Child's Post-Traumatic Stress Differs From Adult'sOctober 29, 2001
HONOLULU (Reuters Health) - Children who have been diagnosed with depression or anxiety may actually be experiencing post-traumatic stress disorder (PTSD), a New York physician said here at the 48th Annual Meeting of the American Academy of Child and Adolescent Psychiatry.
And part of the reason doctors may miss the condition in youngsters is that events that can trigger PTSD can be different from those that cause problems in adults. PTSD symptoms can include intrusive flashbacks to the trauma, nightmares and insomnia, emotional withdrawal and depression.
"We need to be aware that children's traumatic stressors differ from adults' stressors," Dr. Jeffrey H. Newcorn, told Reuters Health.
"The grouping of traumatic stressors reported by adults were typically death, injury, family violence, and other issues that we commonly identify as traumatic," said Newcorn, who is director of child and adolescent psychiatry at the Mount Sinai Medical Center in New York City.
"Children identified those issues as traumatic, but less consistently so. Their traumatic stressors were related to developmentally appropriate fears, such as falling off a bike or being bullied by another child," he added.
Newcorn and colleagues found that 70% to 80% of children and adults surveyed reported that they had been exposed to some stressor, and 60% reported an experience that qualified as a traumatic stressor, in that the experience caused the respondent to feel helpless and afraid in response to the event. The 45 children and their parents or guardians were being seen in an inner-city psychiatric outpatient clinic.
Among respondents who had an experience with an impact consistent with PTSD, 20% to 30% of respondents had full symptomatic PTSD, including symptoms such as re-experiencing of the traumatic event and avoidance of settings related to the event. Approximately 20% had partial PTSD.
"Children in full or partial PTSD more often have problems with anxiety and depression, as well as symptoms of disruptive behavior," Newcorn told Reuters Health. "Clinicians tend to diagnose the mood and anxiety disorders, and miss the PTSD. We have a general lack of awareness of PTSD symptoms. If the diagnosis can be missed in a psychiatric setting, it certainly must be true in a pediatric setting."
In other research presented at the symposium, Dr. Eyal Shemesh, also of Mount Sinai Medical Center, found high levels of PTSD in a small study of children who were being treated in emergency departments and among child transplant recipients. Shemesh found that children with PTSD symptoms were less likely to take immune system-suppressing drugs required after transplant surgery.
When children are exposed to domestic violence, 42% of them may develop PTSD, according to Dr. Claude Chemtob, of the National Center for PTSD in Honolulu, Hawaii. In a survey of mothers who used domestic violence agencies, the mothers could report their own symptoms, but "you couldn't tell which children had PTSD by talking to their mothers," said Newcorn, commenting on the research.
These findings show that domestic violence interventions must focus on the affected children as well as the family unit, in order to be successful, according to Chemtob.