NORMAL — Post-traumatic stress disorder has many faces beyond the returning combat veteran.
Increasingly, childhood trauma survivors are a face of PTSD. The sooner that parents, teachers and medical professionals recognize that PTSD and other illnesses and conduct disorders may be rooted in childhood trauma, the sooner treatment and recovery may begin.
“Some of these children have been under the radar because they’ve been diagnosed with and treated for other things,” including conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder and bipolar disorder, said Dr. Faisal Ahmed, child and adolescent psychiatrist with Advocate Medical Group, Normal.
When they also are diagnosed with PTSD and therapy reveals the root cause of childhood trauma, appropriate treatment may begin, said Ahmed, who wants to increase awareness about childhood trauma leading to disorders such as PTSD.
Lynn Willard, executive director of ABC Counseling & Family Services in Normal, agrees with Ahmed. Ninety percent of ABC’s cases involve child sexual abuse evaluation and counseling.
“The kids need to be assessed and evaluated. We look for symptoms of PTSD,” said Willard, a licensed clinical professional counselor and licensed clinical social worker. “The trend is more kids being diagnosed with PTSD.”
Counseling helps children to process the trauma, Willard said.
But Ahmed believes PTSD remains under-diagnosed and he wants to change that. An estimated 7.8 percent of the population has experienced PTSD but Ahmed said the rate among childhood trauma survivors is higher.
More than 4 million children are exposed to trauma in the United States each year, Ahmed said. Trauma could be sexual or physical abuse, a natural disaster or man-made tragedy such as a car crash, or being exposed to violence, including a neighborhood or school shooting.
Children exposed to trauma have higher rates of ADHD, conduct disorders, mood disorders, anxiety/panic disorders, bipolar disorder and depression than the general population, he said. Ahmed is not saying that most children with those conditions have been exposed to trauma.
“But the trauma predisposes children to various mental illnesses and conduct problems,” he said.
Trauma disrupts childhood development; how much varies with each child. Children who are otherwise healthy, who don’t have a family history of mental illness, who generally have good family support, who were older when the trauma occurred and have a spiritual life tend to be more resilient and less impacted by trauma than less fortunate children, Ahmed said.
Childhood physical, sexual and emotional abuse can reduce the size of the Amygdala, the emotional center of the brain. A reduced Amygdala can result in emotional unconcern, poor behavior control, aggression and impulsivity, Ahmed said.
It’s not uncommon for children to be diagnosed and treated for such disorders as ADHD or oppositional defiant disorder.
But if the cause of their disorder is childhood trauma that isn’t addressed with treatment, a pattern of defiant behavior may continue, Ahmed said. Ahmed knows of cases in which untreated PTSD resulting from childhood physical and sexual abuse resulted in criminal behavior, substance abuse, sex abuse and self-mutilation.
Abused children, left untreated, become violent and unpredictable because they understand the world as being unpredictable and painful and adults as angry, impatient, depressed and distant, Ahmed said. Abused children who develop PTSD may dissociate themselves from emotions, may develop amnesia and may have pain without a medical cause.
Ahmed once met with a 5-year-old boy who had been diagnosed with ADHD and was on medication but remained out of control. He asked the boy to draw. He drew his house and when Ahmed asked him why one of the windows was darkened, the boy said, “Bad things happen there.”
When Ahmed asked him about it, the boy got up and ran out of the room. Ahmed found out from the boy’s mother that her ex-boyfriend had sexually abused the boy. The mother kicked the man out but didn’t report the incident, so the boy wasn’t treated for the abuse.
Ahmed said parents, guardians and doctors should ask aggressively defiant or irritable children whether they have been abused or exposed to trauma. The language used would depend on the age of child.
When children don’t respond well to medicine for ADHD or another disorder, it’s also appropriate to ask whether the child has been traumatized, Ahmed said.
“Ask ‘Has something bad happened to you? Has someone touched you?’ Be direct,” Ahmed said.
“Don’t ignore it,” Willard agreed. Protect the child and get the child professional counseling.
In addition, Ahmed wants the American Psychiatric Association diagnostic criteria of PTSD to be less restrictive, which would make it easier for children to be diagnosed with PTSD to get the treatment they need.
“It’s time to loosen our rigid criteria for diagnosing PTSD,” he said.
Treatment includes therapies (trauma-focused cognitive behavioral, eye movement desensitization and play); medication targeted to anxiety, aggression or depression; and social activities to help children to heal.
Parents are taught to spend more one-on-one time with children to rebuild trust.
“The goal of treatment is coping skills,” Willard said. “You won’t eliminate it (recollection of the trauma).”