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How we can help children and young people experiencing post-traumatic stress

We need to be more open to children and young people’s views rather than dismissing opportunities to learn about trauma alongside them

We need to be more open to children and young people’s views rather than dismissing opportunities to learn about trauma alongside them


Post-traumatic stress symptoms can include intrusive memories, nightmares and flashbacks
Picture: iStock

Exposure to trauma in childhood and adolescence is sadly a common experience, with a large recent UK study suggesting that more than 30% of people may experience a trauma before they become adults (Lewis et al 2019). Symptoms of post-traumatic stress disorder (PTSD) can be a common reaction to trauma in children and teenagers and such intrusive memories, nightmares and flashbacks can be distressing.

Single incident

In our recently published paper (Meiser-Stedman et al 2019), we looked at post-traumatic stress in more than 200 eight-17 year olds who had been involved in some kind of single incident trauma, typically a motor vehicle collision, assault or other medical emergency. These young people were interviewed and assessed for PTSD between two and four weeks following their trauma, and again after two months.

A major report finding was support for the suggestion that traumatic stress is a ‘normal reaction to an abnormal event’.

‘We wanted to explore why children recover after trauma in the way they do, and why some might get “stuck” with persistent PTSD’

In the first weeks post-trauma, many young people experienced some symptoms of post-traumatic stress, even if not meeting diagnostic threshold. Moreover, there was also considerable natural recovery in the following weeks so that the numbers of children and young people above some sort of diagnostic threshold, such as DSM-IV or DSM-5 PTSD, approximately halved between two weeks and two months post-trauma.

What is the DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual that outlines all known mental illnesses, what they are, how they are diagnosed, and in some respects, treatment

Recovery factors

We wanted to explore why children recover after trauma in the way they do, and why some might get ‘stuck’ with persistent PTSD. Factors such as injury severity and demographics had little to do with PTSD; whether the person was younger or older, male or female, PTSD could result from their trauma.

However, children and young people who were admitted overnight were less likely to develop PTSD despite their more serious injuries. Why? Was it because of greater recognition from their peers, families and schools? Or more opportunities to tell their story? Intriguingly, social support was unrelated to PTSD risk.

What became clear was that psychological factors relating to the severity of the trauma were much more important: fear, threat to life and panic certainly, but also greater confusion during the trauma. But these processes only led to the onset of post-traumatic stress, not necessarily its persistence.

Those whose PTSD did not settle down were much more likely to appraise themselves negatively, in particular viewing themselves as weak and fragile, and their psychological reactions as a sign that something was seriously wrong with them and they were permanently ‘damaged’.

Coping mechanisms

We had speculated that those children and young people who sought to talk through their trauma with friends and family or think it through on their own would be more likely to recover. Efforts to deliberately process what had happened would be the opposite of the avoidance that is typically associated with PTSD, and what is thought to maintain this condition. However, this way of coping, which we termed ‘adaptive processing’, was actually associated with a poorer outcome.

What does this mean for how we support children and young people exposed to trauma?

First, we might start by taking the pressure off ourselves. If we, as healthcare professionals, do little in the immediate aftermath of a trauma, we may be giving children and young people a chance to handle trauma successfully on their own terms. It may be difficult for any intervention to outperform the natural recovery we observed, at least after the types of mostly non-interpersonal trauma that were included in this study.

‘It is not unusual for caregivers and professionals to adopt a "let sleeping dogs lie" approach when it comes to childhood trauma’

Second, the normality of immediate post-traumatic stress may be something to explain to children and young people and their families. In my experience, it is not uncommon for the media to ‘talk up’ the risk of catastrophic mental health impacts of trauma on children, but we should be wary of the self-fulfilling prophecy this may engender. This should obviously not extend to being dismissive of any post-traumatic stress, but an appropriate balance needs to be struck.

Recognised responses

Even if a child or young person does get ‘stuck’ in terms of their post-traumatic stress, the recent PTSD guidelines from the National Institute for Health and Care Excellence (NICE 2018) provide good evidence that this condition is treatable.

Third, these findings speak to the need to take children and people’s responses to trauma seriously, not only in terms of the marked distress and suffering a significant minority will experience, but also in recognising that they are actively involved in trying to make meaning of what they have been through.

‘The judgement call for us then is: what is the optimal way of lending support to children and young people?’

It is not unusual for caregivers and professionals to adopt a ‘let sleeping dogs lie’ approach when it comes to childhood trauma, but this study points to how powerfully some children and young people will be mentally battling with what they have been through.

Rather than passively yielding to trauma, children and adolescents with PTSD may be striving to get over their experience. The judgement call for us then is: what is the optimal way of lending support to them?

Finally, it was striking about this study that more than 90% of the participants remained in the study for our two-month follow-up assessment. Like many other studies, we found no reports of harm through being in our research, and participants valued being heard.

The widespread nature of trauma in our society suggests that we need to be more open to listening to the views of children and young people going through these experiences, rather than fearfully shutting down opportunities to learn about trauma alongside them.


References


About the author

Richard Meiser-Stedman is professor of clinical psychology at the University of East Anglia

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