Children react to severe and acute stress in ways that are very similar to adults. Until people started to interview children directly, this was not obvious and initially it had been thought that children rarely developed post traumatic stress disorder. Now it is recognised that even pre-school children manifest symptoms of PTSD and slightly different criteria have been developed to make valid diagnoses. The point prevalence of PTSD in young persons is in the region of 1-5%, but the incidence after particularly frightening experiences can be around 15% after single trauma and over 50% in war exposed children. By age 18, a majority of children will haver experienced at least one very stressful event and so it is clear that only a minority go on to develop PTSD. Cognitive appraisals by the child predominate in determining which of them develop PTSD. Disruption of the HPA axis is involved as are genetic and family factors. Trauma Focused Cognitive Behavioural Therapies have proven to be the most effective interventions at present for both single event and multiple trauma as involved in sexual abuse and domestic violence. The latter may have longer lasting sequelae. Medication is not generally recommended for use with children with PTSD. There is limited evidence as to the best form of early intervention that will both comfort the child and lead to an early resolution of the reactions. There is general agreement that single, one-off interventions are not recommended.
- Acute stress
- Cognitive models