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Key Features

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Essentials of Diagnosis
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  • Signs and symptoms of hyperarousal and reactivity

  • Avoidant behaviors and numbing of responsiveness

  • Flashbacks to a traumatic event such as nightmares, intrusive thoughts, or repetitive play

  • Follows traumatic events such as exposure to violence, physical or sexual abuse, natural disasters, car accidents, dog bites, and unexpected personal tragedies

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General Considerations
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  • Predisposing factors

    • Proximity to the traumatic event or loss

    • History of exposure to trauma

    • Preexisting depression or anxiety disorder

    • Being abused by a caregiver

    • Witnessing a threat to a caregiver

  • Can develop in response to natural disasters, terrorism, motor vehicle crashes, and significant personal injury, in addition to physical, sexual, and emotional abuse

  • Abused children are especially likely to develop PTSD and to suffer wide-ranging symptoms and impaired functioning

  • Symptoms can develop in as many as 25% of young people exposed to violence

  • Children with some symptoms of PTSD can suffer significant distress and functional impairment, even when not meeting full criteria for PTSD

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Clinical Findings

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  • Children and adolescents show persistent fear, anxiety, and hypervigilance

  • They may regress developmentally and experience fears of strangers, the dark, and being alone, and avoid reminders of the traumatic event

  • Children reexperience elements of the events in the form of nightmares and flashbacks

  • Children with a history of traumatic experiences or neglect in infancy and early childhood are likely to show signs of reactive attachment disorder and have difficulty forming relationships with caregivers

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Diagnosis

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  • Clinical

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Treatment

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Nonpharmacologic
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  • Trauma-focused cognitive-behavioral therapy is first-line treatment

  • Child needs support, reassurance, and empathy

  • Treatment also includes building a developmentally appropriate narrative of the event to help the child understand their experience

  • Efforts should be made to establish or maintain daily routines as much as possible, especially after a trauma or disaster that interrupts the family's environment

  • In the case of media coverage of a disaster or event, children's viewing should be avoided or limited

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Pharmacologic
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  • There is not a medication that has FDA approval for treating PTSD in children

  • Medications that target specific symptoms (eg, anxiety, depression, nightmares, and aggression) may be considered

  • Some medications used include clonidine or guanfacine (Tenex), mood stabilizers, antidepressants, and neuroleptics

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Outcome

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Prognosis
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  • Timely access to therapy enhances prognosis

  • Specific fears usually wane with time, and behavioral desensitization may help

  • There is preliminary evidence that eye movement desensitization and reprocessing (EMDR) may also be useful

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References

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Banh  MK  et al: Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care. Gen Hosp Psychiatry 2008 Nov–Dec;30(6):536–545
[PubMed: 19061680] .
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Cohen  JA, Kelleher  KJ, Mannarino  AP: Identifying, treating, and referring traumatized children: the role of pediatric providers. ...

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