Today's topic is about "Children & Adolescents with Post Traumatic Stress Disorder (PTSD)" written with the book Treating Trauma & Grief in Children and Adolescents by Judith A. Cohen, Anthony P. Mannarino, and Esther Deblinger.

Introduction: Traumatic Events  

Children experience stressful events throughout their lives that vary in intensity or difficulty. Ongoing traumas that start early in life have the potential to dramatically alter the trajectory of a child’s development more than chronic traumas that begin later in life.

Examples of a traumatic event include:

• Physical or sexual abuse
• Witnessing or being the direct victim of domestic, community, or school violence    
• Severe motor vehicle or other accidents
• Potentially life threatening illnesses
• Natural and human-made disasters
• Sudden death of parent, sibling, or peer
• Exposure to war, terrorism, or refugee conditions
• Sudden or unexpected events
• Shocking nature of events
• Threat to life or bodily integrity
• Feeling intense terror, horror, or helplessness

Impact of Trauma  

Even after experiencing such traumatic events, many children are resilient and do not develop enduring trauma symptoms. The impact of an identical stressor varies considerably from child to child depending on several factors including:

• Developmental level or age
• Inherent or learned resiliency  
• Learned coping mechanisms
• External sources of physical, emotional, and social support support including family or friends

Trauma Symptoms  

Trauma symptoms refer to the behavioral, cognitive, physical, and/or emotional difficulties that are directly related to the traumatic event. PSTD symptoms include:

• Reexperiencing  
• Intrusive, upsetting thoughts or dreams about the traumatic event  
• Physical or psychological distress upon exposure to the reminders of trauma
• Avoidance and emotional numbing  
• Avoiding people, places, or situations that remind the child of the trauma  
• Emotional detachment or flatness
• Sense of foreshortened future
• Hyperarousal and mood  
• Increased startle reaction
• Hypervigilance
• Disturbed sleep
• Irritability
• Angry outbursts

PTSD also encompasses other depressive, anxiety, or behavioral symptoms including self-injury, substance abuse, imparied interpersonal trust, and affective instability.

Effects on Brain Function & Structure

Children with trauma experience a profound change in the way they seem themselves, the world, and/or other people as a result of their exposure. Everything a person does, thinks, or feels is associated with brain activity. The brain is dynamic and brain structure is interactive with brain functioning. Thus, it is not surprising that traumatic events have the potential to alter brain functioning and may also contribute to structural changes within the brain. For example, in a study children with trauma were found to have:

• Smaller intracranial volume (brain size)
• Lower IQs
• Smaller corpus callosum (the part of the brain that connects the right and left hemisphere)

Conclusion: Reregulation Through Accurate Diagnosis & Treatment

Given this, a return to a more adaptive psychological functioning would correspond to the normalization of brain function and perhaps, structure. Therapeutic and other interventions can result in the reregulation of a child’s emotional, cognitive, and behavioral functioning and can minimize or reverse the adverse impact of trauma on their brains and bodies. This is why a receiving an accurate clinical opinion is crucial; an evaluation can correctly diagnosis PTSD, assess the effects on brain functioning and structure, and identify effective treatment interventions.

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