Post-Traumatic Stress Disorder (PTSD) in Children and Teens

Having a child receive a post-traumatic stress disorder (PTSD) diagnosis can be overwhelming and scary. The pediatric mental health specialists at CHOC provide expert help to kids and teens experiencing PTSD, to help them achieve full and healthy lives and to help preserve the magic of childhood.

teenager with PTSD talking with father on steps

What is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition caused by a traumatic or scary event. Responses to traumatic events are different for everyone and can look different in children than in adults. Some people experience distress immediately after the event, while others may experience it months or years later. If fear and anxiety make it hard to cope with daily life, mental health experts may diagnose post-traumatic stress disorder. Psychologists, therapists and psychiatrists can help children with PTSD deal with hurtful thoughts and negative feelings by facilitating the development of PTSD coping skills, allowing your child to live a normal life.

What causes PTSD in children and teens?

Children may experience post-traumatic stress disorder after experiencing or seeing a traumatic event. Traumatic events come in different forms and may include:

  • Serious accidents, such as car or train wrecks
  • Hospitalization
  • Serious illness or injury
  • Invasive medical procedures
  • Animal bites
  • Natural disasters
  • Violent attacks
  • Death of a loved one, such as a family member, friend or pet
  • Physical or sexual assault
  • Emotional abuse or bullying
  • Neglect

What are the signs and symptoms of PTSD in children and teens?

Children with PTSD feel a lot of emotional and physical distress when exposed to situations that remind them of the traumatic event they witnessed. Some may relive the trauma over and over. Signs and symptoms of PTSD in children may seem similar to stress, anxiety and depression. They may have nightmares or scary memories during the day. Other symptoms of PTSD in children include:

  • Problems sleeping
  • Feeling depressed or grouchy
  • Feeling nervous, jittery or extra alert and watchful
  • Losing interest in things they used to enjoy
  • Seeming or feeling detached or emotionally numb
  • Isolating from others or having trouble feeling affectionate
  • Acting more aggressive than before, even violent
  • Avoiding certain places or situations that bring back the scary memories
  • Having flashbacks, such as images, sounds, smells or feelings
  • Believing the event is happening again
  • Losing touch with reality
  • Reenacting an event for seconds or hours or, in rare cases, days
  • Having problems in school
  • Having trouble focusing
  • Worrying about dying at a young age
  • Acting younger than their age, such as thumb-sucking or bedwetting
  • Having physical symptoms, such as headaches or stomachaches

Note that signs and symptoms of PTSD vary by age. Young children and toddlers may be more likely to have tantrums, poor appetite, separation anxiety and physical complaints such as stomachaches or headaches. Older children may worry about safety, suffer academically or become aggressive or easily startled. Teenagers may become lonely, panic easily, develop risky behaviors, avoid school or have trouble sleeping.

How is PTSD diagnosed?

Pediatric mental health experts can diagnose PTSD through a mental health evaluation. It is important to seek help from professionals specializing in mental health conditions in children. CHOC’s pediatric mental health team is here to help your family through this scary time.

It is important to note that not every child who experiences a traumatic event will develop PTSD. It is diagnosed typically only if symptoms keep happening for more than 1 month and are negatively affecting the child’s life and ability to function. For children with post-traumatic stress disorder, signs and symptoms most often start within 3 months after the traumatic event, but they can also start months or years later.

PTSD Treatment

PTSD can be treated, but the best PTSD treatment for your child depends on their symptoms, age and general health. It is important to seek help from a pediatric mental health expert early on to help ease symptoms, enhance childhood development and improve quality of life.

PTSD treatment may include:

  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): An evidence-based PTSD treatment for ages 3 to 18 years focused on working with the parent and the child as they navigate the child’s traumatic experience. TF-CBT educates the parent/s about reactions the child may experience and helps the child build coping skills and explore the traumatic event through drawing or writing. The child’s work is then shared with the caregiver and assists in enhancing communication between caregiver and child, which builds trust and validation.
  • Cognitive Behavioral Intervention for Trauma in Schools (CBITS): This school-based approach has been used for students from 5th through 12th grade who have witnessed or experienced a traumatic event. It includes building coping skills, learning problem-solving techniques, cognitive restructuring and exposure.
  • Families Overcoming Under Stress (FOCUS): This short-term PTSD treatment (6-8 sessions) was initially designed for military children and families and been expanded into LA school districts and the foster care system. It focuses on building resilience in children and families in order to help them overcome challenges and traumatic stressors.
  • Medication: Medication for depression or anxiety may be a helpful way for a child to cope trauma symptoms by balancing the hormones such as serotonin that cause stress responses.
  • Support Groups: A support group can help children get to know others who have experienced similar trauma and may help them to feel less alone. There are also support groups for parents, caregivers and family members of those with PTSD.

Recovery and treatment from PTSD varies for everyone. Some children recover within months. Others may have symptoms for much longer. Recovery can depend on several factors, such as coping skills, resilience, family support and parent involvement.

PTSD and Co-occurring Illnesses

Some kids and teens with PTSD can experience a co-occurring illness, or a second condition brought on by the PTSD. These can include:

It’s important to see a pediatric mental health expert to help figure out the best treatment for your child’s combination of symptoms.

Call 911 or visit the nearest pediatric emergency department if your child expresses thoughts of harming themselves or others.

PTSD Coping Skills: Tips for Parents or Guardians to Help Kids

CHOC pediatric psychologist Dr. Sheila Modir shares a model for caregivers to follow to help their child cope with PTSD.

Explore what your child already knows in a gentle and calm manner. Allow your child to express their feelings about the event when they are ready through speaking, writing or drawing.

Explain what has happened in a way that your child can understand, based on their age.

  • Address any wrong information your child may have heard and validate that a scary thing did happen. Reassure their sense of safety.
  • Avoid overwhelming your child by providing only answers to the questions they ask.
  • Provide examples of ways that you and your community keep children safe every day (i.e., police officers, firemen, crossing guards, teachers, nurses, doctors, etc.).

Emotionally model healthy expressions of feelings, as children take their cues from their parents. Describe how you cope with your upsetting emotions (i.e., “When something bad happens to me or I feel scared, I talk about it with someone who makes me feel safe”).

Express to your child that their feelings are normal and let them know it is okay to feel scared, sad, mad or angry. Reassure your child that s/he is not at fault.

Ensure stability by continuing your child’s daily routine. This will provide them with a sense of reassurance and safety. Maintaining a daily routine is not meant to ignore what has happened, but rather to provide the child with structure, stability and predictability.

See CHOC’s Mental Health Toolkit for more resources on PTSD in English and Spanish.