Post-Traumatic Stress Disorder (PTSD) In Children Under 6: Causes, Symptoms, Diagnosis And Treatment

Children under six can develop post-traumatic stress disorder after a trauma, too — but PTSD may manifest slightly differently in young children than it would in older people. What do you need to know about the most common causes of PTSD in preschool children, the symptoms, the diagnostic process, and the treatment options?

What kinds of events cause post-traumatic stress disorder in young children?

According to US Veterans Affairs, some of the most common traumatic events that children under six experience are (in this order):

• Abuse, as a direct victim
• Witnessing abuse and violence
• Witnessing or being in vehicle accidents
• Living through a natural disaster
• Living through war
• Being bitten by a dog
• Going through invasive medical procedures

You'll see that experiencing and witnessing abuse (interpersonal violence) top this list. Because abuse often goes on in private, with only victims and perps being aware it's happening, the true prevalence of this kind of trauma will never be known.

Research suggests that many children living through abuse do not speak up — because they don't have the words, they're scared of retaliation, they don't realize what's happening is wrong or a crime, or because they blame themselves for what is happening. In many cases, the perpetrator of the abuse will be a parent or other relative. Protecting the abuser is another reason that causes a child to keep their trauma to themselves.

In the case of "hidden trauma", behavioral changes in a child may be the only warning sign that something's wrong. 

What are the symptoms of PTSD in young children?

Post-traumatic stress disorder in children under six will result in similar symptoms as PTSD in older children, adolescents, and adults. Some PTSD symptoms can manifest differently in young children, though. On top of that, a preschool child who has PTSD as a result of trauma may not be able to verbalize what they are going through, leaving caregivers and medical professionals to interpret their behavior, rather than their words. 

The potential differences in symptoms and the fact that the youngest children are by definition far less able to talk about their feelings and experiences explains why the DSM-5 has included a separate list of diagnostic criteria for PTSD in children under six.

After exposure to a traumatic event, a child under six will meet these criteria to be diagnosed with post-traumatic stress disorder:

• At least one documented intrusion symptom — intrusive memories of the trauma (which may manifest as reenactments in play, during which the child doesn't necessarily have to seem upset), nightmares, flashbacks and other dissociative events (during which the child may seem to have lost connection to reality), and distress when reminded of the trauma.
• At least one symptom signifying avoidance of reminders of the trauma and/or changes in mood and thought — avoiding people, places, situations, or thoughts that remind the child of the trauma, difficult emotions like fear, sadness, guilt, and shame, losing interest in everyday things that can include play, social withdrawal, and reduced expression of positive emotions. 
• Two or more hyperarousal symptoms — irritable or angry outbursts, hypervigilance (always being on guard, expecting new danger), being quick to startle (jumpy), trouble concentrating, and difficulty sleeping. 

These symptoms will last at least a month and have a serious negative impact on daily life in children who are ultimately diagnosed with post-traumatic stress disorder. 

It is important to note that most people, including children, will have symptoms also common in PTSD immediately after suffering a trauma. Only around a third of these people will go on to meet the diagnostic criteria for PTSD a month later, however.

If you are the parent or caregiver of a young child who recently experienced a traumatic event, by all means seek counseling for them (but tread carefully, because early counseling may itself be very stressful, research among adults suggests). PTSD isn't diagnosed right away, however, because trauma-related symptoms during the first month are considered normative. That is, distress after experiencing a trauma is a normal reaction to abnormal circumstances.

Symptoms of panic in the immediate aftermath of a trauma have been associated with a higher risk of later PTSD in young children.

How is PTSD diagnosed in children under six?

Mental health professionals will use screening tools like the Juvenile Victimization Questionnaire to figure out whether a child under six years old has been exposed to a trauma. It is important to note that some conditions, like ADHD, may look a lot like PTSD, and vice versa as well. Post-traumatic stress disorder can only be diagnosed if it's certain that a child has experienced a trauma. This is to ensure that a child does not receive the wrong diagnosis.

Though your child will meet with a psychologist, for this age group, diagnostic questionnaires used to determine if a child has PTSD are addressed to parents or caregivers. 

What are the treatment options for PTSD in young children?

Cognitive behavioral therapy, offered by someone trained to work with traumatized children, is generally considered to be most effective treatment for post-traumatic stress disorder in young children. Play therapy and eye movement desensitization and reprocessing (EMDR) are also used in the treatment of children with post-traumatic stress disorder. What's more, it is important that people in the child's immediate environment, like parents, caregivers, and teachers be taught how to best support the child, as well. Parents can themselves attend therapy to learn how to best support their children.