The symptoms that indicate that a child has PTSD differ depending on his or her age and stage of development when the trauma happened. A 1994 study, conducted by psychiatrist Christopher J. Lonigan, who interviewed 5,687 schoolchildren after Hurricane Hugo, found that younger children are more apt to develop PTSD after a disaster than older kids.
Many of the PTSD symptoms that children suffer, in addition to the absence of flashbacks, are very different from those of adults. Carlos’s little sister, who can’t yet use very many words, began sucking her thumb after their father pushed her down the basement stairs. When her mother leaves her at day care, she screams for hours at a time. Bill’s little brother has nightmares and is terrified of being alone. Their troubles demand immediate attention from adults. According to Terr’s research, children over the age of three or four rarely suffer amnesia, completely forgetting the one-time trauma they have endured. "Children generally accept horrors more easily than adults," she concluded after her study of the young kidnapping victims from Chowchilla. "Adults use more immediate denial." Children, especially older children, do consciously put the trauma out of their minds.
Instead of experiencing denial, children often deliberately try to rid their minds of all thoughts of the traumatic incident and of the feelings that arise when they have these thoughts. By making a decision to avoid thinking or talking about what they’ve gone through, they try to heal their wounds and to appear as if everything is fine. This conscious pushing aside of thoughts and feelings is different from denial, disassociation, or emotional numbing because it is a conscious decision.
Some of the general changes in behavior that indicate a child may be suffering from PTSD are listed below. According to the American Academy of Child and Adolescent Psychiatry, these symptoms can appear soon after the traumatic event, but they may surface months or even years later.
• Clinging to adults. Some children with PTSD will follow a parent around the house, never letting the parent out of their sight. Often this happens because the child fears that any separation, even a brief one, will turn out to be permanent. The child may even refuse to return to school.
• Persistent phobias or fears. Sometimes a child with PTSD is afraid of events or things that remind him or her of the trauma. A child who has been in a car wreck may be terrified of riding in cars or even crossing the street. A child who watched a young friend struck by lightning might hurry indoors at the first sign of rain. According to Terr’s work, children who have endured trauma also often fear the mundane- everyday things which have no relationship to the trauma. Fear of being alone in the dark, strangers, and unexpected noises are examples of mundane fears.
• Sleep problems. Nightmares, screaming during sleep, bed-wetting, and sleepwalking that continue more than several days after the traumatic event are also signs of PTSD. Often the nightmares are repeated several times in a night or for several nights. Sometimes these bad dreams are exact replays of the trauma. Other nightmares are about the trauma but change what has actually happened around, as if the child’s mind is trying to heal itself in sleep. Some trauma dreams change the event so much that when the child talks about them, they don’t seem to have anything to do directly with what has happened to the child. An example of this might be dreaming of being chased by monsters. After a severe emotional shock, some children have terrifying dreams that they can’t remember when they awaken. Researchers believe that very young children who have undergone trauma don’t have nightmares.
• Behavior problems. After a traumatic event, some children become irritable, while others suddenly begin misbehaving in school or at home, acting out feelings of anger by doing and saying things that are unusual for them. The anger children feel after being traumatized can also lead them to play more aggressively, hitting other children or bossing them around. Researchers believe that most traumatized children feel some anger after the event, if only because of the chemical changes high levels of stress put their brains through. When they have no outlet for this feeling, the anger persists. If the child was angry before the trauma, his or her anger may turn to rage. Human-made traumas, such as violent crimes or kidnappings, like the one the Chowchilla children endured, seem to provoke more angry reactions in child victims than do natural disasters like floods or hurricanes.
• Physical problems. In the weeks and months after a child has been traumatized, he or she may complain of stomachaches, headaches, or dizziness. When the child is examined by a doctor, physical causes for these ailments cannot be found. Traumatized children aren’t making these symptoms up. Instead, their physical problems are usually caused by extreme stress. For example, researchers have discovered that children who produce high levels of endorphins in response to trauma, such as incest, often complain of stomachaches. They believe these stomachaches may be caused neurochemically.
• Withdrawal and preoccupation with the trauma. Children who have endured trauma may pull back from family and friends, much like Bill and Karen did. They often appear listless as though they have little or no energy. Their activity level decreases and they suffer from lack of concentration. Many of the things they enjoyed doing in the past give them no pleasure. Like Karen, their minds may wander, their thoughts turning to the traumatic event many times throughout the day. Although the vast majority of traumatized children don’t have intrusive flashbacks like adults do, they do daydream about the horrible thing that has happened to them. These daydreams, according to Terr, come when a child’s mind is at rest and is unoccupied with other things, such as schoolwork. Even though a child’s daydreams may be very vivid and frightening, they don’t interrupt normal daily life. Some of the Chowchilla children said that they felt "haunted" by these daydreams after the kidnapping.
• Repeated reenactment. Children often make-believe they are going through the traumatic event. A child who has been in an automobile accident may play car wreck over and over again. A child who has been physically abused might beat her dolls and scold them, using the same words a parent has said to her. Even though children say they are having fun when they play this way, adults who watch them often use words like grim and serious to describe the children’s behavior at play.
• Regression. Young children sometimes seem to move back through stages in their development after experiencing a traumatic event. A child who was toilet-trained may lose control and need to wear diapers again. Behaviors like thumb-sucking, rocking back and forth, or refusing to speak may appear. Older children may begin talking baby talk or refuse to go to sleep without a teddy bear or an old blanket they slept with when they were younger.
• Foreshortened future. While most children seldom think about death and rarely consider that someday they may die, children who have undergone severe traumas think about these things quite a bit. Many of them believe they will die young. Often they don’t talk about what they want to do when they grow up, because they have a sense of dread that they will not survive until adulthood.
The seriousness of the PTSD symptoms a child develops after a traumatic event depends on the same things adult PTSD depends upon—whether the child witnessed the event or was caught right in the middle of it, how much trauma the child was exposed to, the severity of the event, and the degree of violence involved. Perhaps the most important factor that influences how a child will react to trauma is whether the trauma happened only once or if it occurred over and over again, as incest and physical child abuse and battering usually do.
For example, many children feel angry after they have been traumatized, but when the trauma happens over and over and was done to them by another person whom they know and have trusted, children’s rage can be especially strong. A child who has been repeatedly abused may come up with one of three ways to deal with his or her anger. Some children identify with the aggressor. If they were hurt, they may hurt other children when they play. If they were sexually abused, they may molest younger children.
Other children try to work through their anger after repeated trauma by becoming passive and acting out old victimizations over and over again, either through play or in real life. These kids might allow a playground bully to terrorize them or put themselves in situations where they are in danger of physical abuse. A few children try to deal with their anger by acting in an acceptable way most of the time, so that parents and teachers assume that they are well-adjusted. When these children are frustrated, though, their hidden anger boils to the surface. They have tantrums and even self-destructive fits. During these fits, they may cut themselves with sharp objects, bang their heads against a hard surface, or find other ways to turn their rage on themselves.
When Rayetta was younger, it seemed as though many things upset her. If she misplaced one of her comic books and couldn’t find it or if she made a mistake on her schoolwork, tears of anger would leak from her eyes. She hated herself for being such a "bad girl." As soon as she could, she would sneak away to a private place and start cussing herself. Within a short time, the rage would build so strong that she couldn’t resist the urge to punish herself for being so terrible. Rayetta would sink her teeth into her forearm and bite herself as hard as she could. Sometimes she’d even draw blood. Afterward, when she had calmed down, she was always careful to hide her self-inflicted wounds from her mother.
Although children who have endured trauma don’t usually suffer from flashbacks, intrusive thoughts, disassociation, or emotional numbing when the crisis was a one-time event, they do develop these symptoms if the trauma was ongoing. When disasters start piling up, children develop the ability to deny reality as they brace for shocks, according to Terr: "In an attempt to see no evil, hear no evil, speak no evil, and feel nothing, the youngster starts ignoring what is at hand. His senses go numb and he guards against thinking." Repeatedly abused children who become emotionally numb usually develop one of two personality styles: Some withdraw; others seem to be very sociable and charming around whomever they are with at the time, but they make no deep or lasting connections with other people.
Memory plays tricks on children who have been traumatized over and over again. They may report seeing things that aren’t really there. Sometimes they remember the event differently than it really happened. Sense of time often becomes distorted in children who have disassociated, so that something that took several hours to happen seems to have passed in a minute. An event that went by in an instant may seem to have dragged on for hours. Children who have distorted memories of a trauma aren’t making those memories up—they really believe what they are saying. These memories reflect an inner reality rather than reality in the outside world.
Sometimes, when adults hear a child’s inaccurate stories about a traumatic event, they may disbelieve that the event ever happened to the child. Other times a child may accuse the wrong person of sexually abusing him or her without meaning to. As a result of several day-care scandals in which children accused caretakers of victimizing them in sexual satanic rituals, some law-enforcement officials and mental-health workers wonder whether children are capable of having false memories, memories about something that never happened to them at all. In some cases, social workers examining children for sexual abuse may plant the seeds of false memory in a child’s mind by asking leading questions like "Where did the baby-sitter touch you?" instead of questions more likely to get at the truth, like, "Did the baby-sitter touch you?" In an attempt to please the adult, a child may provide the answers he or she thinks the questioner wants to hear.
While it is possible that children can transform something that occurred to another person, something they have heard about, into a memory, or an event that was suggested to them into a trauma memory, Terr and many other researchers caution that most of the time children’s memories are an expression of the child’s inner reality. These memories need to be taken seriously, especially if a child displays symptoms of PTSD. A shocking number of children are abused. At the same time, we need to remember that the details in children’s trauma memories aren’t always 100 percent accurate.
When Rayetta was little, she told her mother a boogie man came into her room at night, a big monster with fangs for teeth and a sharp tail. He’d poke her with the tail, she said. Her mother thought she was making the story up. "You have an overactive imagination," she told her daughter. She told other people that Rayetta was too high-strung and ignored her daughter’s story. Eventually, Rayetta ignored the reality of her sexual abuse as well. After her mother broke up with her boyfriend and Rayetta was safe, she altogether put what had happened to her out of her mind. Only when Paul began flirting with her did the old memories begin to rise to the surface in the form of dreams. Even though they started to come back into her awareness, she still wasn’t certain what was causing them.
Some children and young people who have endured repeated trauma do manage to forget completely what has happened to them, suppressing the memory deep in their subconscious, as Rayetta did. Their ability to split off from their emotions and physical sensations as well as their ability to "forget" what occurred are coping strategies that help them to survive the continuing trauma when there is no way to end it. In effect, it is an escape hatch. Once the abuse stops on its own or the children are old enough to force it to end, the memories may remain buried until they are later triggered by an event that reminds the person of the trauma.
- Porterfield MA, Kay Marie; Straight Talk About Post-Traumatic Stress Disorder; Facts On File: New York; 1996
Reflection Exercise #10
The preceding section contained information
about symptoms of PTSD in young children. Write
three case study examples regarding how you might use the content of this section
in your practice.
According to Porterfield, what is one way that children cope with trauma that is significantly different from adult coping mechanisms? Record the letter of the correct answer