Childhood

During childhood the key developmental challenges experienced include sleep, toileting, intellectual, learning and communication difficulties, conduct disorder, developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiance Disorder (ODD), fear and anxiety disorders, Post traumatic Stress Disorder (PTSD), depression, bipolar disorder, and Autism Spectrum Disorder (ASD) (Carr, 2015).

Post-traumatic Stress Disorder

Common behaviours displayed by children when they are stressed include crying, becoming aggressive, talking back or becoming irritable. Other children may behave well but become nervous, fearful, or panicky. Emotional and behavioural reactions to a traumatic event are normal, and at times these reactions can be quite strong. Experiencing such things as fear, loss of interest in activities, emotional upheaval, difficulty concentrating and paying attention is a normal human reaction to trauma. (Peterson, 2022), However, when these symptoms of stress continue for longer than a month, are upsetting or interfere with their relationships and activities, a child may be diagnosed with PTSD (Centers For Disease Control and Prevention, 2022).

PTSD can develop as a consequence of experiencing or witnessing a traumatic event, learning about the death or threatened death that has occurred to a close family member or friend (Centers For Disease Control and Prevention, 2022), repeatedly being exposed to traumatic events through media or conversations overheard by adults (Cobham et al., 2016).

Some of the causes of PTSD can include disasters both natural and man-made, family events such as domestic violence, abuse (physical or sexual), or extensive injuries gained from accidents, for example, a car crash. The type of event and the severity of exposure impact the degree to which PTSD is experienced (Hamblen & Barnett., 2022). Regardless of whether the child was a victim or a witness, the symptoms of PTSD can impact the daily functioning of a child (Trickey et al., 2012).

Behaviours can be observed in a variety of settings including the home, school and other environments. Some behaviours seen at home may include developmental regression, bedwetting, nightmares or sleep disturbance. Young children may show unusual clinginess to the carer, have an exaggerated startle response (Peterson, 2022). They may avoid places or people associated with the event, become irritable or experience angry outbursts, they may relive the event over and over in thought and this can be observed in their play (Centers For Disease Control and Prevention, 2022).

At school there may be a decrease in academic performance. A child’s capacity for self-regulation, organisation, comprehension, and memorisation can be severely impacted due to trauma, affecting students academically and socially throughout their school experiences (Thommas et al., 2019). A child may display a lack of positive emotions or may experience feelings of intense ongoing fear or sadness. Constantly looking for possible threats or becoming easily startled, becoming very upset when something causes memories of the event especially if the event occurred at school. The child may even pretend that the event never even occurred (Centers For Disease Control and Prevention, 2022). A child may stop talking and refuse to communicate with those around them.

Evidence of Symptoms 

The brain recognises the situation as dangerous or threatening, feelings of apprehension, tenseness and uneasiness would most likely be experienced and then an automatic arousal occurs to prepare the child for the appropriate response to the danger, fight or flight. In the case of extreme danger, they may freeze. The resulting behaviour whether aggressive or avoidant is dependent on the context in which it occurs. This context usually would involve parents, siblings, school teachers and peers (Carr, 2015).

Many people go through traumatic events but not all people develop PTSD. It has been found that when certain risk factors are present then there is a higher likelihood of the condition occurring. Apart from the level of exposure, other risk factors include female gender, previous trauma exposure, pre-existing psychiatric disorders, parental psychopathology and low social support (Peterson, 2022), poor family functioning and the type of communication between parents and their children (Cobham et al., 2016). Protective factors include parental support and lower levels of parental PTSD have been found to predict lower levels of PTSD in children (Peterson, 2022).

Children may experience time skews which refers to a child mis-sequencing trauma-related events when recalling the memory and ‘omen formation’ which is the belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognise warning signs and avoid future traumas. A child may re-enact the trauma in play, drawings, or verbalisations, they child may compulsively repeat some aspect of the trauma, and this type of play does not tend to relieve anxiety (Hamblen & Barnett, 2022).

A functional behaviour analysis (FBA) would be most beneficial to determine the causes of behaviours to determine if the behaviours being exhibited are indeed PTSD and not something else. This involves collecting data from a review of the child’s school records, interviews with school staff and parents/carers, structured rating scales, a collection of direct observation data, identification of any health and wellbeing concerns or issues and consideration of environmental conditions that may impact behaviours of concern (State of Victoria Department of Education and Training, 2020).

If PTSD is suspected then child should be referred to a health care provider trained in psychotherapy in which the child can speak, draw, play, or write about the stressful event (Centers For Disease Control and Prevention, 2022).

Impact on the Individual and Interactions

At times the behaviour of children with PTSD can be mistaken for the behaviour problems associated with oppositional defiance disorder and conduct disorder (Peterson, 2022), or attention deficit hyperactivity disorder (ADHD) as children may seem restless, fidgety, or have trouble paying attention and staying organized (Centers For Disease Control and Prevention, 2022). Children with PTSD have also been found to experience problems with fear, anxiety, separation anxiety, panic disorder, depression, anger and hostility, aggression, sexually inappropriate behaviour, self-destructive behaviour, feelings of isolation and stigma, poor self-esteem and difficulty in trusting others (Peterson, 2022).

Children with PTSD may find it difficult to communicate with peers or family members due to the stigma attached to the trauma. Further, PTSD in children can damage the child’s relationship with parents and other caregiving adults, siblings, and peers, especially if abuse is the cause of the trauma (Peterson, 2022). In this case attending a family event, where the abuser may be present may trigger the behaviour, or attending school where a child has experienced severe bullying. Travelling in a vehicle after witnessing or being involved in a car accident.

Suggested Interventions

Because of the very nature of PTSD, it is usually treated by professional psychotherapists through play-based therapy or Cognitive Behaviour Therapy. The school guidance counsellor may have training in these areas and therefore would be able to use these methods in the treatment of children suffering from PTSD. However, for those who are not trained, working with students with a trauma informed practice would be highly beneficial (Thommas et al., 2019). Kezelman (2014) states that Trauma Informed Practice is a strengths-based framework which is founded on five core principles – safety, trustworthiness, choice, collaboration and empowerment as well as respect for diversity.

The guidance counsellor could help with building self-esteem, employing positive coping strategies, developing a healthy self-image and learning how to manage stress. Using the information gathered with an FBA, the school team could implement school wide strategies to assist all students in these skills. Because of the multiple behaviours that can be displayed by children suffering from PTSD a child’s Individual Support Plan would need to be structured specifically to the types of trauma reaction displayed (Thommas et al., 2019).