Children's Hospital Colorado

Posttraumatic Stress Disorder (PTSD)

What is posttraumatic stress disorder (PTSD)?

Posttraumatic stress disorder (PTSD) is a group of symptoms that a person may experience in reaction to directly experiencing or witnessing a terrifying or dangerous event.

How is PTSD different from typical emotions after a traumatic event?

Everyone experiences a different range of reactions following a traumatic event. Those people who continue to struggle in the months following the event may be diagnosed with PTSD. The symptoms must represent a change in the person’s mood and behavior that occurs following the traumatic event.

What causes PTSD?

There is no true cause for PTSD; however, the symptoms represent a reaction to a traumatic event.

A traumatic event occurs when there is an observed, perceived or experienced threat to one's personal safety or the safety of others. These can include (but are not limited to) car accident, robbery, natural disaster, physical abuse, sexual abuse, emotional abuse, neglect, witnessing domestic violence and/or chronic medical treatments. What may be considered threatening and traumatic for an adult can be different for a child and vice versa.

Who gets PTSD?

Children, adolescents and adults who experience a traumatic event are at risk for developing PTSD. The condition can occur at any age after the first year of life.

Certain factors related to a child’s environment and his or her own temperament can influence the development of PTSD.

Risk factors for PTSD include anything that increases a person's risk of developing symptoms following a traumatic event, including:

  • Environmental risk factors, such as a dangerous neighborhood
  • Familial risk factors, such as a family history of mental illness
  • Within-child risk factors, such as a child who has an easily overwhelmed temperament

Protective factors include anything that decreases a person's risk of developing symptoms following a traumatic event, including:

  • Environmental protective factors, such as a good school and teachers)
  • Familial protective factors, such as a supportive family
  • Within-child protective factors, such as an active coping style

What are the signs and symptoms of posttraumatic stress disorder (PTSD)?

Each person who experiences a traumatic event will display symptoms differently. However, there are four categories of symptoms that are common following a trauma. PTSD is characterized by the following types of symptoms:

Intrusive thoughts: unwanted thoughts that can occur without warning and are typically distressing. These include:

  • Memories
  • Nightmares
  • Flashbacks

Avoidant behaviors: purposeful avoidance of anything that might be a reminder of the trauma. Examples include:

  • Avoidance of people, places, memories, situations, feelings or objects

Changes in mood and thinking: changes in a child's overall mood and thinking, such as:

  • Difficulty with memory
  • Negative self-concept
  • Depressed, irritable or negative mood
  • Lack of interest in previously enjoyed activities
  • Difficulties having fun or experiencing pleasure

Changes in arousal or reactivity: changes in a child's level of energy, alertness and responsiveness. Examples include:

  • Irritable or angry behavior
  • Hypervigilance (extreme sensitivity to people and things)
  • Increased startle response
  • Problems with concentration
  • Sleep disturbance

It is important to note that the symptoms must represent a change in mood and behavior following the traumatic event. These changes often cause significant distress and negatively impact daily life.

If your child has been experiencing some of the above symptoms but they do not represent a change in behavior, talk with your doctor about alternative diagnoses and treatments.

What tests are used to diagnose posttraumatic stress disorder (PTSD)?

The best way to diagnose PTSD is through an interview with a trained clinician (a psychiatrist, psychologist or social worker). During this interview, parents and children will be asked about their experience of trauma and the presence of the above listed symptoms.

There are some brief questionnaires that ask one to rate his or her experience of various symptoms. These questionnaires cannot alone be used to diagnose PTSD, but can help provide additional information about the child’s experience. Additionally, these questionnaires can help compare the severity of a child’s experience to other children both with and without PTSD.

What to expect from a clinical interview?

Interviews with clinicians can take one to two hours, depending on the amount of information that needs to be gathered. Parents and children should expect a wide range of questions to be asked, some that feel easy to answer and others that may feel personal or difficult to answer.

It's important to be as truthful and forthcoming as possible, as this is the best way for a clinician to truly understand the impact of a traumatic event and the current symptoms. It is also important to know that clinicians are trained to be nonjudgmental and are only gathering information to help inform treatment.

How do providers at Children's Hospital Colorado diagnose PTSD?

Following the initial interview, your clinician will discuss his or her assessment from the information gathered. Your clinician may also request to speak with additional people who are familiar with your child (other caregivers, teachers and/or primary care provider) to gather information about your child in other settings.

How is posttraumatic stress disorder (PTSD) treated?

Individual ("talk therapy" or "play therapy") and family therapy are the most effective treatments for PTSD. Through these treatments, children will learn how to identify and discuss their feelings with safe adults and cope with uncomfortable emotions in a safe way. Through family therapy, caregivers learn strategies to help address a child's symptoms, improve family communication, increase empathy for a child's distressing emotions and identify/increase protective factors.

In addition to psychotherapy, medications are sometimes prescribed. Medications such as certain antidepressants, anxiolytics and prazosin have been shown to be helpful in reducing some of the symptoms of PTSD. Through working together with your prescriber, the best medication(s) can be determined.

During treatment, your prescriber will go over the benefits and risks of each medication, including the potential side effects. The clinicians at Children's Hospital Colorado have many years of experience with managing these psychiatric medications and will address any concerns you may have.

Why choose Children's Colorado for your child's PTSD?

Our clinicians understand the unique ways in which children experience and respond to situations. Because our pediatric experts have specialized training in working with children, they understand the types of situations that often have a negative impact on children and are able to help families identify, respond to and heal from traumatic events.

Additionally, because trauma can be a sensitive and difficult topic to discuss, our clinicians interact with children in a warm and compassionate way to help make treatment safe and healing.