Medically Induced PTSD in Children
Children who have had severe, life threatening illnesses or accidents can develop symptoms of Post Traumatic Stress Disorder. Once thought only to impact soldiers who had experienced the horrors of battle and war, PTSD has come to be recognized as an emotional disorder that can develop in people who have experienced all kinds of trauma, from things like natural disasters to various forms of interpersonal abuse and events surrounding health crises and ensuing needed medical care.
While there are several classic symptoms groupings of PTSD as outlined in the mental health literature and the Diagnostic Statistics Manual (a tool to diagnose and codify mental health issues), it is becoming recognized that the criteria for PTSD does not cover all of the possible issues that cause people to develop symptoms from trauma. The bottom line is that each individual will have a particular ‘profile’ of trauma related symptoms that vary in frequency, intensity, and duration.
For children, it is has been traditionally thought that the younger the child, the less impact there is from traumatic events. Over the past couple of decades, this has been reconsidered and found to be largely false. Very young children can be profoundly damaged emotionally by trauma at ages commonly considered devoid of specific memory. In addition, many people do not realize, for instance, that there are still baby boys being restrained ankle and wrist, and then circumcised without anesthetic. There are also many documented and anecdotal cases of older children and adults who have post-trauma symptoms related to birth trauma or trauma shortly after birth, this author included. This damage in emotions and the resulting neuro-biological- behavioral reactivity can continue to alter the course of the child’s life due to how adults and peers in turn react to the child’s stress reaction behaviors.
While the medical personnel treating the child are not intending, of course, to traumatize the child, the needed treatment may further the (emotional) trauma that was begun at the time the severe medical trauma started. At that point, the child’s life is obviously the priority. Few people (even medical people) think that there is any reason to give close attention to observation for Acute Stress Disorder (just like PTSD but starting within a few hours after the original trauma), especially in such young children. It does not take much imagination to understand how sustaining a physically traumatic injury or illness and the ensuing medical procedures might cause a child (or adult) emotional trauma. While not all children develop PTSD or even Acute Stress Disorder following a medical trauma, enough do to warrant close observation and give timely treatment.
Essentially, when a stimulus (there can be thousands of different types) is experienced that reminds the child of the medical trauma presents, the child will uncontrollably react in a way very similar to the way they did during the original trauma. If a child of say, three, had a terrible, life threatening fall that resulted in emergency medical care is confronted at say, age eight with a relatively innocuous fall off of their bike, the child may emotionally and behaviorally react in very dramatic fashion out of all perspective of the small injury.
Or, if a child at a very young age had a medical trauma such as a severe burn, where the needed medical treatment made it necessary for the child to be restrained, when that child is older and in the classroom and the teacher gives a direction to the child that feels too pressured to the child (forcing the child), the child may react in dramatic fashion. Of course, if the teacher does not know the history, or fails to connect the history with the observed behavior, the teacher may assume that the child is just being oppositional, and add even more pressure. The average student will eventually give in to such adult pressure and comply, the child with PTSD will most assuredly escalate.
It is quite often the case that children who have medical PTSD become mislabeled as kids who are ‘difficult’ or have ‘ADHD-like’ behavioral signs, are ‘moody’ or are ‘always in trouble’. This mislabeling leads efforts to change the behavior to go down many blind alleys that waste time, and worse yet, begin to embitter the child towards school. Because of the adults in their lives not responding with the proper interventions for a child with PTSD, the child’s behaviors continue and often get worse. This creates a failure chain that establishes a ‘reputation’ for the child, which furthers a ‘self fulfilling prophecy’ in the child and the teachers who get the child as a student in the future.
Once medical post trauma emotional and behavioral reactivity is determined to be the source of the observed behaviors, there are steps in response that adults can make in intervention to help children who suffer in this way. The first is to understand and accept the source of the difficult, resistant, or emotionally and behaviorally dramatic behaviors that they are observing come from the original trauma and not just an oppositional, defiant, or lackadaisical child. Secondly, the adults need to learn how to respond to the child with techniques that will help them and not escalate or make the reaction even worse (see Gentling.org for resources).
Of course, any child can become oppositional, defiant, or lackadaisical. And this requires guidance, direction, and sometimes consequences. Adults should never ‘walk on eggshells’ around a child with PTSD; the child still needs discipline. The child’s trauma issues are no excuse for poor behavior, but the intervening adult does best when they assist the child to traverse the trauma induced stress episode prior to processing any misbehavior and resulting consequences. Discerning the source of the observed behavior (either trauma related or just a child misbehaving) becomes a challenge, but one that can be met with proper attention and care.
There are many adults who have a very difficult time reconciling the difficult behaviors in the child with the source being trauma; many find the Gentling Approach to be ‘coddling’ or ‘indulgent’, or ‘making excuses’. If properly understood and enjoined, and with patience, Gentling is very effective in helping kids with medical PTSD to manage and overcome their symptoms.