Most people think of post-traumatic stress disorder as a condition that afflicts combat veterans.
Too often we hear or read about ex-military men and women who commit suicide or acts of aggression who have been diagnosed with PTSD; some estimate that up to 20 percent of veterans from recent wars are afflicted. There is little doubt that the ravages of warfare can overwhelm even the hardiest of individuals.
What is less understood and appreciated, however, is that PTSD is not just a disease of war. It can affect any individual, at any age, who has experienced a highly threatening psychological or physical event or events. For children, the effects of PTSD can be especially challenging to identify, and often children do not receive effective treatments until they have suffered for many years.
The May 22 terrorist bombing at an Ariana Grande concert in Manchester, England — an event attended by tweens and teens — brings this to the forefront.
So, too, does the recent school bus accident in Lancaster County.
My colleagues and I at the Penn Center for Youth and Family Trauma Response and Recovery have worked with many children who have been traumatized by events. We know that physical recovery is only half the battle.
Family and friends might expect children to be “fast healers,” and that can be true in a physical sense. But kids — lacking an adult’s maturity, perspective and life experiences — can also have a more difficult time processing their thoughts, fears and emotions surrounding a traumatic event.
If unresolved, these emotions can present as classic symptoms of PTSD: sleep disturbances or nightmares; unusual irritability or anger; anxiety and panic attacks; withdrawal from regular friends, hobbies or interest in school; or unexplained physical ailments like headaches, stomachaches, or a racing heartbeat.
Sometimes these symptoms may not appear for weeks or even months after the event. Left untreated, they can linger for years — even into adulthood — and are known to contribute to a range of health and social issues such as obesity, drug and alcohol abuse, disrupted education, employment problems and increased risk of incarceration.
There is good news, however. With early diagnosis and intervention, children suffering from PTSD can make a full recovery. Symptomatic kids, much like veterans, don’t simply “get over it” or forget about what happened. Successful treatment helps children understand and manage their feelings about the traumatic event in a way that lets them function normally and productively.
Treatment gives kids the means to incorporate the trauma into the fabric of their life story so that it takes on no more power than the occasional sorrow or suffering common in every person’s life.
It is important for adults to provide an open and supportive environment for a child recovering from PTSD. This means allowing — but not forcing — a child to express his or her fears and anxieties without judgment. It means taking steps to ensure the child does not isolate him or herself, but remains engaged in the normal routines of school, sports, family events and playing with friends. It means watching for symptoms of PTSD and engaging professional help when needed.
Counseling often can extend to parents and siblings, who experience their own kind of trauma when they think about how close their loved one may have come to serious injury or death.
The potential for childhood trauma is not limited to headline-grabbing events like a bus accident or terrorist bombing. Trauma can be a chronic condition for children growing up in unstable or dangerous environments at home, school or in their community.
Of course, not every child reacts the same way, and many will recover their emotional and behavioral balance on their own after a traumatic event.
Regardless, adults must be vigilant. By being aware of the possibility of PTSD and its symptoms, parents, teachers, coaches and other adults engaging with young trauma victims have an opportunity to be a source of healing and recovery.
Steven Berkowitz, M.D., is director of the Penn Center for Youth and Family Trauma ResponseRecovery.