Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ 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 +++ General Considerations ++ 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 +++ Clinical Findings ++ 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 +++ Diagnosis ++ Clinical +++ Treatment +++ Nonpharmacologic ++ 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 +++ Pharmacologic ++ 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 +++ Outcome +++ Prognosis ++ 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 +++ References + +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] .+ +Cohen JA, Kelleher KJ, Mannarino AP: ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.