Acute and Posttraumatic Stress Disorders in Children and Adolescents
Acute and posttraumatic stress disorders are reactions to overwhelming traumatic events that involve recurring, intrusive memories of the event as well as emotional numbness and increased tension or alertness (arousal). Children tend to avoid reminders of the event.
The disorder may develop after children witness or experience an act of violence, such as a dog attack, a school shooting, an accident, or a natural disaster.
Children not only reexperience the event, but they may also feel emotionally numb, extremely tense, and jittery.
The diagnosis is based on symptoms that occur after a traumatic event.
Treatment involves psychotherapy, behavioral therapy, and drugs.
Acute stress disorder (ASD) typically begins immediately after the traumatic event and lasts from 3 days to 1 month.
Posttraumatic stress disorder (PTSD) can be a continuation of ASD or may not develop until 6 months after the event.
Stress disorders may develop after children witness or experience an event that threatens their own or another’s life or health. During the event, they typically feel intense fear, helplessness, or horror. These events include acts of violence, such as child abuse, school shootings, car accidents, attacks by a dog, injuries (particularly burns), fires, wars, natural disasters (such as hurricanes, tornados, or earthquakes), and deaths. In young children, domestic violence is the most common cause. Not all children who experience a severe traumatic event develop a stress disorder.
Children do not have to directly experience the traumatic event. They may develop a stress disorder if they witness a traumatic event happening to others or learn that one occurred to a close family member.
Children constantly feel anxious. They usually fail in their attempts to avoid remembering the event. They may reexperience the traumatic event while they are awake (flashbacks) or asleep (as nightmares). Flashbacks are usually triggered by something associated with the original event. For example, seeing a dog may trigger a flashback in children who were attacked by a dog. During a flashback, children may be terrified and unaware of their surroundings. They may desperately try to hide or escape, acting as though they are in great danger. Less dramatically, children can reexperience the event in thoughts, mental images, or recollections, which are nonetheless greatly distressing.
Feeling emotionally numb or detached from their body is common. Children may lose interest in their usual activities, withdraw from other people, and worry about dying at a young age. They may feel extremely tense (called hyperarousal), making them jittery and unable to relax. They have difficulty sleeping.
Children may also feel guilty—for example, because they survived when others did not or because they could do nothing to stop the event. They may not remember important details of the event or may remember it incorrectly. For example, they may think that they were responsible for it.
Supportive psychotherapy may help. Therapists reassure children that their response is valid but encourage them to face their memories (as a form of exposure therapy). Behavioral therapy can be used to systematically desensitize children to situations that cause them to reexperience the event.
Children with acute stress disorder usually fare better than those with posttraumatic stress disorder, but they still benefit from early treatment.
SSRIs (a type of antidepressant—see Table: Drug therapy for depression) may help relieve some symptoms.