PTSD in Children: Child Specific Symptoms

PTSD in Children: Child Specific Symptoms

It is well known that children often express disease and disorder in a substantially different manner than adults. This certainly makes sense even from a purely communication aspect: children do not have the life experience and vocabulary to verbally explain what they are feeling and experiencing as well as an adult may. In the realm of psychological disorder, children often express a different pattern or even unique behaviors and symptoms that an adult who has the same disorder may not.

Through my years of treating children who have developed Post Traumatic Stress Disorder as a result of often chronic interpersonal abuse (neglect, physical abuse, or sexual abuse), I have noted anecdotally several behavioral signs that appear to be child specific. The pertinence of these observations are that evaluating psychologists and treating clinicians may be missing a significant pattern of behavioral signs that could be used in making more accurate assessments and diagnosis of PTSD in children.

In a review of my historical case load of children (and adolescents) with PTSD as a result of interpersonal trauma, a remarkable number demonstrate the following behaviors: enuresis (both nighttime and day time), encopresis (both day time and night time), feces manipulation or play, excessive and or/public sexual self stimulation, lack of recall following a stress episode, sleepiness following a stress episode, pupil dilation (and other physical sigsn) while in a stress episode, food hoarding or overeating, sugar craving, self harm behaviors, rage accompanied by very colorful vulgar language, and excessive clinginess with the caregiver.

While each of these behavioral signs alone would not necessarily cause alarm to the adult observer, and indeed, even in extreme may be indicative of other mental health or physical disorders, when combined support a closer look at the possibility of a PTSD diagnosis. This is especially true in the circumstance where there is a known history of some type of abuse, including the child witnessing domestic abuse of a parent (usually mother) by another adult.

Traditional diagnostic procedures for PTSD (the DSM) of course, have a closed set of criteria that must be met in order to give the PTSD diagnosis. The above noted child-specific behavioral signs may not be considered to ‘fit into’ the established criteria, thus leaving the child diagnosed with some other disorder. In many cases, these children, by default, receive diagnoses as wide ranging as ADHD, Oppositional Defiant Disorder, Adjustment Disorder, and even Bi-Polar Disorder.

It is incumbent upon the fields of psychology, psychological diagnostics, and clinical treatment providers to make a continuing effort to refine, define, and articulate the differences that children and adolescents demonstrate. In most cases, it is the direct caregivers (parents, foster parents, and direct care clinicians) who notice and begin to formulate pattern of behavior theories attached to specific mental health disorders in children. There is a clear need for those responsible for continuing editing of the Diagnostic Statistics Manual to make deep consideration of defining a more specific criteria for the diagnosis of PTSD in children who are experiencing significant life dysfunctions as a result of interpersonal abuse.

Psychological diagnosis is simply a tool to help direct treatment to a fruitful and positive outcome, but when a child who is suffering from what is primarily a stress disorder is diagnosed with some other disorder, the subsequent treatment at least will do no good, and at worse, make their primary and genuine disorder worse.