Recognizing When Children Need Help

One of the most difficult tasks for a parent whose child has been exposed to a traumatic event, natural disaster or a death is deciding whether or not additional help from a mental health professional is needed. Parents are generally well versed in the routine doctor visits for physical ailments such as the flu or ear infections, but are sometimes confused about obtaining mental health care. Parents may feel embarrassed or ashamed; think they should handle the problem on their own; feel the situation is hopeless; disagree when others suggest the need for outside help; or dismiss or misunderstand a child’s problem. But just like physical problems, prognosis is better when the mental health problem is identified and treated early.

Although many children show signs of stress in the first few weeks after a trauma, most will return to their usual state of physical and emotional health. However, it is not unusual for the reactions of any individual child to change many times in the days and weeks following a crisis.While some of these reactions are short-lived and resolve on their own, others may linger for months or years after the event has occurred. In addition, some difficulties may not even appear until months or even years after the event. For those children experiencing more difficulty returning to normal, professional help may be necessary.

When to Seek Professional Help

Many physical and emotional signs suggest a possible mental health problem. Problems can range from those of serious concern (for example, when a child or adolescent has lost touch with reality or is in danger of harming him or herself) to those of less concern (for example, when a child or teen experiences a change in eating or sleeping, is irritable or angry or is particularly fearful of something). Further investigation should be considered when a child seems out of step with peers or exhibits changes or problems in any of the following areas:

• Eating/appetite
• Sleeping
• School work
• Activity level
• Mood
• Relationship with family or friends
•  Aggressive behavior
• Return to behavior typical of a younger child
• Developmental milestones such as speech and language

In general, when bringing a child to a mental health professional, symptoms will first be evaluated with respect to their:

• Intensity
• Duration
• Age-appropriateness
• Level of interference with daily life: in school, at home, with peers

Mental Health Problems of Concern

All children exposed to the intense fear and helplessness associated with trauma or death of a loved one may be susceptible to posttraumatic stress disorder (PTSD), anxiety disorders and/or depression. Each of these diagnoses will be discussed in detail below.

Posttraumatic Stress Disorder in Children

All children experience stressful events, but some children experience or witness unusual, sudden and frightening traumatic events. Examples of such events are child abuse, community violence, natural disasters like Hurricane Katrina and the events of September 11th.These events may involve the actual or threatened death or serious injury to the children themselves or to someone they know.

What are the symptoms of PTSD?

Children’s PTSD symptoms fall into the following categories:

Re-experiencing

• Moments when a child seems to replay the event in his/her mind
• Intrusion of recurrent memories of the event or repetitive play about the even
• Nightmares

Arousal

• Disorganized and agitated behavior
• Irritability or anger
• Nervousness about everyone and everything around him or her (e.g., when people get too close)
• Jumpy when hearing loud noises

Avoidance

• Avoidance of thoughts, feelings or places that remind the child of what happened
• Numbing or lack of emotions

Other behaviors

• Regression to earlier behavior, such as clinging, bed-wetting or thumb sucking
• Difficulty sleeping or concentrating
• Detachment from others or social withdrawal
• Excessive use of alcohol or other substances to self-medicate

Who is likely to have PTSD?

Following a traumatic event such as the attack on the World Trade Center or a natural disaster such asHurricane Katrina, children and teens most at risk for PTSD are those who:

• Directly witnessed the event(s)
• Suffered direct personal consequences (such as the death of a parent, or injury to self)
• Had other mental health or learning problems prior to the event
• Lack a strong social network

What causes PTSD?

Not everyone who goes through the same experience responds in the same way. People are born with different biological tendencies in how they respond to stress— some are more adaptable, others more cautious. Reactions and recovery also are affected by the length and intensity of the traumatic event.

Can PTSD be prevented?

Parental support influences how well the child will cope in the aftermath of the event. Parents and professionals can help children by: