Mental health is just as important as physical health to a child's well-being.

Mental health is just as important as physical health to a child's well-being.

Where to Start

Signs and Symptoms of Traumatic Stress

It is important to understand the difference between normal stress and child traumatic stress. For example, if your child has a math test and is feeling stressed or anxious or if your child has to get a tetanus shot and is upset about it, these are normal stressors. A parent or caregiver can help their child through these daily stressors and they usually do not have a lasting effect. However, traumatic stress results from experiencing significant events that threaten the well-being of the child and their daily lives.

The following are examples of some of the post-traumatic symptoms that a child/adolescent may experience after a traumatic event. These acute reactions are normal in the short-term and may include:

  • Sleep disturbances – nightmares, night waking
  • Appetite changes – lack of appetite, overeating
  • Separation anxiety – child does not want to go to school, leave a parent/caregiver for an activity, or playdate
  • Hypervigilance – constantly scanning the situation for threats, overly aroused, over-stimulated
  • Physical complaints – aches and pains, nausea
  • Irritability – easily angered, aggressive
  • Emotional upset – crying easily
  • Regressive behaviors – reverting back to younger behaviors, losing previously acquired skills
  • Withdrawal – wanting to be alone all the time
  • Blunted emotions – no emotional reaction, emotional numbness
  • Distractibility – cannot focus, daydreaming, cannot remember the trauma
  • Changes in play – play that re-enacts the trauma or somber play
  • Changes in social functioning – not enjoying family or peers

When to Worry

All children facing an abnormal traumatic experience are likely to develop some (but usually not all) short-term symptoms as described in the above categories. These reactions in the immediate aftermath of an event can be normal. However, if these reactions persist, there may be reason for concern. A child should be referred for a trauma-focused assessment or treatment: a) when symptoms persist for weeks and months beyond the trauma exposure, b) when changes in the child’s behavior or mood are severe or life-threatening (seek emergency care), and c) to support the child’s and family’s recovery in the acute aftermath of a traumatic event. Parents and caregivers typically know their children best. If your child has been exposed to a potentially traumatic event and seems to be suffering or having a hard time with their daily life, you should seek help from a qualified professional.

When post-traumatic symptoms become chronic they can interfere with a child’s day-to-day functioning and lead to a myriad of difficulties. The following are four types of chronic symptoms that can persist:

Four major symptom areas for Chronic Post-Traumatic Stress

  1. Traumatic Repetitions
    • Traumatic play
    • Play reenactment
    • Nightmares
    • Flashbacks and dissociation
    • Distressed when reminded
    • Somatic (bodily) complaints when reminded
  2. Avoidance & Fear
    • Avoids thinking or talking about event
    • Avoids reminders of event (people, places, and things)
    • Impaired recollection or memory
    • New fears (e.g., separation, being alone, darkness)
    • Sense of a foreshortened future or impending doom
  3. Increased arousal
    • Nightmares or night terrors
    • Difficulty falling or staying asleep
    • Decreased attention or concentration
    • Hyperactivity
    • Irritability and changes in mood
    • Increased aggression
    • Hypervigilance and exaggerated startle response
  4. Decreased responsiveness numbing & regression
    • Diminished interest in play and normal activities
    • Social withdrawal, peer difficulties or feelings of detachment and isolation
    • Restricted range of emotion
    • Developmental regression

Children who seek help for these symptoms can be at risk of being misdiagnosed for a variety of disorders including: ADHD, major depression, Bipolar Disorder, Oppositional Defiant Disorder, Conduct Disorder, specific phobias, and learning/academic difficulties—especially if the traumatic event is not revealed or discussed. It is important to talk with your primary care doctor or mental health provider about your child’s symptoms and to ask for a referral to a mental health provider who can conduct a thorough trauma screening or assessment. If your doctor is not aware of providers who offer trauma-focused treatment in your area, you can consult our referral list of agencies in Connecticut who provide these services or call 211. See section “Trauma-Focused Services and Resources.”

Mental health clinicians who conduct assessments will work with the parent or caregiver to complete a trauma screening or assessment for children ages 3-18. Depending upon the child’s developmental level, a child can complete an interview by themselves with a mental health specialist around the age of 7. The trauma screening should take about 3-10 minutes, depending upon the number of traumas the child has experienced as well as the age of the child. More in depth assessments may take a bit longer, but typically can be completed in one meeting. See the next sections on “Effective Treatments for Child Traumatic Stress” and “Trauma-Focused Services and Resources.”