Neglect, Physical and Sexual Abuse: A Look at Posttraumatic Stress Disorder in Children and Adolescents

Alternatively known as "shell shock" or "combat neurosis", Posttraumatic Stress Disorder (PTSD) has long been around, but has not always been recognized as a disorder in the world psychiatric classifications. With PTSD being identified with war, the idea that other traumatic events could cause detrimental symptoms was often disregarded. This belief was especially geared towards children and adolescents. Although the idea of PTSD symptoms being present in youth was thoroughly examined, nothing concrete was commenced until Terr (1979, 1983) conducted a study examining a group of children who were kidnapped and held hostage. These outcomes provided support that children and adolescents could develop PTSD. The four-year follow up study that took place in 1983 examined how the severity of the incident and children's posttraumatic symptoms interacted with the individual's history. This study led to the groundbreaking notion that PTSD symptoms can be present in children and adolescents as well as developing an initial understanding of the effect trauma can have on this population According to the American Psychiatric Association (DSM-IV-TR), "Posttraumatic Stress Disorder (PTSD) is characterized by the re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and by avoidance of stimuli associated with the trauma" (APA, 2000, pp. 468469). Although there are minimal studies available regarding Posttraumatic Stress Disorders, it is known that this disorder is highly prevalent in a wide range of settings, most commonly those related to sexual abuse (Stien, Zungu-Dirwayi, Van Der Linden, & Seedat, 2000). With the enormous personal and societal costs PTSD takes from individuals and their families, the disorder must be examined from a multifaceted perspective. In the United States an immense number of children are involved in traumatic events in the early years of their lives. Approximately 5.5 million children are involved in some sort of maltreatment case every year (Hamblen & Barnett, 2010). Of these traumatic events reported in 2009, 78 percent were due to neglect, 18 percent were due to physical abuse, 10 percent to sexual abuse, and 8 percent to psychological abuse (Gaudiosi, 2009). These percentages total more than 100 percent because children who were victims of more than one type of maltreatment were counted for each type of maltreatment they experienced (Gaudiosi, 2009). These statistics show the intense reality of abuse in the United States. With many of these cases resulting in the diagnosis of PTSD or posttraumatic symptoms, the awareness of the treatments available, course the disorder takes, and diversity issues are critical issues for mental health professionals. To be a child or adolescent diagnosed with PTSD, there is a list of criteria that must be met. The child or adolescent must have experienced, witnessed, or been confronted with an event or events that involved actual or threatened death, serious injury, or physical integrity of self or others (DSM- IVTR, 2000). In children, PTSD manifests in responses of disorganized or agitated behavior and possible feelings of intense fear or helplessness (DSM-IV-TR, 2000). Frightening dreams often occur along with distressing recollections associated to the traumatic event. The child or adolescent will experience persistent avoidance of the stimuli associated with the traumatic event and often might have difficulty concentrating (i.e, in school) and have exaggerated startled responses (DSM-IV-TR, 2000). There are three main risk factors that enhance the likelihood of a child or adolescent developing PTSD after a traumatic event. These factors include the severity of the traumatic event, the parental reaction to the traumatic event, and the physical proximity to the traumatic event (Birmaher, Brent, & Benson, 1998). The awareness of these risk factors is important to families and loved ones so they are able to be supportive, understanding of the symptoms, and even participate in the therapy process. …