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PTSD in Children and it Impacts 8 pages

Child and PTSD


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Post-traumatic Disorder


Nature equipped the body with an inherent mechanism to avoid danger or defend oneself against it (NIMH, 2013). But in some persons, this naturally protective mechanism goes haywire and the reaction to fight or flee remains even in the absence of real danger. This abnormal condition is called post-traumatic disorder (NIMH).


The condition grows out of a horrifying experience of physical violence or threat in the person, a loved one or even a stranger as witnessed by the person who later develops the condition (NIMH, 2013). PTSD was first recognized as a mental and emotional condition among returning war veterans. But it can also develop from other traumatic experiences, such as rape, torture, beating, captivity, accidents, fires, road accidents or natural disasters (NIMH).


Social Workers and PTSD


The social worker performs a number of professional roles. They act as brokers, advocates, case managers, educators, facilitators, organizers, and managers. In handling PTSD cases, the social worker functions fundamentally as a case manager (CSC, n.d.). As a case manager, she helps the client locate the services needed and how to access them. She handles difficult situations, such as homelessness, helplessness, physical and mental health conditions like PTSD, crime victimization and vulnerability in children. In the process, however, she performs the other roles in connection with the nature of PTSD (CSC).


But social workers are as human as anybody else. Their task as frontline professionals to assist victims of violence and disasters cope with their traumas exposes them to the same traumas as their victims (Nauert, 2007; University of Chicago, 2007). New studies found that repeated exposures or narrations of trauma from victims render social workers vulnerable to developing PTSD themselves. One such study was conducted by Assistant Professor Brian Bride of the University of the Georgia School of Social Work. Findings showed that 7.8% of the general population experienced PTSD in their lifetime. In comparison, 15% of social workers surveyed experienced the condition (Nauert, University of Chicago).


Over and above assisting disaster victims, social workers also hear from children accounts of their own misfortunes (Nauert, 2007; University of Chicago, 2007). These children undergo a variety of stressful or traumatic situations, such as aggression, incest and sexual abuse. Assistant Professor Bride found that social workers who repeatedly hear and absorb such accounts over and over again and as part of their profession undergo secondary traumatic stress disorder. This side effect was only recently recognized by researchers in the spouses of returning war veterans and among the families of survivors of the holocaust. Bride’s study was the first of its kind to explore the phenomenon among social workers (Nauert, University of Chicago).


From his sample group of 300 practicing social workers in mental health and substance abuse, child welfare and school social work, Bride listed and rated the effects of PTSD on the practitioners (Nauert, 2007; University of Chicago, 2007). Of the total surveyed, 40% continued to have thoughts about the clients’ traumas unconsciously; 22% experienced detachment from others; 26% experienced emotional numbness; 28% felt that their lives would be short; 27% were irritable; and 28% had concentration problems. Although the rate of secondary traumatic stress has been found to be significant among social workers, the awareness about the problem is inadequate. When they suffer from work burnout, they may mistake it for a lack of self-care rather than possible secondary PTSD (Nauert, University of Chicago).


Bride’s recommendations include educating social work students on understanding and minimizing the risk of secondary PTSD; employers’ provision for continuing education on the phenomenon, reasonable workloads, support, time-off and mental health insurance; professionals’ involvement in enjoyable activities of their choice; and the sharing of schedule of most difficult and distressing cases (University of Chicago, 2007; Nauert 2007). He warned incoming social workers about the potential of PTSD’s debiting the quality of care they could provide. If not appropriately handled, this phenomenon may cause them to abandon their profession. Bride also suspected that this could one reason why social workers give up on their profession (University of Chicago, Nauert).


II. Problem Overview


Prevalence, Populations Affected


Child protective agencies receive reports of approximately 3 million PTSD cases every year, 5.5 million which are those of children (JIF, 2005). Of this number, 30% have evidence of abuse and the different types of abuse. These are 65% neglect, 18% physical abuse, and 7% psychological or mental abuse. Statistics also reveals that 3-10 million children experience or witness violence at home every year. About 40% to 60% of the cases involve physical abuse. Yet a large 2/3 of child abuse cases remain un-reported (JIF).


Contributing and Risk Factors


Major studies showed that 15-43% of girls and 1-43% of boys experience at least one traumatic experience and 3-15% of girls and 1-6% of the boys develop PTSD (JIF, 2005). Rates are higher for those who go through the most severe traumas. These are lower for those who receive family support and if their parents are less affected by the trauma. Those who are distant from the trauma are also less affected (JIF).


Other contributing factors to developing PTSD are witnessing beatings, assaults or rape (JIF, 2005). The more frequently a child is exposed to the trauma, the greater the risk of his developing PTSD. Girls are also more likely to develop PTSD than boys. Some studies provide evidence that certain ethnic groups have higher levels of PTSD symptoms than Whites (JIF).


Impacts on the System




PTSD often develops in combination with other mental or emotional disorders (JIF, 2005; PTSD, 2014; AACAP, 2013). These include depression, memory and cognition problems (Harney, 2000 as qtd in JIF), anxiety and externalizing disorders. Anxiety disorders include separation anxiety and panic disorder. Externalizing disorders include attention-deficit or hyperactivity disorder, oppositional defiant disorder and misconduct (Hamblen, 1999 as qtd in JIF). A 2003 National Child Traumatic Stress Network study found that 25% of children with this disorder were substance abusers as compared with those who had no PTSD. If PTSD is not promptly or adequately treated, it can further affect children and other age groups in many other ways (JIF).


Relationship and Behavior


Children who have been subjected to traumas develop disturbed relationships with their own family members and peers and exhibit this by acting it out (Hamblen, 1999 as qtd in JIF, 2005). Many studies have illustrated the connection between exposure to trauma, such as that that occurs as community violence, and aggressive and anti-social behavior (NIMH, 2001 as qtd in JIF), such as PTSD (JIF).


Physical Health


A study conducted by Solomon (2005 as qtd in JIF, 2005) revealed that PTSD exacerbates the risk for serious and chronic illnesses. These include circulatory, digestive, musculoskeletal, endocrine, respiratory, and infectious diseases. Victims are also discouraged from valuing and protecting their health. Other studies also trace adult health problems to maltreatment suffered in childhood (Felitti et al., 1998 as qtd in JFI).


School Performance


PTSD also logically creates behavioral problems in school, relationships, mental health, attention to class, concentration on lessons and memorizing (Goodman, 2002 as qtd in JIF, 2005).


It is clear that PTSD inflicts damage on the child welfare system (JIF, 2005) The potential costs alone of the disorder on the children and society itself are large enough to warrant prompt and serious attention (JIF, 2005). All involved workers and agencies can and should respond to this sensitive condition in children and their families affected by PTSD (JIF).


III. Etiology Theories


Causes and Consequences


Like older people, children go through stressful experiences, which may either just disappear without effect or impress deep emotional or physical impact (AACP, 2013; PTSD, 2014; Lubit, 2014). A child’s likelihood of developing PTSD depends on the seriousness of the trauma to his perception, its repetition, his closeness or involvement in it and his relationship to the victim. The child first becomes confused or restless or exhibit strong fear, helplessness, rage, fright or deep sadness. He may even be in denial of it. When the experience is repeated, he may turn emotionally numb in order to block the pain that the memory brings, a defense mechanism called dissociation. He avoids places or situations that will relive the trauma. In addition, he may be less emotionally less responsive or more depressed, withdrawn or detached from his own feelings. The problem may be maintained or persist if he remembers the tragic events frequently; has troubling or frightening dreams because of it; behaves or feels that it is recurring; or has developed repeat physical or emotional symptoms, which remind him of the original trauma (AACAP, PTSD, Lubit).


Symptoms they may exhibit include worrying about dying early, a loss of enthusiasm, body aches and pains, sudden and extreme emotional responses, sleep problems, irritability or outbursts of anger, disturbed or loss of the ability to concentrate, childishness, unusual sensitiveness to the environment and repeating the traumatic behavior itself (AACAP, 2013; PTSD, 2014; Lubit, 2014). These symptoms can linger and repeat for months to years. Hence, it calls for early intervention (AACAP, PTSD, Lubit).


Diagnosis and Treatment




The DSM-5 criteria set for PTSD in children older than 6 and those younger than 6 are similar (Lubit, 2014). This is exposure to a real, actual or threatened death, injury or sexual attack. There should be one or more symptoms linked to the traumatic event or experience. These must be persistent avoidance of the stimulus connected with the event or disturbed perception of it as well as the mood linked to the event. There should also be strong changes in arousal and reaction to the event. The disturbance should be more than a month. There should also be great mental suffering or disturbed relationship with family members, caregivers or changed behavior in school. The victim should demonstrate an inability to connect the disturbance to any physical effect of a substance taken or a medical condition (Lubit).


No specific laboratory or imaging studies are used in diagnosing PTSD but certain psychological tests have helped establish it (Lubit, 2014). These are the Child and Adolescent Psychiatric Assessment: Life Events Section and PTSD Module or CAPA-STD; Children’s PTSD Inventory or CPTSDI; Child PTSD Symptom Scale; Abbreviated UCLA PTSD Reaction Index; Trauma Symptom Checklist for Children (TSCC); Impact of Events Scale Screen for Child Anxiety Related Disorders (SCARED); Beck Depression Inventory; and the Mississippi Scale for Combat-Related PTSD (Lubit).


Treatment Goals and Forms


In the overall, treatment aims at providing the suffering child with a safe environment and to attend to his or her pressing medical conditions (Lubit, 2014). It will be psychological, non-pharmacological and pharmacological combined support. Psychological therapy includes helping him regain mastery over his traumatic experience with an end-view of re-establishing a sense of safety. It also aims at eliminating the shame associated with the symptoms and addressing other ensuing emotional and behavioral problems. This is the task of the social worker. Non-phamacological regimen can be in the form of cognitive-behavioral therapy, relaxation techniques, and play therapy. The most effective cognitive-behavioral therapy has been the trauma-focused CBT. Relaxation techniques include biofeedback, yoga, deep relaxation, self-hypnosis, medication and self-efficacy. Pharmacological treatment may include selective serotonin reuptake inhibitors for anxiety, depression, avoidance behavior and intrusive recollection. These medications are, however, not allowed for pediatric patients. Other pharmacological support can be provided with beta blockers, alpha-adrenergic agonists, mood stabilizers, and, at infrequent times, atypical antipsychotics (Lubit).


Early intervention is certainly the first option when the trauma has already occurred (AACAP 2013, PTSD 2014, Lubit 2014). Parents, school and peers must extend support. There must be a comprehensive effort at re-establishing a sense of safety in the victim. The social worker is a main healthcare figure in this task. She may help provide psychotherapy for the child, his family or his group. It should help the child verbalize, sketch, play or write about the trauma as part of therapy and healing. Behavior modification techniques and cognitive therapy can also help lessen or eliminate the child’s fears and insecurities, which he cannot handle. And when needed, medication should be administered to control agitation, anxiety, depression or sleep disorders. Child psychiatrists and social workers will be most helpful in detecting and treating PTSD in children. If his family and these professionals show enough sensitiveness and support, the child can learn to cope with the memory of the trauma and lead a healthy and useful life (AACAP, Lubit, PTSD). #




AACAP (2013). Posttraumatic stress disorder. Number 70, Facts for Families”


American Academy of Child and Adolescent Psychiatry. Retrieved on October 12,


2014 from


CSC (n.d.). Roles of a social worker. Chadron State College: Nebraska State College


System. Retrieved on October 12, 2014 from


JIF (2005). PTSD and children in child welfare system. Vol. 10 # 3, Practice Notes: Jordan Institute for Families. Retrieved on October 12, 2014 from


Lubit, R.H. (2014). Posttraumatic stress disorder in children. Medscape: WebMD. LLC.


Retrieved on October 12, 2014 from


Nauert, R. (2007). Social workers at rsk for PTSD. Psych Central: University of Georgia.


Retrieved October 12, 2014 from


NIMH (2013). What is post-traumatic stress disorder. National Institute of Mental


Health: U.S. Department of Health and Human Services. Retrieved on October 12, 2014




PTSD (2014). PTSD in children and teens. National Center for PTSD: U.S. Department of Veterans Affairs. Retrieved on October 12, 2014 from


University of Georgia (2007). Social workers may indirectly experience post traumatic stress disorder. Science Daily: Science Daily LLC. Retrieved on October 12, 2014



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