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PTSD: National Center for PTSD

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PTSD in Children and Teens

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PTSD in Children and Teens

Trauma happens to people of all ages. If diagnosed with PTSD, the symptoms in children and teens can look different from those in adults. Children may be more likely to show signs of PTSD in their play while teenagers may be more impulsive. As in adults, trauma focused cognitive behavioral therapy is the most effective treatment.

What does PTSD look like in children?

School-aged children (ages 5-12)

These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.

Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.

Teens (ages 12-18)

Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.

What are the other effects of trauma on children?

Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of what we know about the effects of trauma on children comes from the research on child sexual abuse. This research shows that sexually abused children often have problems with

  • Fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others
  • Behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol

How is PTSD treated in children and teens?

For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years if they do not get treatment. There are many treatment options, described below:

Cognitive-Behavioral Therapy (CBT)

CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF-CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert himself or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, "the world is totally unsafe."

Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD.

CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children.

Psychological first aid/crisis management

Psychological First Aid (PFA) has been used with school-aged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem solving skills. PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe symptoms may be referred for added treatment.

Eye movement desensitization and reprocessing (EMDR)

EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work.

Other treatments

Special treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol.

What can you do to help?

Reading this information is a first step toward helping your child. Learn about PTSD and pay attention to how your child is doing. Watch for signs such as sleep problems, anger, and avoidance of certain people or places. Also watch for changes in school performance and problems with friends.

You may need to get professional help for your child. Find a mental health provider who has treated PTSD in children. Ask how the therapist treats PTSD, and choose someone who makes you and your child feel at ease. You, as a parent, might also get help from talking to a therapist on your own. Please see our Where to Get Help page for treatment resources.

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PTSD Information Voice Mail:
(802) 296-6300
ncptsd@va.gov
Also see: VA Mental Health