Post-traumatic Stress Disorder in Children Symptoms, Impact on the Brain, and Treatment

By Luke Dalfiume, PhD, Licensed Clinical Psychologist, Co-Owner, John R. Day & Associates, Christian Psychological Associates

When a child has experienced a traumatic event, they may develop Post-traumatic Stress Disorder (PTSD). There are several characteristics associated with PTSD (noted in the professional manual of disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or the DSM-5):

A person with PTSD may only exhibit one of the following clusters of symptoms (though there is often overlap among the symptoms):

1. Anhedonic or dysphoric mood states and negative cognitions may be prominent.
2. Fear-based re-experiencing, emotional, and behavioral symptoms.
3. Arousal and reactive-externalizing symptoms are prominent.
4. Dissociative symptoms.

Trauma may cause the following problems in the brain:  

1. Cortisol and other stress hormones interfere with the inhibitory function responses of the Neocortex. This can result in hyperactive, impulsive behaviors. Many children with PTSD are given diagnoses of Attention Deficit Hyperactivity Disorder (ADHD).
2. Trauma memories become fragmented. This lack of integration means that when they are activated, there is little or nothing to reduce the anxiety response (anxiety in the present is not connected by the person to the past trauma).
3. Unhelpful behaviors that temporarily reduce the anxiety may be used.
4. Higher level processing at the level of the neocortex is impaired, with the result that the trauma response will remain. This is why, in therapy with both children and adults, trauma must be “worked through” by talking about it or processing it in other active ways (to enable the higher level processing to occur).

Emotional trauma has a very similar impact on the brain to physical trauma. Trauma can make one feel emotionally weaker, less able to deal with subsequent stressors: easily traumatized, easily stressed. It can contribute to one holding back, not taking ‘age-typical’ chances (e.g., regarding schooling, jobs, interpersonal relationships). It can also contribute to one doubting one’s own perceptions.

Because of the way the brain processes trauma, it is important that any treatment encourage the processing of experiences at the level of the neo-cortex (higher-level processing). One model for this treatment is the Tri-Phasic Model described by Judith Herman in Trauma and Recovery. This model for treatment emphasizes the following:

• Safety and Stabilization. Safety is the central task. If the person is still being traumatized, then they need to be put in a situation where they are kept safe. This is why, for sexual abuse victims, having someone believe them and protect them is so important. People are often retraumatizing themselves. They are so reactive to external stimuli that internally they have symptoms that re-traumatize them (intrusive thoughts, heart racing, etc.).The goal is a movement from, as Herman says in her book (p. 155) “unpredictable danger to reliable safety.” This may take some time to achieve.
• Remembrance and Mourning. The traumatic story must be reconstructed in detail. There is repeated exposure to the story of the trauma in a safe environment. The person is able to relive and make sense of the traumatic experiences, “working it through” with the therapist. There are different techniques to help with this process. However, the following must be present to help the person effectively process their experiences: to be entirely safe (not continuing to be traumatized outside of therapy), to be relaxed, and, while relaxed, to have re-exposure to the trauma. This re-exposure will allow the person to cognitively restructure how they their own self and their world.
• Reconnection. This final stage of recovery involves redefining oneself in meaningful relationships. The goal for the client is to have processed trauma sufficiently so they can go on without letting the traumatic experience or experiences define them permanently.

For more information or to book an appointment, contact John R. Day & Associates, Christian Psychological Associates, located at 3716 West Brighton Ave., Peoria or their additional locations in Normal, Canton, Pekin, Princeton, or Eureka. Call us at 309-692-7755 or visit us online at www.christianpsychological.org.