This week we are thinking about PTSD and, specifically, PTSD in children and young people. PTSD stands for Post- Traumatic Stress Disorder, and it is a mental condition that people may develop after a traumatic life-threatening event or serious injury occurs. Many people associate PTSD with soldiers returning from active war missions, but did you know it can occur after anything that is perceived to be a trauma? And that PTSD can happen in children? Yes – PTSD can occur at any age.
It is important to bear in mind that most people recover from traumatic incidents with their mental health intact. However, when an individual feels that their mental health has deteriorated after the event, or that symptoms are lasting for longer than one would expect, then it is worth considering seeing a GP to talk about the possible occurrence of PTSD. PTSD has a unique set of symptoms which last for longer than six weeks, interfere with normal life and for which mental health support is available.
So, what defines a traumatic event is that it has the ability to elicit feelings of panic, helplessness, or dread as a direct result of the threat of serious injury or death.
Some examples of traumatic events may include:
- road traffic incident
- natural disasters such as fire
- child abuse
- witnessing domestic violence
- acts of terrorism
- traumatic childbirth
However, trauma is subjective, which means that something that may be traumatic to one person may not be to another. For a child, this can be something like losing sight of their parents or caregivers in a crowded place, experiencing the absence of a parent or caregiver due to unforeseen circumstances, seeing parents or caregivers in the hospital, or the death of a loved one.
Young people can experience a trauma for one of three reasons:
- because it happens to them
- they see it happen to others
- they hear about it
That means that trauma can happen vicariously. We are advanced creatures; in that we can often share the emotional responses of others just by witnessing them.
Have you ever been watching an episode of ‘You’ve Been Framed!’ when someone has sent in a video of themselves having an accident? Some of us can watch, whilst some of us wince and must look away. Have you ever wondered why it seems like we can feel their pain, sometimes in the very same body part? There is an evolutionary survival mechanism at play here.
We are hard wired to avoid dangers in life, to ensure that we survive as a species. This goes right back to stone age times when people lived in tribes and had to be on constant high alert for what would be a threat to the tribe:
- This means that even hearing where a danger is, will often trigger that part of our brain that detects danger; the fight, flight, freeze area of the brain known as the amygdala.
- When this area of the brain is heightened, and it often will be during a traumatic incident, it notices all the relevant information from that scene; the sights, smells, light, temperature, and sounds and stores them in an area called the hippocampus.
- Now this part of the brain knows to avoid those things in the future because it believes that they pose a real and serious threat to survival.
- These stored memories often form what survivors of PTSD refer to as triggers. So, a soldier who has returned from war, for example, may be going about their day, quite happily, then suddenly they hear a car backfire, and it can take them right back in their hippocampus to a time and a place where that noise meant danger.
PTSD is when the nervous system seems “stuck” in a state of constant alert, making the sufferer feel vulnerable and unsafe continually, or feeling like they are reliving the traumatic experience repeatedly. Often a person suffering with PTSD will report feeling stuck – and you can imagine how this would affect their everyday life.
So, what does this mean for children? Statistics show that “75% of children will have experienced at least one trauma by the end of adolescence.” (Eleanor Leigh, Patrick Smith, Andrea Danese, South London and Maudsley NHS Foundation Trust, www.NipInTheBud.org) Now, not all young people will develop PTSD, but we can be reminded here that PTSD is the brain’s normal reaction to extremely adverse situations, only stuck on repeat; much like a record that keeps on skipping. The child may be reliving the traumatic event repeatedly.
Immediately following a traumatic event, young people will often feel:
- in shock
Most people will show some short-term distress directly following a trauma. As the weeks and months go on, the trauma becomes less and less pertinent, and people are left with a narrative memory, which is often unpleasant, but they can talk about it and often compartmentalise it with some rational thought, maybe even a dose of humour.
In the early days following a traumatic event there are things the family can do to help the child to process these feelings of fright, distress and shock.
You might feel unsure of what to do or say when your child has suffered a trauma so here are some things which may help:
- Be with them and give them time. Let them talk at their own pace – it’s important not to pressure or rush them, but often just sitting next to them, showing your proximity and concern without questioning can be a huge comfort.
- Focus on listening rather than overly questioning. Respect what they are choosing to share and see any sharing as a privilege that they feel able to share with you at this point.
- Try repeating what they say, to show you’ve heard them. If they say, “I’m scared of roads now.” You could say, “I am hearing that you’re feeling scared of roads now. Is that right?”
- Understand that they may have mixed feelings. For example, accept their feelings of sadness about what has happened, and equally accept that they may feel anger, disbelief or even laughter. Sometimes without thinking, we may accidentally deny their feelings because we want to help them. For example, if they say, “I feel so guilty and bad.” We might quickly, without thinking say, “No you shouldn’t feel guilty!” but a better reaction might be to say, “It’s a normal reaction to feel guilty after an accident. I can remember once when I did…xyz…and I felt so guilty. The feeling sat there in my stomach like a lump! It turned out it wasn’t my fault at all, I just blamed myself for so long. I’ve learned from that not to feel guilty for too long and to accept that everybody makes mistakes.” When we normalise our children’s feelings and relate to it with a time when we felt that way, we can really help support their mental wellbeing.
- Be careful not to blame them or criticise their reactions. You may be questioning whether they did everything they could to prevent the disaster but keep those thoughts to yourself as the child may feel that they need to take the blame. Bear in mind the fact that they survived a life-threatening situation as best they could. Some children react in ways that don’t seem to make sense to us, like laughing. This may be because they simply don’t know how to deal with the sheer number of emotions they may be experiencing. Some children may even dissociate.
- Try not to reject the seriousness of the trauma. Often well-intentioned comments like, ‘don’t worry, it could be worse’ may be true, but this isn’t usually helpful to hear. It’s important to recall that people have no choice in what they find traumatic or how they’re affected after a trauma.
- Keep important discussions private or change topic if the child suddenly walks in. After trauma, children are often on high alert and hypervigilant to everything. They may be listening specially to hear how the adults are dealing with the situation.
- Look after your own mental health too, by getting support from family, friends, the
GP or your own counsellor.
So, how might you become aware that your child may be experiencing PTSD instead of recovering from a trauma in a timely way? Those who have concerns about the symptoms they are seeing in their child are advised to see their GP; it is a good idea to keep a diary of behaviours that you see so that if you do choose to see a GP, you’ll have a record of how your child has progressed after the event. According to Eleanor Leigh, Patrick Smith, Andrea Danese of the South London and Maudsley NHS Foundation Trust ‘about one in seven young people develop persistent PTSD.’ (Nipinthebud.com)
Things to look out for:
- Re-living the trauma. This can include intrusive memories and flashback experiences. Your child may report seeing images in their mind, and equally they may say that they can feel, hear, or even smell things that occurred during the event. The memories are often felt to be out of their control and have a real quality to them. Your child may report that they feel as if the trauma is happening again. Children may go over the event through play, younger children especially may repeat a scenario through their role play with dolls or cars for example.
- Changes in thinking. Your child may now perceive the world as a dangerous place and find that things they used to do without thinking seem scary or dangerous. They may be feeling excessively guilty or worried to a point that this may stop them from taking normal risks.
- Trouble sleeping often marked by reoccurring nightmares. Your child may revert to earlier behaviours such as bed wetting or needing soothing toys or routines that they had given up previously. They make wake in the night and come to your bedside again, or may experience frightening nightmares or night terrors.
- Avoidance of traumatic triggers. This can include people, places, and things, but may also include thinking. For example, your child may be trying to get rid of the pictures in their mind, which might be perceived as lacking concentration in class, when really, they are trying anything to distract themselves from the recurring thoughts. They may make you drive a different route, to not have to pass the place where the trauma occurred.
- Changes in the body. A form of physiological hyperarousal which can be seen as being jittery or unusually spooked. This can also manifest as sleep disturbance, poor concentration, feeling grumpy, and a hypervigilance to threat, often manifesting as looking over one’s shoulders, scanning the environment.
- Mood changes. Your child may show signs of being withdrawn, depressed or may cry much more easily. They may also be annoyed or irritable.
It’s not a sign of weakness to develop PTSD, but it is important to do something about it. According to the long-term health study done in America called the ACE Study (Adverse Childhood Experiences Study) we know that Post-Traumatic Stress (PTS) symptoms which persist during childhood or adolescent years, often leave the person more susceptible to relationship and mental health issues such as depression or low self-esteem later in life. It may even lead to self-harm, or drug or alcohol abuse and early death.
The first thing to do is to seek help from your GP, who can make a referral to Child and Adolescent Mental Health Services (CAMHS). Often there may be a waiting period with CAMHS, but they may be able to offer Trauma Focused CBT or EDMR which have been known to help in cases of PTSD. In addition, finding a qualified therapist is another way to support your child which can complement what the GP suggests. There is evidence that talking therapies are helpful, including Solution Focused Hypnotherapy and Psychotherapy, which is what we offer at the Youth Fairy. Other therapies such as art, body movement and creative therapies may offer help.
Don’t forget that your support can make a massive difference in your child’s recovery. You don’t need to have the right answers or find ways to make things perfect for them. Sometimes just having the knowledge that you are there for them, really listening to them with empathy and understanding, and not making assumptions about how they feel, can make the biggest difference.
You can educate yourself about PTSD. Take care of your own mental and physical health, which models healthy behaviour for when they are ready to do the same. Again, it’s that old analogy of putting on your oxygen mask first, so that you can have enough oxygen to go on to help your child – this illustrates for us all just how vital your role is.
You can keep doing normal things with them, schedule fun things but don’t be upset if they can’t go on the day. Normalise their mixed feelings after experiencing such a traumatic event.
Most of all, be patient. Recovery is a process that takes time and often involves setbacks. The important thing is to stay positive and maintain support for your young one. When you can hold your child’s hand, offer hugs, and stay present and curious, you know you are doing the best you can in a difficult situation.
For more information on PTSD please have a look at these websites:
www.nipinthebud.org(short film on PTSD)