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PTSD in Children and TeensThis fact sheet provides an overview of how trauma affects school-aged children and teens. You will also find information on treatments for PTSD in children. To learn about PTSD in very young children, please see our fact sheet Very Young Trauma Survivors: The Role of Attachment.
What events cause PTSD in children?Children and teens could have PTSD if they have lived through an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend's suicide, or seeing violence in the area they live.
Child protection services in the U.S. get around three million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur:

• 65% neglect
• 18% physical abuse
• 10% sexual abuse
• 7% psychological (mental) abuse

Also, three to ten million children witness family violence each year. Around 40% to 60% of those cases involve child physical abuse. (Note: It is thought that two-thirds of child abuse cases are not reported.)
How many children get PTSD?Studies show that about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3% to 15% of girls and 1% to 6% of boys develop PTSD. Rates of PTSD are higher for certain types of trauma survivors.
What are the risk factors for PTSD?Three factors have been shown to raise the chances that children will get PTSD. These factors are:

• How severe the trauma is
• How the parents react to the trauma
• How close or far away the child is from the trauma

Children and teens that go through the most severe traumas tend to have the highest levels of PTSD symptoms. The PTSD symptoms may be less severe if the child has more family support and if the parents are less upset by the trauma. Lastly, children and teens who are farther away from the event report less distress.
Other factors can also affect PTSD. Events that involve people hurting other people, such as rape and assault, are more likely to result in PTSD than other types of traumas. Also, the more traumas a child goes through, the higher the risk of getting PTSD. Girls are more likely than boys to get PTSD.
It is not clear whether a child's ethnic group may affect PTSD. Some research shows that minorities have higher levels of PTSD symptoms. Other research suggests this may be because minorities may go through more traumas.
Another question is whether a child's age at the time of the trauma has an effect on PTSD. Researchers think it may not be that the effects of trauma differ according to the child's age. Rather, it may be that PTSD looks different in children of different ages.
What does PTSD look like in children?School-aged children (ages 5-12)These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.
Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.
Teens (ages 12-18)Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.
What are the other effects of trauma on children?Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of what we know about the effects of trauma on children comes from the research on child sexual abuse. This research shows that sexually abused children often have problems with

• Fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others
• Behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol

How is PTSD treated in children and teens?For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years if they do not get treatment. There are many treatment options, described below:
Cognitive-Behavioral Therapy (CBT)CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert himself or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, "the world is totally unsafe."
Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD.
CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children.
Psychological first aid/crisis managementPsychological First Aid (PFA) has been used with school-aged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem solving skills. PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe symptoms may be referred for added treatment.
Eye movement desensitization and reprocessing (EMDR)EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.
Play therapyPlay therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other methods to help children process their traumatic memories.
Other treatmentsSpecial treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol.
What can you do to help?Reading this fact sheet is a first step toward helping your child. Learn about PTSD and pay attention to how your child is doing. Watch for signs such as sleep problems, anger, and avoidance of certain people or places. Also watch for changes in school performance and problems with friends.
You may need to get professional help for your child. Find a mental health provider who has treated PTSD in children. Ask how the therapist treats PTSD, and choose someone who makes you and your child feel at ease. You, as a parent, might also get help from talking to a therapist on your own. Please see our Where to Get Helppage for treatment resources.

suffice to say....
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Very Young Trauma Survivors: The Role of Attachment
Years ago, little was known about PTSD in infants and young children. Today, we know that trauma and abuse can have grave impact on the very young. We also know how much the attachment or bond between a child and parent matters as a young child grows. This can make a difference in how a child responds to trauma. Below we discuss rates of trauma-related problems in infants and young children, as well as treatment options.

(Please see PTSD in Children and Teens to learn about trauma in older children and teens.)

How many infants and young children are abused?
In the United States, Child Protective Services receives reports on the abuse or neglect of about 5.5 million children in a year. Infants and young children have more risk of abuse than older children. Over one-third of proven reports to child protection services are for children under the age of five years. Further, children are most often hurt or killed from abuse when they are in the first year of life. Over three-quarters of children killed due to abuse are under the age of three years.

How do trauma and neglect affect infants and young children?
As with adults, following trauma, most children will have some symptoms. Young children may show a fear of strangers or be scared to leave their parent. They might also have sleep problems or bad dreams. Young children may also repeat themes of the trauma in their play. For example, a child who was sexually abused in her bed might play out "dark" bedroom scenes with dolls. They might also be more fussy, irritable, aggressive, or reckless. Young children may lose skills they once had, such as toilet training. They might go back to earlier habits, like sucking their thumb. Very young children may not show the same PTSD symptoms we see in adults. This may be because many of the symptoms of PTSD require that the child be able to talk about what happened.

Early trauma affects the child's nervous system. The nervous system is shaped by the child's experiences. Stress over a period of time can lead to changes in the parts of the brain that control and manage feelings. That is to say, stress and trauma early in life can change the brain. This can have long-term effects on physical, mental, and emotional growth. What's more, the impact of early abuse often extends into later childhood, teen, and even adult years.

Diagnosing PTSD in infants and young children
Although most children have symptoms following trauma, only a few will go on to get PTSD. Diagnosing PTSD in children can be difficult. The definition of trauma that is used to diagnose PTSD is specific. It says that a person must feel fear, helplessness, or horror for an event to be a "trauma." It is hard to say if this happens for a very small child. Young children are often not able to describe in words the event or how they felt about it. For this reason, other ways of diagnosing PTSD have been created for use with children ages zero to three years.

What is attachment?
Attachment is the connection found in the main relationship in a child's life. Usually it is with his or her caregiver. Children and parents are meant to form attachments with each other. For example, your baby is born knowing how to cuddle and cry, and it causes you to respond. Also, infants like their caregiver's face and voice more than other sights and sounds. The type of attachment between a child and caregiver can affect how a child will relate to the people she or he comes across in life.

Why is attachment important when dealing with trauma?
A child's main attachment helps him learn to control his emotions and thoughts. When a caregiver's responses are in tune with a child's needs, the child feels secure. The child then uses this relationship pattern as practice to build coping skills. On the other hand, a child who gets confusing or inconsistent responses from the caregiver might be fussy, have a hard time calming down, withdraw from others, or have tantrums.

Children also use their caregivers to guide how they should respond to events. Have you noticed how a child sometimes looks at his or her parent to know how to respond? When you stop your child from doing something unsafe, he in time learns to stop himself. So a parent's reaction to trauma affects the child. Through a relationship with their caregiver, children learn how to be in charge of feelings and behaviors, and how to act with other people.
Here are some examples:

• If a caregiver often helps a child manage her feelings, the child can build coping skills. This could lead to better healing for children who go through trauma.
• A traumatic event might hurt the attachment between a caregiver and child due to strong feelings that get in the way of a good relationship. Sometimes a child can be angry toward her parent for not keeping her safe. Even very young children can have these feelings. Or, a parent might feel guilty about the event and this might affect the relationship.
• If the caregiver has her own trauma history, her symptoms (trying not to feel, always worried about danger) might get in the way of caring for her child.

What kind of help is out there?

• Child health care settings, doctors, and other health care providers can give support, education, safety planning, and information about treatment.
• Child and family social services can help caregivers with many issues.
• In-home nurses and other providers can help new parents provide good care for their young children. They might help with feeding, sleep, safety, or illness.
• Therapy is needed if relationship problems or PTSD symptoms do not get better. Treatment that involves the caregiver and child together is best for cases with poor attachment and trauma. One such treatment is called child-parent psychotherapy (CPP). CPP helps caregivers understand their children, keep them safe, and give emotional help.
• For some children, treatment does not take place for many years. No matter the age, when trauma and PTSD are involved, evidence-based, effective treatment exists.

its been 102 days without mommy...

I'm trying to be strong for you... but it's tough!

​Her lies killed me... (not mommy's.)