Quinta was a 4-year-old girl who entered treatment when her mom noticed her reluctance to play with other children at school. Quinta was severely shy, had nightmares almost every night, and would often “zone out” at home. People often associate the term “PTSD” with adult war veterans, but did you know that infants as young as 1 year old can meet criteria for this diagnosis?
Symptoms of PTSD (Post-Traumatic Stress Disorder) can develop after a person experiences an event that is perceived as dangerous and emotionally overwhelming. For children, these experiences might include witnessing domestic violence at home (hitting, screaming, throwing objects), being in a severe car accident, being threatened with physical violence, or experiencing a sexual act that is not appropriate for their age and against their will. Children can also develop PTSD symptoms if they themselves did not directly experience the event. Witnessing or learning about traumatic events can be overwhelming in and of itself, and ultimately lead to the development of PTSD.
The symptoms and behaviors associated with Post-Traumatic Stress Disorder are organized into four categories and can look different in each person. These categories include Intrusion Symptoms, Avoidance, Change in Mood and/or World View, and Changes in Reactivity.
- Intrusion Symptoms
Intrusion symptoms include unwanted memories of the event, nightmares, and forms of dissociation. We often see intrusion symptoms emerge at bedtime. For example, Jackson entered treatment because it was taking him over an hour to fall asleep, he cried for his mom to stay in bed with him, had nightmares nearly every night, and wet the bed five nights per week (a form of dissociation). Bedtime can be a very scary time for kids, because it is dark, children are often encouraged to be alone in their beds, and the quiet and still atmosphere allows for scary memories to resurface. When a child is experiencing intrusion symptoms, it is very important to help them learn how to reconnect to their bodies in a safe way. One way you can do this is by teaching your kiddo to identify where they experience emotions in their bodies. For example, they might feel tension in their jaw when they’re anxious or feel heat throughout their body when they’re angry. Another way to decrease intrusion symptoms is to allow your child to process their experiences through play. Since play is the universal language of children, we often see them use toys (dolls, animal figures, cars) to reenact aspects of the traumatic event, such as yelling, inappropriate touching, or cars crashing together. When we allow children to show us their perception of the event, we are supporting them in healing and making sense of their experience.
Avoidance is another behavior associated with PTSD and occurs when someone actively tries to avoid reminders of the traumatic event. Trauma reminders might include memories, thoughts, or feelings about the event (including positive ones), or people, places, or objects associated with the event. Genesis began therapy after she witnessed a physical altercation between her mom and dad. After attending her cousin’s 8th birthday party, mom and dad began fighting, and mom sustained injuries that required medical attention. While family parties were once associated with joy and excitement, Genesis began to throw a tantrum before family gatherings because they triggered memories of her parents’ scary fight. If your child has experienced a trauma, it’s helpful to assist them in recognizing their triggers and to notice what they might be avoiding. For example, some children become avoidant toward people who identify as the same gender as their perpetrator or the location of the traumatic event (the bathtub, the car, their school). In the case of a car accident, you might remind your child that although the scary event happened in the car, that does not mean that cars are always unsafe. You can also assist your child in identifying what might help them feel safer in the car, such as bringing their favorite stuffy for comfort or “being in charge of the directions” to promote a sense of control. If your child is experiencing avoidance, compassion and patience are key.
- Traumatic Events
Traumatic events can also impact the way your child views the world and how they view themselves. Mistrust, guilt, and self-blame are themes we commonly observe when working with kiddos who have experienced trauma. For example, when Diego heard that his father had been killed, he told his mom that it was his fault and that he should have done more to protect his dad. According to Diego, if he hadn’t stopped to get snacks on his way home from school, his dad would still be alive. Hearing your child make statements such as, “I’m bad” or “It’s all my fault” might feel heartbreaking (or like an irrational exaggeration), but these statements are windows into how your child is viewing themselves and the role they played in the traumatic event. A mental health therapist can help your child reevaluate these distorted thoughts and process their feelings of guilt, anger, horror, etc.
- Change in Mood/Word View and Changes in Reactivity
A change in alertness/reactivity is another symptom of PTSD and can be viewed on a spectrum. If your child is over-reactive, they might be fidgety, reckless, or get startled easily, and if your child appears under-reactive, they might have difficulty concentrating or appear sleepy or lethargic. Lila, for example, would often get in trouble at school for “daydreaming” and not paying attention in class, and her teacher encouraged mom to have her tested for ADHD. However, when Lila’s therapist asked her about her difficulty concentrating in class, Lila told her therapist that she was unable to focus because all she could think about was her dad, who had been deported unexpectedly 3 months prior.
If your child has experienced or witnessed a scary, overwhelming event and is experiencing any of the symptoms described above, a mental health therapist can support them in managing their symptoms and healing from their experience. That being said, while many experiences can lead to PTSD, not all children who experience a trauma develop full criteria for a PTSD diagnosis. If you suspect your child might have PTSD or would benefit from additional support, there are clinicians who are trained and ready to help. To set up an assessment, please call our Intake Department at 888.526.2211.
Megan Bunting is a clinical therapist in The Guidance Center’s Long Beach Outpatient Program where she helps guide children and families struggling with mental health conditions or abuse toward positive and productive futures. She is especially passionate about helping families heal, communicate and connect through play. Before joining The Guidance Center team in 2018 as an intern, Bunting worked as a residential counselor at an emergency shelter for runaway and exploited teens. Bunting earned a Master’s Degree in Social Work at Cal State Los Angeles.