DESCRIPTION

• Post-traumatic stress disorder (PTSD) may occur after the child’s/adolescent’s exposure(s) to trauma by experiencing, witnessing, or learning about serious injury or death of a loved one, serious injury to self, and threats or actual physical and sexual violence.
• The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria include the following:
  • One or more distressing intrusion symptoms associated with the traumatic event(s) including involuntary memories, dreams, and dissociative reactions (e.g., flashbacks); prolonged, marked psychological and/or physiologic distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
  • Persistent avoidance of stimuli associated with the traumatic event(s)
  • Negative alterations in cognitions and mood
  • Marked alterations in arousal and reactivity; youth may demonstrate irritable behavior and angry outbursts, reckless or self-destructive behaviors, hypervigilance, and sleep disturbances.
  • Symptoms must be present for >1 month with impairments in one or more domains: social, cognitive, academic, or in any other areas of functioning.
• A distinction is made for symptomatic expression in children aged <6 years who may express distressing traumatic memories in expressive play or frightening dreams with or without explicit content related to the trauma. Children aged <6 years may also engage in repetitive play without appearing to be distressed. Traumas occurring to caregivers at this developmental stage are especially distressing. Disturbances can be seen in relationships with parents, siblings, peers, and other caregivers as well as with negative changes in school behavior.

EPIDEMIOLOGY

• Studies show a higher prevalence of PTSD in girls (3–15%) than in boys (1–6%).
• A national survey of >10,000 children aged 13 to 18 years indicated that 5% met the criteria for PTSD in their lifetime with an increased prevalence in older adolescents. There are no definitive studies of prevalence rates of PTSD in younger children in the general population.

ETIOLOGY

Although PTSD may be considered in the aftermath of any traumatic event, the most predominant etiology of the disorder is experiencing a serious threat of physical injury or death, sexual assault, sexual and physical abuse, and witnessing domestic violence at home. Children and adolescents with these traumatic experiences should be observed for changes in cognitive and behavioral functioning. These changes may present differently depending on the youth’s age.

RISK FACTORS

• Severity of the trauma
• Parent’s reaction to the trauma and/or parental psychopathology
• Low social support
• How physically close or far away the child is to the trauma
• Experiencing multiple traumatic events especially when the events involve people hurting other people
• Female gender
• Previous trauma exposure
• Preexisting psychiatric disorders
• Research suggests a genetic heritability for PTSD risk between 5% and 20%.

GENERAL PREVENTION

• The best prevention of PTSD is parent and social support following trauma exposure.
• Assessment and psychiatric treatment in the immediate aftermath of trauma exposure can also prevent PTSD or reduce the severity of potential PTSD symptoms.

PATHOPHYSIOLOGY

Children and adolescents with abuse-related PTSD have been found to have significant impairment in attention and executive function. They have greater difficulty with tasks of sustained attention, are more easily distracted, and are more impulsive than peers without PTSD.

COMMONLY ASSOCIATED CONDITIONS

• Anxiety disorders
• Depression
• Externalizing behavior disorder
• Substance use disorders among adolescents
• Self-harm and suicidal behaviors