Post-Traumatic Stress Disorder

What is Post-Traumatic Stress Disorder (PTSD)?

PTSD is a trauma and stress disorder that a child or youth may develop after experiencing or witnessing a threatening event (called a trauma). This event could have led to a serious injury or death and they may have felt overwhelming fear, helplessness, or horror.

Here are some examples of traumatic events:

  • domestic or family violence, dating violence
  • community violence (shooting, mugging, burglary, assault, bullying)
  • sexual or physical abuse
  • natural disaster such as a hurricane, flood, fire, or earthquake
  • a serious car accident
  • sudden unexpected or violent death of someone close (suicide, accident)
  • serious injury (burns, dog attack)
  • major surgery or life-threatening illness (childhood cancer)
  • war or political violence (civil war, terrorism, refugee)

Children exposed to the same trauma may react very differently, even if they are in the same family. Even though many children will experience some trauma in their lives, many of them will not develop PTSD. The chances increase with how bad the trauma is. For example, a child who is the victim of sexual violence or who has witnessed the sudden violent death of a parent is at a higher risk of developing PTSD. Children and youth with PTSD continue to suffer the effects long after the trauma is over.

How do I know if my child has PTSD?

Signs and Symptoms

If the symptoms started after the child or youth experienced or witnessed a traumatic event, and if the symptoms don’t go away, they might have PTSD.  The symptoms can start right after the trauma or months or even years after.

There are four different types of post-traumatic stress reactions. To be diagnosed with PTSD, the child or youth should have at least one symptom from each of these three types.

1. The child or youth may re-live the trauma in their minds. They may:

  • have upsetting and disturbing memories, 'pictures', and thoughts stuck in their minds about what happened
  • act out parts of the event during play
  • have frightening dreams
  • act out the traumatic event or feel like it's happening right now
  • be very upset or have physical reactions when seeing or hearing reminders of the trauma (a siren, photo of a family member, door slamming, bedroom)

2. The child or youth may avoid things that remind them of the trauma. They may:

  • stay away from things associated with the trauma (clothing, dogs, if trauma was a dog attack)
  • avoid thoughts, feelings or conversation associated with the trauma

3. The child or youth may experience changes in thoughts and feelings as a result of the trauma. They may:

  • forget parts of the trauma or be confused about when things happened
  • think more negatively about themselves, others, and the world
  • blame themselves or others for the event
  • feel negative emotions (anger, fear, horror etc.) that wont’ go  away
  • lose interest in things they used to enjoy (quit sports team or dance class, no longer want to swim or play with friends)
  • show little emotion after a trauma or not want to be around people
  • not be able to feel positive emotions (pleasure, satisfaction etc.)

4. The child or youth may seem extremely alert and "on guard". They may:

  • have difficulty falling asleep or staying asleep
  • have a hard time concentrating or completing tasks
  • often be on "guard" or look for signs of danger
  • feel jittery or nervous, or easily startled; jump at sounds or possible threats (telephone ringing, a dog barking)
  • do things that are reckless and dangerous
  • become angry easily

PTSD in different age groups

The following chart lists symptoms that can be seen in children suffering from PTSD at different ages. It's important to remember that some of these symptoms may occur during stressful times and not just with PTSD. But if a child or youth has symptoms in reaction to a frightening event that remain for a long time, they may be suffering from PTSD.

 

Stage

Symptoms

Early childhood

  • fear of strangers, family, or situations (clingy, avoiding, crying)
  • replays trauma through play or artwork
  • more alert (easily startled, very aware of danger)
  • act younger or no longer use already learned skills (stop using the potty, start sucking thumb)
  • body complaints (stomach aches, headaches, aches and pains)
  • frightening dreams unrelated to the traumatic event

School-aged children

  • afraid of being separated from caregivers (doesn’t want to be apart, trouble sleeping alone)
  • loss of trust (doesn't trust caregiver to keep them safe)
  • negative view of the world (thinks world is dangerous)
  • replays trauma through play or artwork
  • difficulty concentrating
  • loss of appetite
  • does more things without thinking first (impulsive, fights without considering the consequences)
  • defiant, or has intense anger outbursts or aggression
  • mood changes, be unhappy or depressed
  • loss of interest in activities they used to enjoy
  • body complaints (stomach aches, headaches, aches and pains)

 

Teenagers young adults

  • afraid to be separated from caregivers (clingy, resists being alone, tries to be near)
  • loss of trust (mistrusts caregiver)
  • negative view of the world (thinks world is dangerous)
  • very irritable, angry outbursts
  • impulsive behaviour (substance use, self-harm)
  • defiant, aggressive
  • repeated thoughts of death, dying, killing themselves
  • risky behaviour, self-injury (cutting themselves, alcohol and drug use, unprotected sexual behaviour)
  • mood changes, seem unhappy or depressed
  • loss of appetite
  • loss of interest in activities they used to enjoy
  • body complaints (stomach aches, headaches, aches and pains)

 

 

What can be done?

The first step is to make sure the child or youth is safe and their basic needs are being met. After that, if they keep experiencing stress symptoms for a month or more after the trauma, it is important to seek professional help.

Getting help

Cognitive-behavioural therapy (CBT)

CBT is the most effective treatment for PTSD. It teaches children and their caregivers about trauma and ways to cope with and manage anxiety. The child or youth learns to gently face fears instead of avoiding them. They learn to identify and challenge or "boss back" their unhelpful beliefs such as "the world is a totally unsafe place" or "it's all my fault." In CBT, they may be asked to talk about the trauma while practicing how to relax. They retell the story to work through the event and soften the power of the memory and feelings about it.

In working on 'brave behaviour' the child or youth practices many types of situations with their therapist. They will follow up at home with bravery goals. A bravery goal could be retelling the story of the trauma or sleeping alone. If the trauma was a car accident, they might have a goal riding in a car again. They might imagine riding in the car and then touch the car. Later they might sit in the parked car and then ride in it on an empty street, etc. They learn to take baby steps and pay attention to their stress levels as they go along.

Medications

Medications such as antidepressant and anti-anxiety medications can help some children deal with symptoms of depression, anxiety, anger, sleep problems, and nightmares. To learn more about medications used to treat symptoms of PTSD, click here.

Parents and other caregivers play a very important role in helping children with PTSD. Parents can help their children learn about anxiety and practice ways to relax. They can also help their child challenge unhelpful or fearful thinking by using helpful coping thoughts, and by learning how to engage in brave behaviours.

Other tips to try at home:

  • have a calm, structured home environment (practice ways to relax)
  • develop and keep the same routines (morning, school, homework, bedtime)
  • provide clear expectations, limits, and consequences
  • help your child learn about and identify feelings
  • pay attention to your child’s feelings
  • remain calm when your child is anxious
  • have realistic expectations for your child’s age
  • plan for transitions (getting to school, visiting relatives)
  • help your child focus on the here and now ( ask child  describes what they hear, see, smell, etc.)
  • show your child the way you identify and accept your feelings
  • show how to solve problems
  • take care of your own needs – talk to others for support, and ask for help when you need it
  • be aware of and manage your own reactions. Get help if you are struggling with this
  • praise and reward your child's efforts to cope with trauma and stress (powerful ways to reinforce behaviour)

Research has shown that healthy living is very important for managing PTSD and in promoting wellness. Healthy living includes:

  • regular exercise
  • relaxation
  • a balanced diet
  • healthy relationships
  • stress management
  • good sleep
  • community involvement
  • social support 

Where to from here? 

Talk to your doctor and look for help from a mental health professional by:

For additional information about options for support and treatment in BC, visit the Finding Help section of our site.

Below you will find some key resources. A full list of resources are on the right hand side bar. 

Post-Traumatic Stress Disorder (AnxietyBC)
The Post-Traumatic Stress Disorder section introduces PTSD, lists symptoms of PTSD on the basis of age difference and provides home management strategies for families of people with PTSD.

BC Children's Hospital

This is an agency of Provincial Health Services Authority, providing provincial tertiary mental health services to the citizens of British Columbia. Programs include: Adult Tertiary Psychiatry, Geriatric Psychiatry, Forensic Psychiatric Services, Child & Adolescent Mental Health, Women’s Reproductive Mental Health, as well as the Provincial Specialized Eating Disorders Program for children and youth located at the BC Children’s Hospital.

Provincial Health Services Authority

Provincial Health Services Authority (PHSA) is one of six health authorities – the other five health authorities serve geographic regions of BC.

Ministry of Health

British Columbia Ministry of Health

RBC Children's Mental Health Project

RBC Children’s Mental Health Project is RBC's cornerstone “health and wellness” pillar; RBC Children’s Mental Heath Project is a multi-year philanthropic commitment to support community-based and hospital programs that reduce stigma, provide early intervention and increase public awareness about children’s mental health issues.

BC Children's Hospital Foundation

Through a wide range of fundraising events and opportunities, The BC Children's Hospital Foundation is united with its donors by a single, simple passion - to improve the health and the lives of the young people who enter BC Children's Hospital every day.