Post Traumatic Stress Disorder and Children

Nana Finds information for grandparents raising grandchildren on the after-affects a traumatic experience can have on grandchildren. Often times, grandparents are raising grandchildren because of a traumatic experience that occurred in their grandchildren’s life, such as witnessing a violent act, physical or sexual abuse, parent’s death, or sudden abandonment. The trauma may cause Post Traumatic Stress Disorder (PTSD).

Read on to learn how to recognize PTSD, prevent it, teach your grandchildren coping skills, and how to help your grandchildren overcome Post Traumatic Stress Disorder.

Post Traumatic Stress Disorder (PTSD)

Post Traumatic Stress Disorder: development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (APA, 1996).

Under some circumstances, grandchildren may have been exposed to trauma in their personal lives and that is why they are being raised by their grandparents. Child psychologists suggest grandparents can help prepare grandchildren to cope with trauma by understanding the nature of trauma, teaching grandchildren skills for responding to an emergency, and learning how to mitigate the after-effects of trauma.

PTSD Related Trauma

By the very unexpected nature of trauma, one can never totally prepare for it. And because each individual responds differently to emotional upset, it is impossible to predict trauma after-effects. Under certain circumstances, trauma can induce Post Traumatic Stress Disorder (PTSD). Unrecognized/untreated PTSD can have a lifelong negative impact on the affected individual. Grandparents raising grandchildren can influence the outcome of a grandchild’s response to trauma stress by creating an environment in which PTSD is less likely to develop to the point of life impact.

Not all emotionally upsetting experiences will cause PTSD. Trauma sufficient to induce PTSD has specific characteristics and circumstances, including situations

• perceived as life-threatening,
• outside the scope of a child’s life experiences,
• not daily, ordinary, normal events,
• during which the child experiences a complete loss of control of the outcome, and
• when death is observed.

Disasters, violence, and accidents are just some of the experiences that can lead to PTSD. Preparing grandchildren for trauma involves giving them skills and knowledge to survive the experience and emerge with as little potential as possible for developing PTSD.

Skills to Survive Traumatic Experiences

Survival skills for traumatic experiences are essentially emergency action plans. Carrying out emergency action plans not only helps a child retain some personal control, but increases the potential for a healthy outcome. Children must know how to:

• Follow directions in any emergency (i.e., stay in their classroom during a lock down)
• Get help in any type of emergency (i.e., dial 911 or call a neighbor)
• Mitigate specific emergencies (i.e., take shelter during a tornado)
• Report the circumstances (i.e., tell an adult if a stranger approaches them or touches them)
• Say “no” and mean it (i.e., firmly shouting “no, don’t touch me”).

Implementing survival skills requires knowing right and wrong. Children must know or be able to recognize:

• Appropriate vs. inappropriate touching (i.e., shoulder vs. genitals).
• Appropriate vs. inappropriate information sharing (i.e., who is at home at what times).
• Presence of appropriate vs. inappropriate people (i.e., the teacher on playground duty vs. a prowling stranger).

Skills to Mitigate PTSD

While there is no predictability in who will develop PTSD, it is possible to take steps to prepare children ahead of time and by doing so, lessen the PTSD potential. Children need to be taught lessons about trauma. Learning about people who have experienced trauma and gone on to live healthy lives gives children role models and hope for their own future.

During a traumatic experience, children will survive better if they have a structure to follow and can maintain some sense of control. Learning the survival skills will aid in maintaining this control. You can help your grandchildren by providing them with accurate and specific information about their immediate safety, about what has happened and about what will happen to them next (James, 1989). Knowledge helps them control their thoughts and feelings.

Following a trauma, debriefing is critical. Your grandchildren will vary concerning their willingness and readiness to talk about their experiences. Some will play out the event, while others may be more comfortable writing or drawing about the event. What is important is the opportunity to communicate. There are different avenues for your grandchild to communicate, including online discussion forums for children (Sleek, 1998).

Trauma Counseling

Your grandchild’s initial debriefing should be child-centered and nonjudgmental. You, or another adult, doing the debriefing should recognize that each child did his or her best, no matter what the outcome, and refrain from offering advice. Grandparents should recognize that no two children will have the same thoughts, feelings, or opinions. All expressions about the trauma are acceptable.

Following a trauma, it is also important to help your grandchild reestablish control. Reviewing survival skills and drills and planning for “next time” reestablishes strength. Allowing your grandchild to make choices reestablishes their governance over their own lives. It is advised by child psychologists that the child be involved in trauma counseling.

Identifying PTSD Symptoms

Everyone reacts to trauma. What differentiates normal reaction from PTSD is the timing of the reaction, its intensity, and the duration of the reaction. Trauma includes emotional as well as physical experiences and injury. Even second-hand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or disaster, even if only through graphic media reports, should be watched for signs of emotional distress (National Institute of Mental Health, 2000).

Symptoms lasting more than one month post trauma may indicate a problem. Specific symptoms to look for include:

• Re-experiencing the event (flashbacks),
• Avoidance of reminders of the event,
• Increased sleep disturbances, and
• Continual thought pattern interruptions focusing on the event.

In children, symptoms may vary with age. Separation anxiety, clinging behavior, or reluctance to return to school may be evident, as may behavior disturbances or problems with concentration. Children may have self doubts, evidenced by comments about body confusion, self-worth, and a desire for withdrawal. As there is no clear demarcation between adolescence and adulthood, adult PTSD symptoms may also evidence themselves in adolescents. These may include recurrent distressing thoughts, sleep disturbances, flashbacks, restricted range of affect, detachment, psychogenic amnesia, increased arousal and hypersensitivity, and increased irritability and outbursts or rage.

How to Help Your Grandchild with PTSD

Making the diagnosis of PTSD requires evaluation by a trained child psychologist. Children often express themselves through play. Because the teacher sees the child for many hours of the day including play time, the teacher may be the first to suspect all is not well. Where the traumatic event is known, caregivers can watch for PTSD symptoms. However, traumatic events can involve secrets. Sexual abuse, for example, may take place privately. Children should be monitored for changes in behavior that may signal a traumatic experience or a flashback to a prior traumatic experience.

Grandparents can help a grandchild suspected of post traumatic stress disorder by:

• Gently discouraging reliance on avoidance; letting your grandchild know it is all right to discuss the incident;
• Talking understandingly with your grandchild about their feelings;
• Understanding that children react differently according to age – young children tend to cling, adolescents withdraw;
• Encouraging a return to normal activities;
• Helping restore your grandchild’s sense of control of his or her life; and
• Seeking professional help with a child psychologist specializing in trauma counseling.

Professional assistance is most important since PTSD can have a lifelong impact on a child. Symptoms can lie dormant for decades and resurface many years later during exposure to a similar circumstance. It is only by recognition and treatment of PTSD that trauma victims can hope to move past the impact of the trauma and lead healthy lives. Thus, referral to a child psychology professional is critical. The school psychologist is a vital resource, and guidance counselors can be an important link to an effective mental health professional.

Although professional assistance is ultimately essential in cases of PTSD, grandparents must deal with the immediate daily impact. Becoming an informed caregiver is the first step in helping traumatized grandchildren avoid the life long consequences of PTSD.

Resources to Help You

• American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Avenue, NW, Washington, DC, 20016-3007, 202-966-7300, http://www.aacap.org
• American Psychiatric Association, 1400 K Street, NW, Washington, DC 20005, 202-682-6000; http://www.psych.org
• American Psychological Association, 750 First Street, NE, Washington, DC 20002, 202-336-5500, http://www.apa.org
• Anxiety Disorders Association of America (ADAA), 11900 Parklawn Drive, Suite 100, Rockville, MD 20852, 301-231-9350; http://www.adaa.org
• Disaster Stuff for Kids, http://www.jmu.edu/psychologydept/4kids.htm
• Federal Emergency Management Agency http://www.fema.gov/kids
• International Society for Traumatic Stress Studies (ISTSS), 60 Revere Drive, Suite 500, Northbrook, IL 60062, http://www.istss.org
• National Center for Kids Overcoming Crisis, (includes Healing Magazine online) 1-800-8KID-123, http://www.kidspeace.org/facts
• National Center for PTSD, 215 N. Main Street, White River Junction, VT 05009; 802-296-5132; http://www.ncptsd.org
• National Center for Post-Traumatic Stress Disorder of the Department of Veterans Affairs http://www.ncptsd.org/
• National Institute for Mental Health (NIMH) 6001 Executive Boulevard, Rm 8184, MSC 9663, Bethesda, MD 20892-9663; 301-4513, Hotline 1-88-88-ANXIETY, http://www.nimh.nih.gov