Recognition & Clinical Assessment of Childhood Ptsd

Compared to the literature on adult PTSD that on PTSD in children is sparse, and one cannot generalize the adult findings to children. Parents, teachers and even the mental health professionals' under-recognize prevalence of PTSD in children. Possibly, by the use of psychological mechanisms like denial, rationalization that children are too young to remember the trauma and the need to reassure themselves that the children are not 'damaged' (American Academy of Child and Adolescent Psychiatry [AACAP] , 1998). The mainfestation of PTSD in children is different from that in adults in several ways. Re-experiencing can mainfest as repetitive play in which the trauma is enacted, dreams which may or may not have any specific trauma related contents and actual reenactment of the trauma. Numbing and avoidance may take the form of restlessness, hyperalertness, poor concentration and behavioral problems. Children may have periods during which they have only re-experiencing or only avoidance and numbing which alternate between each other, rather than exhibiting both groups of symptoms simultaneously. One of the varied manifestations is a dissociative symptom, which may take the form of hallucinations or disorganized thinking and behavior. Preschool children can present with features of separation anxiety, stranger anxiety, fear of monsters or animals, avoidance of situations that may or many not have connection to the event. They may be preoccupied with certain words or symbols that may or may not have connnection with the event (AACAP, 1998). There can be compulsively repetitive play, which represents part of the trauma but fails to relieve anxiety (Post traumatic play) or play which represents part of the the trauma but which is less repetitive and more like normal play (play re-enactment), both of which can be representative of re-experiencing. In the place of avoidance/ numbing, only constriction of play, social withdrawal, restricted range of affect or loss of acquired developmental skills can be present. Another interesting manifestation may be "omen formation" (Terr, 1983). Children start believing that there are certain signs, which predict a traumatic event and if they are alert, they can detect these signs (omens). Clinical Assessment Children present unique challenge to the clinician assessing the PTSD symptoms. They may not report their psychological reactions to the trauma unless they are specifically asked about aspects of trauma. Hence, experts believe that directly asking the child about PTSD symptoms as they relate to the stressor is always required (AACAP, 1998). Cognitive immaturity …