Supporting children and young people with post traumatic stress disorder (PTSD)

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition which may develop following exposure to an extremely threatening or horrific event or series of events. These potentially traumatic events include accidents, assaults, war, natural disasters, physical, sexual or emotional abuse, and the death of loved ones. It may also include events such as animal bites or attacks, bullying, emotional neglect, separation from parents or carers, or being exposed to high conflict or abuse between parents or carers.

It should be noted that not all children who experience potentially traumatic events will develop PTSD.  Distress and difficulties immediately after such events are completely normal but, usually, the distress and difficulties diminish over the following days and weeks. A diagnosis of PTSD will only be considered when a person continues to experience distress and difficulties for several weeks.

If you are looking for advice and guidance about supporting a child or young person following a recent traumatic event, we recommend you read Traumatic events: How children and young people can react and how adults can respond.

For those children and young people who develop PTSD, it may not present immediately after an event and symptoms may manifest months or years later making it difficult to recognise or attribute to the event. Young people who suffer from PTSD may find it hard to let go of their distress, and they may experience intrusive and disturbing thoughts which lead to them reliving these traumatic events through flashbacks or nightmares.  This may result in them avoiding people or situations that might remind them of traumatic events.   

Signs that a child or young person is experiencing PTSD

The signs and symptoms that a child or young person may be suffering from PTSD are easy to miss or misinterpret at times. Core symptoms of PTSD which you may notice include:

1. Intrusions or re-experiencing of the event: This may include memories of pictures of an event unexpectedly popping into the mind, repeatedly playing or drawing events, nightmares, flashbacks and distress triggered by reminders of the event or events

2. Increased arousal: This may include problems with concentration, perhaps due to being over-vigilant of potential threats, irritability and sleep problems

3. Avoidance: This may include avoiding of thoughts, feelings or memories of an event or events, or avoiding people, places or situations that are associated with an event or events

The severity and duration of PTSD symptoms will also differ from person to person. Sometimes recovery can be quick and sometimes it may take much longer. Recovery depends on several factors and the person should not be rushed into healing or shamed for taking their time. Children and young people experiencing PTSD might also experience other mental health problems such as anxiety, depression, self-harm and suicidal thoughts. It is, therefore, important to seek help from your GP who may refer your child for an official diagnosis and treatment.

Common issues parents and carers may have to contend with

Supporting a child or young person with PTSD can be very challenging and upsetting for a parent or carer. Your child may try to avoid conversations about their feelings regarding an event as it is too painful and overwhelming for them to talk about. They may experience flashbacks or memories which make them feel as if they are reliving the event time and again and these intrusive thoughts may occur at any time and be extremely scary for them. Your child may also try to avoid certain events or locations and they may be hyper-vigilant to potential threats in their surroundings. Parents and carers will, therefore, need to be patient with their child and try to acknowledge their symptoms without expressing frustration or annoyance to the child. Some children and young people may benefit from professional help and it is important to reassure them that this is a positive step, that we all need help sometimes, and that the additional help will hopefully help reduce their symptoms of PTSD. For more information on what professional support may look like, please see Receiving Support.

It may also be that parents and carers and other members of a family, including siblings, may have experienced the same traumatic event and also need professional help processing their feelings and emotions. It is important to note that each person’s symptoms may differ greatly and that their recovery may also be very different. Some children and young people may require more time and support than others and the mechanisms or strategies which one child finds useful may not always help another child.

How to support a child or young person with PTSD

One of the main things for any child or young person experiencing PTSD is feeling safe again. Taking time to physically and emotionally reassure them and make them feel secure can be very helpful including spending time on uplifting activities such as watching their favourite films or playing games together. You may find that these activities provide a safe space for your child to talk about their feelings or emotions without forcing the issue. Try to ensure that your child knows that they can talk to you or others whenever they feel able but let them know you may check in on them sometimes to ensure that they aren’t bottling things or trying to appear brave when actually they are struggling and that you hope they understand why you might do this.

Familiar routines and structure, such as going to school or college and engaging in their normal social activities, can also help a child or young person feel more secure. It may help to talk about places you may go so that your child can mentally prepare themselves for what to expect and you might practice some breathing exercises together which may help them regain control if they suddenly feel afraid or overwhelmed. Children and young people may also find it helpful to write their feelings down in a journal or diary and they may find it easier to share this with you than to talk directly. Writing things down may also help if they are struggling to concentrate or sleep.

Finally, for children experiencing grief or loss, it is important to communicate to them that they can share whatever they are feeling and that it isn’t strange or abnormal to do so. This will help them to open up. Sometimes children and young people actually find it easier to talk to someone outside their immediate family, such as a teacher or other professional. If the child or young person isn’t opening up to you, it is important to remain patient and perhaps seek professional help like that of a psychotherapist.

What to say to schools and colleges

For educators, handling trauma and PTSD can be very challenging. Since children and young people can spend a considerable part of their day at school or college, it is important to make that environment less triggering. Sometimes something seemingly as small as a door slamming or something being dropped on the floor can trigger a behaviour or response that might seem bizarre to someone who doesn’t know the root of it. Children and young people may also find it difficult to focus on lessons when they are hyper-vigilant to potential dangers. Therefore, informing schools or colleges may help avoid situations where a child or young person might be misunderstood and punished unfairly.

Schools and colleges being aware of traumatic events can help you monitor any drastic changes that may result from a child or young person’s trauma which may be a sign that they are not coping and may require additional help or support from a professional.

It should be noted that, for some children and young people, the school or college environment could be the cause of trauma through potentially bullying from their peers. In these instances, parents and carers should familiarise themselves with the bullying policy of their school or college and ask the school or college what actions they will specifically take to support your child.

What to say to siblings?

Siblings can be a good support system for the child or young person suffering from PTSD. But this depends on the age of the siblings. If they are too young, perhaps sharing overwhelming information about a trauma might scare or shock them. Younger siblings can be told things like your elder brother or sister is going through a rough patch and ask them to not bother them or make fun of them and be more sensitive towards them.

Older siblings, however, can be easier to speak to. They may already have a good understanding of what has happened and have concerns and questions which you should take time to discuss with them which may help them feel connected to the recovery process and feel less isolated. They can also be made aware of their sibling’s struggle and triggers and, if the siblings go to the same school or college, they may feel able to keep an eye out for their sibling and check in with them throughout the day.

What to say to extended family

Building a support network in the family and extended family can be helpful as it can both help the child feel safe and less alone and offer additional support for you as a parent or carer.

But trauma is something which is very personal and potentially debilitating. So, you will want to think carefully about what to say to whom. Your child may not appreciate lots of people knowing, and suddenly giving them lots of attention.

The extended family can also be made aware of some of the triggers that can be easily avoided to make family gatherings and situations less stressful for the child or the young person. Since the child or young person will often struggle with showing affection or getting involved in group activities, the extended family can be made aware of how it isn’t intentional and that they’re not being rude or inconsiderate.

Additional support for parents and carers

• Looking after your child following trauma – leaflet produced by the Greater Manchester Resilience Hub and funded by NHS for parents and carers.

• After the event – Resources to help children and young people recover after potentially traumatic events.

• UK Trauma Council  - advice and guidance.