All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD). 

Examples of PTSD symptoms include 

• Reliving the event over and over in thought or in play 
• Nightmares and sleep problems 
• Becoming very upset when something causes memories of the event 
• Lack of positive emotions 
• Intense ongoing fear or sadness 
• Irritability and angry outbursts 
• Constantly looking for possible threats, being easily startled 
• Acting helpless, hopeless or withdrawn 
• Denying that the event happened or feeling numb 
• Avoiding places or people associated with the event 

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).  

Examples of events that could cause PTSD include 

• Physical, sexual, or emotional maltreatment 
• Being a victim or witness to violence or crime 
• Serious illness or death of a close family member or friend 
• Natural or manmade disasters 
• Severe car accidents 

Treatment for PTSD 

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families may be needed. Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry.  Medication may also be used to decrease symptoms. 

Prevention of PTSD 

It is not known exactly why some children develop PTSD after experiencing stressful and traumatic events, and others do not. Many factors may play a role, including biology and temperament.  But preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.