pediatrics
Acute and Posttraumatic Stress Disorders (ASD and PTSD) in Children and Adolescents
Symptoms and Signs
Symptoms of ASD and PTSD are similar and generally involve a combination of the following: Intrusion symptoms:Recurrent, involuntary, and distressing memories or dreams of the traumatic event (in children<6 years, it may not be clear whether their distressing dreams are related to the event); dissociative reactions (typically flashbacks in which patients reexperience the trauma, although young children may frequently reenact the event in play); and distress at internal or external cues that resemble some aspect of the trauma (eg, seeing a dog or someone who resembles a perpetrator) Avoidance symptoms:Persistent avoidance of memories, feelings, or external reminders of the trauma Negative effects on cognition and/or mood:Inability to remember important aspects of the traumatic event, distorted thinking about the causes and/or consequences of the trauma (eg, that they are to blame or could have avoided the event by certain actions), a decrease in positive emotions and an increase in negative emotions (fear, guilt, sadness, shame, confusion), general lack of interest, social withdrawal, a subjective sense of feeling numb, and a foreshortened expectation of the future (eg, thinking “I will not live to see 20”) Altered arousal and/or reactivity(eg, hyperarousal):Jitteriness, exaggerated startle response, difficulty relaxing, difficulty concentrating, disrupted sleep (sometimes with frequent nightmares), and aggressive or reckless behavior Dissociative symptoms:Feeling detached from one's body as if in a dream and feeling that the world is unreal Typically, children with ASD are in a daze and may seem dissociated from everyday surroundings. Children with PTSD have intrusive recollections that cause them to reexperience the traumatic event. The most dramatic kind of recollection is a flashback. Flashbacks may be spontaneous but are most commonly triggered by something associated with the original trauma. For example, the sight of a dog may trigger a flashback in children who experienced a dog attack. During a flashback, children may be in a terrified state and unaware of their current surroundings while desperately searching for a way to hide or escape; they may temporarily lose touch with reality and believe they are in grave danger. Some children have nightmares. When children reexperience the event in other ways (eg, in thoughts, mental images, or recollections), they remain aware of current surroundings, although they may still be greatly distressed. 