TABLE 2

Symptoms of Posttraumatic Stress Disorder24

Exposure: The child is exposed to actual or threatened death, serious injury, or sexual violence. This may be through the child’s direct experience; by witnessing the traumatic event, especially when involving a caretaker; or by the child learning that the traumatic event occurred involving a close family member or friend without any direct experience or witnessing of the event by the child.
The following symptoms must occur for more than 1 month’s time:
 1. Intrusion
  • The child has repeated distressing memories and/or dreams (nightmares) about the traumatic event; it is not required for children to remember the content of these distressing dreams. For some children, repetitive play activities may involve themes or aspects of the traumatic event.
  • The child may display a loss of awareness of present surroundings (dissociation) and act as if the traumatic event is reoccurring (flashbacks).
  • The child may experience intense or prolonged psychological distress and/or physiologic reactions at exposure to internal or external cues that symbolize or resemble the traumatic event.
 2. Avoidance
  • The child attempts to avoid distressing memories, thoughts, feelings, activities, and/or places that remind him or her of the traumatic event.
 3. Negative alterations in cognitions and mood
  • The child has problems remembering important aspects of the traumatic event.
  • The child maintains negative beliefs or expectations about oneself, others, or the world.
  • The child has thoughts about the cause or consequences of the traumatic event that lead to blame of self/others.
  • The child experiences negative emotional states, such as depression, and has trouble experiencing and expressing positive emotions.
  • The child shows a markedly diminished interest or participation in significant activities, including play.
  • The child feels distant from others, which may lead the child to become socially withdrawn and avoid people, conversations, or interpersonal situations.
 4. Increased arousal and reactivity associated with the traumatic event
  • Irritable and angry outbursts (extreme temper tantrums).
  • Reckless or self-destructive behavior.
  • Hypervigilance.
  • Exaggerated startle response.
  • Problems with concentration.
  • Sleep disturbance.