Post-traumatic stress disorder (PTSD): Signs and symptoms

What are the main symptoms of post-traumatic stress disorder in children and teens?

The main symptoms of post-traumatic stress disorder (PTSD) are divided into four categories:

• intrusion symptoms
• avoidance of stimuli associated with the traumatic event
• negative changes in thoughts and mood
• altered reactivity

Intrusion symptoms

Intrusion symptoms are those where the traumatic event 'intrudes' on the child or teen's everyday life. They include:

• recurring, unwanted and uncontrolled memories of the traumatic event
• in children, repetitive play with trauma-related themes
• recurring dreams related to the traumatic event or the emotions the child or teen felt at the time
• flashbacks about the event — experiencing the traumatic event again, sometimes with a complete loss of awareness of present surroundings
• intense and prolonged psychological or physical distress at reminders of the trauma

Avoidance of stimuli associated with traumatic event

As the term suggests, this involves a child or teen avoiding or trying to avoid all memories, thoughts or feelings related to the event. It can also involve avoiding, or trying to avoid, external reminders (such as people, places, conversations, activities, objects or situations) that bring up distressing memories, thoughts or feelings about the traumatic event.

Negative changes in thoughts and mood

A child or teen with PTSD may:

• be unable to remember an important aspect of the traumatic event
• hold persistent and exaggerated negative beliefs or expectations about themselves or those around them
• blame themselves or others for the causes or consequences of the traumatic event because of persistent and distorted thoughts
• experience ongoing negative emotions such as fear, horror, anger, guilt or shame
• lose interest in or cut back on activities that once mattered to them
• feel detached (separate) from others
• be persistently unable to experience positive emotions such as happiness, satisfaction or love

Altered reactivity

If a person experiences PTSD, they may be more reactive to their surroundings and what is said to them. For example, they may:

• be more irritable or have angry outbursts with little or no provocation
• be verbally abusive or physically aggressive towards people or objects, including through extreme temper tantrums
• be more easily startled or more aware of their surroundings
• find it hard to concentrate
• have disturbed sleep
• engage in reckless or self-destructive behaviour

How PTSD affects children

Although they are less able to express themselves, young children likely have thoughts, memories and/or dreams about a traumatic event. Rather than talking about what they think or remember, they are more likely to be irritable and withdrawn and to play out trauma-related themes.

How PTSD affects teens

Teens may withdraw from their usual activities, self-harm or engage in impulsive and reckless behaviour such as substance use.

How PTSD is diagnosed

Your child's doctor will speak to you and your child and ask you both about:

• your concerns and the symptoms that are interfering with your child's everyday functioning
• the current stressors in your child's life and what could have triggered the onset of the PTSD symptoms
• your child's development (from pregnancy to the present time)
• your family's mental health history
• your family's general functioning and any stressors (such as conflict, impending divorce, bereavement, moving house) that might be contributing to your child's difficulties.

A doctor will only consider PTSD as a diagnosis if your child or teen has been exposed to serious physical injury, sexual violence or actual or threatened death (through violence or by accident). Your child must have either:

• directly experienced the violence or injury
• witnessed the violence or injury in person (not just have seen it on TV, in movies, in videogames or in other media)
• learned that the violence or injury occurred to a close family member or friend.

What your child's doctor can do for PTSD

If your child is diagnosed with PTSD, you and your child's doctor will decide the most appropriate course of action together. Your doctor may require input from your child's teacher or other family members.

Your doctor may also suggest that your child see a therapist or a psychiatrist or recommend that your child take medications.

Further information

For more information on post-traumatic stress disorder (PTSD), please see the following pages:

PTSD: Overview

PTSD: Treatment with psychotherapy and medications