By Vivian Chan, MC, RCC

As is common with many mental disorders, the symptoms of post-traumatic stress disorder (PTSD) may present differently in children than in adults. Adolescents and children may be caught somewhere in the middle of these symptoms, so special attention is needed to make accurate diagnoses. There are many instruments that are helpful in assessment of PTSD including the Pynoos version of the PTSD Reaction Index, the 15-item Child/Adolescent Impact of Events Scale, that Child PTSD Checklist, or the 30-item Child Stress Reaction Checklist (Donnely & Amaya-Jackson, 2002).

Definition
A trauma is considered to be the following according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision:

exposure to an extreme stress involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate

Symptoms
The diagnostic criteria involves the following symptoms: distressing recollections of the event (may be demonstrated in repetitive play), nightmares, reliving experience (may be demonstrated through trauma re-enactment), intense distress at reminders of trauma, and reactivity to external cues that resemble trauma. In order to meet the criteria for a diagnosis, the child must also persistently avoid any stimuli associated with the trauma and have symptom of increased arousal levels (such as difficulty sleeping, outbursts of anger, difficulty concentrating, etc) that were not present before the trauma.

Impacts of Psychological, Social, and Family Functioning
As is to be expected, all areas of a child’s life can be impacted by the symptoms of PTSD. Psychologically, the child may be internally tormented with nightmares and flashbacks. They may not have any way of expressing the feelings that arise for such fearful events.

Therefore, the behavioural outbursts, dissociative symptoms, or avoidance behaviours may affect the child in social settings. Playmates may no longer be interested in playing the same game over and over, or they may be afraid when the traumatized child begins expressing fearful aspect of the event. The traumatized child may perform poorly in school, due to their difficulty concentrating. The child might also become less social due to hypervigilence and an increased startle response, especially if the trauma is ongoing such as with abuse.

An entire family system may be affected by the trauma of a child, even if the trauma was exclusively the experience of the child (which I think is rarely the case). Due to the drastic changes in the child’s behaviours, siblings and parents are apt to respond differently to the child only multiplying the confusion that the child is already experiencing.

This excerpt serves as a brief description of only a few ways in which childhood PTSD can impact a child’s entire world. In conclusion, I find it helpful to recall the resiliency that many children have and to recognize the vast evidence that children can still grow and function in a healthy way even if they have experienced trauma.
The Vancouver Wishing Wells Counselling Service provides counselling support for individuals, couples, children, and families in Greater Vancouver. Our office is located in the Oakridge area across from Oakridge Mall, accessible by public transit. Our counselling services include Play Therapy, Filial Therapy, Child Behaviour Consultation and Support, and Counselling for Adolescents. Should you need to discuss with one of our therapists for consultation, please Contact Us for more information.

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