conflict with family and peers
• Physical symptoms, like stomachaches and headaches

Symptoms of PTSD in Teens

The symptoms of PTSD in teenagers can vary, but can include:

• Flashbacks: Vivid, recurring memories of the traumatic event.
• Nightmares: Terrifying dreams related to the traumatic experience.
• Unwanted memories: Distressing and intrusive thoughts or images related to the trauma.
• Irritability: Feeling angry, irritable, or easily agitated.
• Difficulty sleeping: Having trouble falling or staying asleep.
• Hypervigilance: Being overly alert or on edge, constantly scanning for threats.
• Exaggerated startle response: Reacting strongly to noises or unexpected touches.
• Negative changes in mood: Persistent negative emotions, such as fear, anger, guilt, or shame.
• Negative changes in thinking: Distorted beliefs about oneself or others (e.g., “I can’t trust anyone”).
• Blaming oneself: Feeling guilty or responsible for the traumatic event, even if it was not their fault.
• Headaches, stomachaches, or other unexplained pains: Physical complaints without apparent cause.
• Changes in appetite or weight: Significant changes in eating habits leading to weight loss or gain.

Outward Signs of PTSD in Children

Children with PTSD may show different signs depending on their age.⁶ For example, young children may cry and cling to their parents, while teens may be more likely to act out by using drugs or alcohol, self-harming, or having risky sex. You may notice changes in different areas of your child’s life, like school, friendships, and how they eat and sleep.

Common signs of PTSD in children include:⁶

• Displays of anxiety, depression, guilt, and/or shame
• Distress when separated from a parent or caregiver
• Excessive crying or screaming
• Changes in weight or appetite
• Sleeping problems
• Poor concentration
• Drug or alcohol use
• Self-harming
• Disordered eating, like binging or restricting their food

Outward Signs of PTSD in Teens

Outward symptoms of PTSD in teenagers can manifest in various ways, and they might not always be immediately recognized as signs of trauma.

Some common outward symptoms of PTSD in teenagers include:

• Aggression: Acting out, being irritable, or having angry outbursts.
• Avoidance: Avoiding people, places, or situations that remind them of the traumatic event.
• Withdrawal: Becoming socially isolated, spending more time alone, or avoiding social interactions.
• Risk-taking behavior: Engaging in dangerous activities without considering the consequences.
• Regression: Reverting to behaviors typical of a younger age, such as bedwetting or excessive clinging.
• Academic problems: Decline in school performance, lack of interest in school, or frequent absences.
• Mood swings: Rapid and intense changes in mood, from anger and irritability to sadness and fear.
• Anxiety: Excessive worry, restlessness, or a constant state of fear or apprehension.
• Depression: Persistent feelings of sadness, hopelessness, or a lack of interest in activities.
• Guilt or shame: Feeling responsible for the traumatic event or feeling ashamed about it.
• Trouble sleeping: Insomnia, nightmares, or night terrors.
• Physical complaints: Frequent headaches, stomachaches, or other unexplained pains.
• Fatigue: Feeling constantly tired or lacking energy.
• Difficulty trusting: Having difficulty trusting others, even close friends and family members.
• Strained relationships: Experiencing conflicts and difficulties in relationships with family, peers, or authority figures.
• Social withdrawal: Avoiding social interactions and isolating themselves from friends and family.
• Self-harm: Engaging in self-destructive behaviors such as cutting or burning oneself.
• Substance misuse: Using drugs or alcohol as a way to cope with the trauma.

What Causes PTSD in Children?

Any event where a child feels that their life or the life of someone they care about is threatened can lead to PTSD. Certain risk factors can increase the likelihood that a child who experiences a trauma goes on to develop PTSD, including family problems, a lack of social support, having a parent with mental health issues, and a history of emotional problems.^4,5

Some common causes of PTSD in children include:⁴

• Sexual, physical, or emotional abuse
• Natural disasters like hurricanes, fires, or tornadoes
• School shootings
• Kidnapping
• Car accidents
• Suicide of a friend or family member
• Domestic violence at home
• Community violence
• War

Which Children Are at a Higher Risk of Developing PTSD?

Children and teenagers can develop PTSD after experiencing a traumatic event, but certain factors may increase their risk. Having multiple risk factors only increases a child’s chances of developing PTSD after being exposed to a traumatic event.

Some risk factors for children developing PTSD include:

• Direct exposure: Children who directly experience a traumatic event are at higher risk.
• Personal injury: If the child was physically harmed during the event, the risk of developing PTSD increases.
• Close family member involvement: If a close family member experiences the trauma, it can indirectly affect the child.
• Witnessing trauma: Children who witness traumatic events, especially those involving violence or accidents, are at risk.
• Lack of parental support: Children who do not receive adequate support and comfort from parents or caregivers after a trauma are at higher risk.
• Lack of community support: Limited support from the community or social network can increase the risk.
• Pre-existing mental health conditions: Children with pre-existing anxiety or mood disorders may be more susceptible.
• Previous trauma: Children who have experienced previous traumatic events are at higher risk.
• Genetic factors: Some research suggests a genetic predisposition to anxiety disorders, which could include PTSD.
• Ineffective coping strategies: Children who lack effective coping skills or problem-solving abilities may struggle to process and deal with traumatic events.
• Ongoing stress: Persistent stressors in the child’s life, such as poverty or ongoing family conflict, can exacerbate the risk.
• Secondary adversities: Additional stressful events occurring after the trauma, like displacement or loss of a loved one, can increase vulnerability.
• Bullying or victimization: Children who are victims of bullying or other forms of victimization are at higher risk.
• Social isolation: Lack of social support and feelings of isolation can contribute to the risk.

Can Childhood PTSD Symptoms Show Up Long After the Traumatic Event?

It’s important to note that not every child who experiences a traumatic event will develop PTSD. Many children are resilient and can recover with the appropriate support and interventions. Early detection and timely, evidence-based interventions, including therapy, can significantly reduce the impact of trauma and help prevent the development of PTSD in at-risk children.

However, childhood PTSD can persist if it is not effectively treated. If traumatic experiences in childhood are not adequately addressed, the symptoms of PTSD can continue to affect a person as they grow older. In some cases, symptoms may even appear or become more severe in adulthood, especially when an individual encounters additional stressors or triggers that remind them of the original trauma.

How Is PTSD Diagnosed in a Child?

Childhood PTSD, like PTSD in adults, is typically diagnosed by mental health professionals, such as psychiatrists, psychologists, or licensed therapists. The diagnosis is made based on a thorough assessment of the individual’s symptoms, history, and behavior.

Here are the general steps involved in diagnosing childhood PTSD:

1. Interviews: The mental health professional conducts interviews with the child (if age-appropriate) and, if possible, with parents or caregivers to gather detailed information about the child’s symptoms, experiences, and behaviors.
2. Observation: The professional observes the child’s behavior, emotional responses, and interactions during the assessment process.
3. DSM-5 criteria: The mental health professional evaluates the child’s symptoms based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard classification of mental disorders used by mental health professionals.
4. Exploring the traumatic event(s): The mental health professional explores the child’s history to identify specific traumatic events and assess the impact of these events on the child’s emotional well-being.
5. Assessing severity: The professional evaluates the severity of the traumatic experiences and their impact on the child’s mental health.
6. Rule out other disorders: The mental health professional differentiates PTSD from other mental health disorders with similar symptoms, ensuring an accurate diagnosis.
7. Comorbidity: Identifies and evaluates any coexisting mental health conditions that might be present alongside PTSD.
8. Duration of symptoms: PTSD symptoms must persist for at least one month to meet the diagnostic criteria.
9. Functional impairment: The clinician evaluates how the symptoms of PTSD are impairing the child’s daily functioning, such as school performance, relationships, and overall well-being.
10. Collaboration with other professionals: Mental health professionals often collaborate with other professionals, such as pediatricians or school counselors, to gather a comprehensive understanding of the child’s situation.
11. Feedback and discussion: The professional discusses the findings with the child and their parents or caregivers, providing feedback and explaining the diagnosis.

Treatment for PTSD in Children

If your child has experienced a traumatic event, consider seeking professional PTSD treatment for them, even if they’re not showing signs of PTSD. Getting help shortly after a trauma may help prevent PTSD.⁵ If your child is already showing signs of PTSD, talk to their pediatrician or find a therapist using an online therapist directory where you can search for those with expertise in childhood trauma and trauma-informed care.⁷

Types of therapy used to treat childhood PTSD include:

• Cognitive behavioral therapy (CBT) is commonly used for children with PTSD.⁵ While it was originally intended to treat depression and anxiety, it’s been adapted to help with PTSD.
• Trauma-focused cognitive behavioral therapy (TF-CBT) is also designed for this purpose.⁴ It focuses on changing negative thoughts and beliefs related to the trauma and teaching children coping skills to manage anxiety.
• Cognitive processing therapy (CPT) is another type of CBT that has been used with children who have experienced trauma.⁸ It also helps them change negative thought patterns and develop more adaptive ones, but it is typically limited to 12 sessions.
• Eye movement desensitization and reprocessing (EMDR) is another type of treatment where a therapist asks a client to recall the trauma while engaging them in side-to-side rapid eye movements.⁵
• Young children may benefit from play therapy, which uses toys, games, and art to help children talk about and process their trauma.⁴

Medication for Childhood PTSD

Medications can be prescribed to help manage symptoms of PTSD in children, especially when the symptoms are severe and significantly impact the child’s daily functioning and well-being. However, it’s essential to approach medication as part of a comprehensive treatment plan that includes therapy and support from mental health professionals. Medications should be prescribed and monitored by qualified healthcare providers, such as child psychiatrists or pediatricians with expertise in mental health.

How to Explain PTSD to a Young Child

Telling a child about their PTSD diagnosis is a delicate and sensitive process. It’s essential to approach the conversation with care, honesty, and reassurance.

Here are some steps and tips to consider when talking to your child about their PTSD:

• Pick a calm moment: Choose a time when your child is relaxed and receptive, not when they are upset or distracted.
• Find a quiet, comfortable space: Create an environment where your child feels safe and secure.
• Keep it simple: Explain PTSD in simple terms suitable for your child’s age and level of understanding. Avoid using complicated or scary language.
• Use metaphors: Sometimes, metaphors or analogies can help children grasp difficult concepts. For example, you might compare the brain to a computer and explain that PTSD is like a glitch in the system that can be fixed with help.
• Be honest: Be truthful about their feelings and experiences. Acknowledge their emotions without judgment.
• Reassure them: Emphasize that PTSD is a common reaction to trauma and that it is not their fault. Assure them that with support, time, and appropriate help, they can feel better.
• Open the door for questions: Let your child know it’s okay to ask questions. Be patient and willing to answer them honestly.
• Validate emotions: Allow your child to express their feelings, whether it’s fear, sadness, confusion, or anger. Reassure them that their emotions are valid.
• Explain the role of therapy: Let your child know that therapy is a safe space where they can talk about their feelings and learn coping strategies. Explain that therapists are trained to help people with PTSD feel better.
• Discuss supportive resources: Mention support groups, hotlines, or helplines that can provide additional assistance if needed.
• Be patient: Understand that it might take time for your child to process the information and come to terms with their diagnosis. Be patient and offer ongoing support.
• Listen actively: Encourage your child to share their feelings and thoughts. Listening without judgment is incredibly important.

10 Tips for How to Care for a Child With PTSD

As a parent or caregiver, you play a vital role in supporting a child with PTSD. Giving your child an opportunity to talk about their trauma, supporting them, and encouraging positive habits can help them cope with their symptoms. Also taking good care of yourself is important so you can be the best possible support.

Here are 10 ways parents and caregivers can help children with PTSD:

1. Create a Safe Environment for Them to Talk About Their Trauma

Children may vary in how comfortable they are talking about their trauma. Explain that you are here to talk if they would like, but don’t pressure them to open up before they are ready.

2. Acknowledge Their Feelings

Hearing your child talk about their trauma can be difficult and you may feel like there is nothing you can do to “fix” it. Instead, focus on listening and expressing empathy. Use feeling words to help children label their emotions (e.g., “scared,” “worried,” or “sad”).

3. Avoid Harsh Discipline

Children who have experienced trauma, particularly those who have been abused, can be further traumatized by harsh forms of discipline, like spanking. When discipline is necessary, stick to gentler approaches, like taking away electronics. Always try to ensure that the punishment is fair and remember to offer praise when they exhibit good behavior.

4. Support Their Self-Confidence

Children with PTSD often have low self-esteem, especially if their trauma involved abuse. You can help encourage their confidence by highlighting their strengths. Also be sure to refrain from name-calling or putting down the child, even when they misbehave.

5. Create a Schedule

Children who are dealing with emotional concerns like PTSD can benefit from structure and a schedule. Come up with a consistent wakeup and bedtime and encourage them to eat regular meals and get good sleep. This gives them stability, which is important for trauma survivors.

6. Collaborate With Their Teachers & Other Childcare Providers

Collaboration between parents and teachers is essential for a child’s educational and emotional well-being. When parents and teachers work together, they can create a supportive and consistent environment for the child, leading to positive outcomes.

7. Encourage Good Sleep Hygiene

Children with PTSD often have difficulty sleeping and may struggle with nightmares. You can help your child sleep well by encouraging a consistent bedtime, limiting sugar, caffeine, and liquids before bed, and doing a relaxing activity each night. If your child continues to struggle with sleep, speak with their pediatrician about other options.

8. Encourage Their Participation in Positive Activities

Isolation is a common response to trauma. Try to help your child engage in positive and healthy activities, like joining a sports team or club. If they are too anxious, you can agree to go with them in the beginning and then gradually encourage them to do it on their own for longer periods of time.

9. Teach Them Healthy Coping Techniques

Children who are dealing with PTSD can benefit from learning healthy coping skills, like mindfulness or grounding techniques. These skills can help reduce anxiety and promote calm. Consider learning about them and practicing together as a family.

10. Engage in Your Own Self-Care

As a parent, it’s important that you also take care of your own physical and emotional needs. This allows you to be a better support to your child and models healthy behavior. Be sure to do positive, healthy activities for yourself and don’t hesitate to seek your own therapy if needed.

Can PTSD in Children Be Prevented?

Preventing childhood PTSD involves creating safe, supportive, and nurturing environments for children. While it’s impossible to prevent all traumatic events, there are strategies and interventions that can reduce the risk of developing PTSD after a traumatic experience.

How Long Can PTSD Last?

The duration of childhood PTSD can vary significantly from one individual to another. Some children may experience symptoms for a relatively short period, while others may have persistent symptoms that last for months or years. The length of time PTSD symptoms persist can be influenced by several factors.

Final Thoughts on PTSD in Children

Supporting a child with PTSD can be difficult. Knowing the signs of childhood trauma and PTSD can give you a sense of what to look for in your own child. If you suspect that your child is dealing with PTSD, don’t hesitate to reach out for help today.