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DrFee, Psychologist
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What are symptoms of PTSD in children? Is there an age group

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What are symptoms of PTSD in children? Is there an age group that is more vulnerable? Any long term affects? How to help children cope after parental abduction when court-ordered visitation?
Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.

I am sorry if this issue has touched your life personally. PTSD is a painful condition for all ages.

The diagnostic criteria for PTSD are going to be divided into a subgroup for children under the age of 6 with the new Diagnostic Manual (which is coming out in 2013). You didn't specify if the child is younger or older than six, so I will give you the symptoms for the under 6 subgroup. (Let me know if you want the other list).

But --before I do --I'll give you the three criteria that define any trauma:

1. It is unexpected
2. The victim is unprepared
3. There's nothing the victim can do to prevent the trauma (helpless)

Here's the DSM-V criteria:

Subtype: Posttraumatic Stress Disorder in Preschool Children

A. In children (less than age 6 years), exposure to one or more of the following events: death or threatened death, actual or threatened serious injury, or actual or threatened sexual violation, in one or more of the following ways:

1. directly experiencing the event(s)

2. witnessing, in person, the event(s) as they occurred to others, especially primary caregivers (Note: Witnessing does not include events that are witnessed only in electronic media, television, movies or pictures.)

3. learning that the traumatic event(s) occurred to a parent or care giving figure;

B. Presence of one or more intrusion symptoms associated with the traumatic event(s) , beginning after the traumatic event(s) occurred:

1. spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) (Note: spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.)

2. recurrent distressing dreams in which the content and/or affect of the dream is related to the traumatic event(s) (Note: it may not be possible to ascertain that the frightening content is related to the traumatic event.)

3. dissociative reactions in which the child feels or acts as if the traumatic event(s) were recurring, (such reactions may occur on a continuum with the most extreme expression being a complete loss of awareness of present surroundings). Such trauma-specific re-enactment may occur in play.

4. intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)

5. marked physiological reactions to reminders of the traumatic event(s)

One item from criterion C or D below:

C. Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event occurred, as evidenced by avoidance or efforts to avoid:

1. activities, places, or physical reminders that arouse recollections of the traumatic event

2. people, conversations, or interpersonal situations that arouse recollections of the traumatic event.

D. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by one or more of the following:

1. markedly diminished interest or participation in significant activities, including constriction of play

2. socially withdrawn behavior

3. persistent reduction in expression of positive emotions

E. Alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred, as evidenced by two or more of the following:

1. irritable, angry, or aggressive behavior, including extreme temper tantrums

2. hypervigilance

3. exaggerated startle response

4. problems with concentration

5. sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.

H. The disturbance is not attributable to another medical condition.

You asked if any age group is more vulnerable than another age group. There are variables that make people more vulnerable to the development of PTSD in addition to age. I'll list them for you:

1. Age is often a factor -- Child abuse often starts at a young age and children actually make up the majority of PTSD victims --even more than combat veterans.

2. Single Incident Trauma vs. Repeated Trauma --Sufferers of repeated trauma are far more vulnerable for developing PTSD than are sufferers of single incident traumas.

3. Natural Disasters/Accidents vs. Purposeful/Man Made Disasters --Acts of terror or something done on purpose by people are more likely to result in PTSD in victims than are victims of natural disasters such as earthquakes, hurricanes, etc.

How to cope:

1. Therapy is one the best ideas. There's two types of therapy that are often recommended to address PTSD

Eye Movement Desensitization and Reprocessing (EMDR)
It's a very gentle, but effective approach where you process the trauma while fully aware that it's over, you're safe, and you are distant from it. People who do EMDR with children have to be specially trained above and beyond the normal EMDR training.

Trauma Focused CBT for Children:
This approach is more "exposure based" (i.e. you need to be desensitized to the trauma) although it does address the need for safety, relaxation, grounding etc. It's shown in the research to be highly effective, I just prefer the EMDR philosophy/approach.

2. Reassure the child that they are safe (make sure they are indeed safe)
3. Be honest with them (talk to a therapist if you need help in HOW to talk to your child about the trauma).
4. Don't expect more than is age appropriate for your child --they can't handle the trauma like an adult would (and adults often don't do that well, either!)
5. Help your child express their feelings --drawing with them, chance to talk, or just play (especially with younger children--they work out feelings via play) --get help with this if you need it.
6. monitor exposure to news/media --they don't really need to hear about other traumas right now.
7. Above all --express love! Hugs, words, fun times together.

Please feel free to follow up with me about any of these points.

Warm Regards,
Dr. Fee

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