Posttraumatic Stress Disorder in Children 

  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Apr 20, 2011
 

Background

Posttraumatic stress disorder (PTSD) in children and adolescents occurs as a result of a child's exposure to one or more traumatic events that were life-threatening or perceived to be likely to cause serious injury to self or others. In addition, the child or adolescent must have responded with intense fear, helplessness, or horror. Traumatic events can take many forms, including physical or sexual assaults, natural disasters, traumatic death of a loved one, or emotional abuse or neglect. Severe emotional trauma has widespread effects on children's development. These effects include undermining children's sense of security in a reasonable and safe world in which they can grow and explore, as well as causing a child to not believe that their parents can protect them from harm. The premature destruction of these beliefs can have profound negative consequences on development.

Traumatized children and adolescents are frequently preoccupied with danger and vulnerability, sometimes leading to misperceptions of danger, even in situations that are not threatening. Multiple researchers (eg, Kardiner, van der Kolk[1] ) note that, once posttraumatic stress symptoms emerge, PTSD leads to neurophysiologic correlates that impact brain function in developing children and adolescents.

In 1980, the term PTSD first came into existence in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III).[2] Only in 1987 did the DSM series make reference to traumatized children. The first major studies of the effects of large traumas on children were Bloch's 1956 study of the effect of a tornado in Mississippi, Lacey's 1972 study of the effects of an avalanche on a Welsh school, Newman's 1976 work on the Buffalo Creek disaster,[3] and Terr's 1979 research on the Chowchilla bus kidnapping.[4]

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Pathophysiology

Evidence indicates a genetic predisposition for PTSD, suggesting that it may be linked to the individual's temperament and to reactivity of the hypothalamic pituitary axis.

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Epidemiology

Frequency

United States

Lifetime prevalence of PTSD is 8%.[5] The incidence and course of PTSD vary and depend on various factors, including the type of trauma, the proximity to the stressor, and the reaction of the child's parents. After being kidnapped, witnessing the death of a parent, or suffering domestic violence, the rate of PTSD may be 95-100%. Following a sniper attack at school, 40% of children experienced moderate-to-severe PTSD. In one study of children in foster care, 64% who had experienced sexual abuse had PTSD, and 42% who had experienced physical abuse fulfilled the PTSD criteria. Moreover, 18% of the children who were not abused also met PTSD criteria, presumably because they had witnessed violence.

International

The prevalence in a location overwhelmingly depends on the endemicity of violence in the region.

Mortality/Morbidity

Alone, PTSD is not a fatal disorder. Nevertheless, it frequently leads to conduct disorder, substance abuse, depression, and risk-taking that poses considerable danger.

PTSD has a considerable morbidity rate, particularly for children. In addition to the symptoms of numbing, hyperarousal, and recollections of the event that adults experience, children suffer from a decreased ability to participate in the normal academic and social activities of childhood. Therefore, a traumatic event can send a child down a new developmental path, one that is less favorable than the one the child was previously on.

A host of emotional and behavioral problems frequently arise as a result of PTSD and are not part of the criteria for categorical diagnosis. These include disruptive behavior disorders, eating disorders, sexual acting out, other risk-taking activities, depression, the full range of anxiety disorders, dissociation, mood lability, violence, and difficulty concentrating.

Studies of adults who were sexually or physically abused as children demonstrate significantly higher rates of PTSD (72-100%) than studies of children who were abused (21-55%). This finding indicates that the full impact of abuse may not be experienced until a child reaches adulthood, engages in adult relationships and responsibilities, and develops more sophisticated cognitive capabilities.

Race

No major racial predominance is observed; however, PTSD is more common among individuals in low socioeconomic groups and among those living in areas in which violence is endemic.

Sex

PTSD is more common in women than in men.

Age

PTSD occurs in people of all ages, but younger and elderly persons are the most vulnerable.

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Contributor Information and Disclosures
Author

Roy H Lubit, MD, PhD  Assistant Clinical Professor, Mount Sinai School of Medicine; Clinical Faculty, Department of Child Psychiatry, New York University School of Medicine; Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Angelo P Giardino, MD, PhD  Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc

Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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