What Are Early Childhood Mental Disorders?

Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school and in their communities.

Mental health disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day. Among the more common mental disorders that can be diagnosed in childhood are Attention-deficit/hyperactivity disorder (ADHD), Anxiety Disorder, Mood Disorder, Post-Traumatic Stress Disorder and Behavior Disorders.

Other childhood disorders and concerns that affect how children learn, behave, or handle their emotions can include learning and developmental disabilities, Autism Spectrum Disorder, Developmental Disabilities, Language Disorders and Learning Disorders.

What Are The Symptoms of Childhood Mental Disorders?
Symptoms of mental disorders change over time as a child grows, and may include difficulties with how a child plays, learns, speaks, and acts or how the child handles their emotions. Symptoms often start in early childhood, although some disorders may develop during the teenage years. The diagnosis is often made in the school years and sometimes earlier. However, some children with a mental disorder may not be recognized or diagnosed as having one.

Can Childhood Mental Disorders Be Treated?

Childhood mental disorders can be treated and managed. There are many treatment options based on the best and most current medical evidence, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members.

Taking advantage of all the resources available will help parents, health professionals, and educators guide the child towards success. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders.

Types Of Disorders

Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, which cause distress and problems getting through the day.

Children with mental, emotional, and behavioral disorders can have other health or developmental conditions at the same time. Sometimes the difficulties from having a chronic health condition-those that go on for a long time and often don't go away completely-or disability increase the risk for developing mental health problems. Sometimes having more than one condition can make mental health symptoms worse. Careful diagnosis to guide treatment is important.

Healthcare professionals use the guidelines in The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5)1, to help diagnose mental health disorders in children. Infant Mental Health professionals use the guidelines in Diagnostic Classification of Mental Health and Developmental Disorder of Infancy and Early Childhood (DC:0-5) during the diagnosis process in young children from newborn to 5 years old and 11 months.

Other conditions and concerns that affect children’s learning, behavior, and emotions include learning and developmental disabilities, autism, and risk factors like substance use and self-harm.

Reference
  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Scientists do not know yet exactly what causes these differences for most people with ASD. However, some people with ASD have a known difference, such as a genetic condition. There are multiple causes of ASD, although most are not yet known.

ASD begins before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with ASD show hints of future problems within the first few months of life. In others, symptoms may not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had. Studies have shown that one third to half of parents of children with an ASD noticed a problem before their child’s first birthday, and nearly 80%–90% saw problems by 24 months of age.

There is often nothing about how people with ASD look that sets them apart from other people, but they may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged.

Children with ASD usually have significant difficulties in the following 3 areas:

Social Skills

Social issues are one of the most common symptoms in all of the types of ASD. People with an ASD do not have just social "difficulties" like shyness. The social issues they have cause serious problems in everyday life.

Examples of social issues related to ASD:

  • Does not respond to name by 12 months of age
  • Difficult to get a responsive smile by 6 months of age
  • Avoids eye-contact
  • Prefers to play alone
  • Does not share interests with others
  • Only interacts to achieve a desired goal
  • Has flat or inappropriate facial expressions
  • Does not understand personal space boundaries
  • Avoids or resists physical contact
  • Is not comforted by others during distress
  • Has trouble understanding other people's feelings or talking about own feelings

Communication

Each person with ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood.

Examples of communication issues related to ASD:

  • Delayed speech and language skills
  • Repeats words or phrases over and over (echolalia)
  • Reverses pronouns (e.g., says "you" instead of "I")
  • Gives unrelated answers to questions
  • Does not point or respond to pointing
  • Uses few or no gestures (e.g., does not wave goodbye)
  • Talks in a flat, robot-like, or sing-song voice
  • Does not pretend in play (e.g., does not pretend to "feed" a doll)
  • Does not understand jokes, sarcasm, or teasing

Unusual Interests and Behaviors

Many children with ASD have unusual interest or behaviors. A child with an ASD might spend a lot of time repeatedly flapping their arms, rocking from side to side, spinning self in a circle for a long time, repeatedly turning a light on and off or spin the wheels of a toy car. They types of activities are known as "self-stimulation" or "stimming".

Examples of unusual interests and behaviors related to ASD:

  • Lines up toys or other objects
  • Plays with toys the same way every time
  • Likes parts of objects (e.g., wheels)
  • Is very organized
  • Gets upset by minor changes
  • Has obsessive interests
  • Has to follow certain routines
  • Flaps hands, rocks body, or spins self in circles

Autism and Co-Morbid Mental Health Condition

  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Anxiety Disorder
  • Attachment Disorder
  • Depression
  • Obsessive-Compulsive Disorder(OCD)
  • Oppositional Defiant Disorder(ODD)
  • Post-traumatic Stress Disorder(PTSD)
Screening and Diagnosis

Screening: There are many different developmental screening tools. Some examples of screening tools for general development and ASD including Ages and Stages Questionnaires (ASQ) and Modified Checklist for Autism in Toddlers (MCHAT).

ASD can sometimes be detected at 18 months of younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.

Diagnosis: ASD Diagnostic tools usually rely on two main sources of information-parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior. Two examples of diagnostic tools including Autism Diagnosis Interview- Revised (ADI-R) and Autism Diagnosis Observation Schedule (ADOS-2).

Treatment

According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help children with ASD are those that provide structure, direction, and organization for the child in addition to family participation.

Research shows that early intervention treatment services can improve a child's development. Early intervention services help children from birth to 3 years old learn important skills. It is important to talk to a specialist as soon as possible if you think your child might have an ASD or other developmental problems.

There are NO MEDICATION that can cure ASD or even treat the main symptoms. But there are medications that can help some children with related symptoms, such as manage high energy levels, inability to focus, depression, or seizures.

Types of behavioral treatment

Applied Behavior Analysis (ABA)

ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills. The child's progress is tracked and measured.

Developmental, Individual Differences, Relationship-Based (DIR/Floortime)

Floortime focuses on emotional and relational development (feelings, relationships with caregivers). It also focuses on how the child deals with sights, sounds, and smells.

Speech Therapy

Speech therapy helps to improve the person’s communication skills. Some people are able to learn verbal communication skills. For others, using gestures or picture boards is more realistic.

Sensory Integration Therapy

Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a child who is bothered by certain sounds or does not like to be touched.

Dietary Approaches

Some dietary treatments have been developed by reliable therapists. But many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but may not help another. If you are thinking about changing your children's diet, talk with nutritionist to make sure your child is getting important vitamins and minerals.

Effects of electronic devices

The study found that the more handheld screen time parents reported, the more likely their toddlers were to have delays in expressive language skills. For every 30 minute increase in handheld screen time, there was a 49% increase in the risk of speech delay.

Vaccine Safety

A meta-analysis of ten studies involving more than 1.2 million children reaffirms that vaccines don’t cause autism. If anything, immunization was associated with decreased risk that children would develop autism, a possibility that’s strongest with the measles-mumps-rubella vaccine.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.

It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.

There are three different types of ADHD, depending on which types of symptoms are strongest in the individual.

Type 1: Inattention/Distractibility
  • Careless
  • Easily distracted
  • Avoid tasks requiring sustained attention
  • Difficulty concentrating and learning in school
  • Often doesn’t seem to listen
  • Struggle to follow instructions
  • Can’t organize
  • Loses important items
  • Forgetful in daily activities

Child must have 6 or more symptoms for > 6 months

Type 2: Hyperactivity/Impulsivity

Hyperactivity

  • Squirms and fidgets
  • Can’t stay seated, restless
  • Runs/climbs constantly
  • Can’t play/work quietly
  • “On the go”/ “Driven”
  • Talks excessively
  • Difficult sleeping

Impulsivity:

  • Blurts our answers
  • Can’t wait for turns
  • Grab things from people
  • Intrude/interrupts others
  • May have more accidents/injuries

Child must have 6 or more symptoms for > 6 months

Type 3: Combined Presentation

Symptoms of the above two types are EQUALLY present in the person. Because symptoms can change over time, the presentation may change over time as well.

Diagnosis

There is no “blood test” or single test to diagnose ADHD. Deciding if a child has ADHD takes a several step process. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include: parent and teacher questionnaires, clinical observations, school observations and standardized tests to administer to child.

Treatment

Behavior therapy for young children: Training for parents

The 2011 clinical practice guidelines from the American Academy of Pediatrics (AAP) recommend that behavior therapy is the first line of treatment for preschool-aged children (4-5 years of age) with ADHD. Parent training in behavior therapy has the most evidence of being effective, but teachers and early childhood caregivers can use behavior therapy in the classroom as well.

Why should parents try behavior therapy first, before medication?

Behavior therapy is an important first step because:

  • Behavior therapy gives parents the skills and strategies to help their child.
  • Behavior therapy has been shown to work as well as medication for ADHD in young children.
  • Young children have more side effects from ADHD medications than older children.
  • The long-term effects of ADHD medications on young children have not been well-studied.

The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for children younger than 6 years of age. The review found enough evidence to recommend parent training in behavior therapy as a good treatment option for children under 6 with ADHD symptoms and for disruptive behavior, in general. The review also identified four programs for parents of young children with ADHD that reduced symptoms and problem behaviors related to ADHD:

  • Triple P (Positive Parenting Program)
  • Incredible Years Parenting Program
  • Parent-Child Interaction Therapy
  • New Forest Parenting Programme
Footnotes:

[1] The ADHD Molecular Genetics Network. Report from the third international meeting of the attention-deficit hyperactivity disorder molecular genetics network.

Anxiety Disorder

Separation Anxiety Disorder
  • Being very afraid when away from parents
  • Being overly clingy
  • Refusing to go to school
  • Panic or tantrums at times of separation from parents
  • Frequent stomachaches and other physical complaints
  • Trouble sleeping or nightmares

These symptoms must be present for at least one month

Social Anxiety Disorder
  • Being very afraid of school and other places when there are people
  • Fears of meeting or talking to people
  • Avoidance of social situations
  • Few friends outside the family

These symptoms must be present for 2 months or more

Generalize Anxiety Disorder
  • Many worries about bad things happening
  • Constant worries or concerns about family, school, friends, or activities
  • Repetitive, unwanted thoughts (obsessions) or actions (compulsions)
  • Fears of embarrassment or making mistakes
  • Low self-esteem and lack of self-confidence

These symptoms must be present for 2 months or more and the diagnosis should be made with caution in young children less than 36 month old.

Phobias and Panic Disorder
Phobia:
  • Extreme fear about a specific thing or situation (ex. dogs, insects, or needles)
  • The fears cause significant distress and interfere with usual activities
Panic Disorder:
  • Repeated episodes of sudden, unexpected, intense fear coming with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty….
Diagnosis

If anxieties become severe and begin to interfere with the child’s usual activities, (for example separating from parents, attending school and making friends), parents should consider seeking an evaluation from a qualified mental health professional or a child and adolescent psychiatrist to get the best diagnosis and treatment.

The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that healthcare providers routinely screen children for behavioral and mental health concerns. Early treatment can prevent future difficulties, such as failure to reach social and academic potential and feelings of low self-esteem.

Treatment

Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key.

Behavior therapy for anxiety is one form of therapy that may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur.

Attachment Disorder

Attachment Disorders are psychiatric illnesses that can develop in young children who have problems in emotional attachments to others. Parents, caregivers, or physicians may notice that a child has problems with emotional attachment as early as their first birthday.

Most children with attachment disorders have had severe problems or difficulties in their early relationships. They may have been physically or emotionally abused or neglected. Some have experienced inadequate care in their own home or other out-of-home placement ( for example: residential programs, foster care or orphanage). Others have had multiple traumatic losses or changes in their primary caregiver. The physical, emotional and social problems associated with attachment disorders may persist as the child grows older.

Disinhibited Social Engagement Disorder (DSED)
  • Having extreme negative experiences with adults in their early years
  • Not fearful when meeting someone for the first time.
  • Overly friendly, walk up to strangers to talk, hug or even kiss them.
  • Allow strangers to pick them up, feed them.
  • Willingness to go home with an unfamiliar adult with little or no hesitation.
  • The criteria does not met for Autism Spectrum Disorder

The diagnosis of DSED is made before a child turns 5 years of age.

Reactive Attachment Disorder (RAD)
  • Having extreme negative experiences with adults in their early years
  • Rarely or minimal seeks or responds to comfort when being distressed
  • Appear unhappy, irritable, scared while having normal activities with their caretaker.
  • Have little to no emotions when interacting with others.
  • The disturbance is evident before 5 years of age

The diagnosis of RAD is made if symptoms become chronic. Children who have Disorganized Attachment may develop RAD.

The 4 main child/adult attachment styles have been identified as:

Secure Attachment

As Children
  • Are able to separate from parents
  • Seek comfort from parents when frightened
  • Greet return pf parents with positive emotions
  • Prefers parents to strangers
As Adults
  • Have trusting, lasting relationship
  • Tend to have high self-esteem
  • Are comfortable sharing feelings with friends and partners
  • Seek out social support

Avoidant Attachment

As Children
  • May avoid parents
  • Does not seek much contact or comfort from parents
  • Shows little or no reference for parents over strangers
  • Might develop Disinhibited Social Engagement Disorder
As Adults
  • May have problems with intimacy
  • Invest little emotions in social and romantic relationship
  • Unwilling or unable to share thoughts and feelings with others

Ambivalent Attachment

As Children
  • May be wary of strangers
  • Become greatly distress when parents leave
  • Do not appear to be comforted when parents return
As Adults
  • Reluctant to become close to others
  • Worry that their partner does not love them
  • Become very distraught when their relationship ends

Disorganized Attachment

At Age 1
  • Shows a mixture of avoidant and resistant behaviors
  • May seem dazed, confused or apprehensive
At Age 6
  • May take on a parental role
  • May act as a caregiver toward the parent
  • May develop Reactive Attachment Disorder when growing up.
Diagnosis
Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are serious clinical conditions. Children who exhibit signs of RAD or DSED need a comprehensive psychiatric assessment and individualized treatment plan. Treatment must involve both the child and the family. A close and ongoing collaboration between the child’s family and the treatment team will increase the likelihood of a successful outcome.

Treatment

Attachment work has its roots in providing the nurturing responses that the client missed in early childhood and requires a very skilled therapist who is familiar with Attachment work. Attachment difficulties will get better, however it does take a long time. The family will need to re-create an emotionally safe environment for the child; be consistent and see the behaviors from an Attachment perspective (for example: an argumentative/ defiant behavior is a reflection of their independence; running away is trying to escape from others and their own feelings; self-harm is to release their pain, mitigate their numbness, consolidate their feelings).

Depression in Early Childhood

Occasionally being sad or feeling hopeless is a part of every child's life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations where they could do something to address the situations. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.

Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is the leading form of death. Some children may not talk about helpless and hopeless thoughts, and they may not appear sad. Depression might also cause a child to make trouble or act unmotivated, so others might not notice that the child is depressed or may incorrectly label the child as a trouble-maker or lazy.

Signs and symptoms

  • Feeling sad, hopeless, or irritable a lot of the time
  • Social isolation, poor communication
  • Not wanting to do or enjoy doing fun things
  • Difficult with relationship
  • Changes in eating patterns – eating a lot more or a lot less than usual
  • Changes in sleep patterns – sleeping a lot more or a lot less than normal
  • Changes in energy – being tired and sluggish or tense and restless a lot of the time
  • Having a hard time paying attention
  • Feeling worthless, useless, or guilty
  • Self-injury and self-destructive behavior
Diagnosis

Depression is a real illness that requires professional help. Early diagnosis and treatment are essential for depressed children. Some of the signs and symptoms of anxiety or depression are shared with other conditions, such as trauma. Specific symptoms like having a hard time focusing could be a sign of attention-deficit/hyperactivity disorder (ADHD). It is important to get a careful evaluation to get the best diagnosis and treatment from a qualified mental health professional.

Treatment

The first step to treatment is to talk with a healthcare provider to get an evaluation. Comprehensive treatment often includes both individual and family therapy. For help, parents should ask their physician to refer them to a qualified mental health professional, who can diagnose and treat depression in children. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are forms of individual therapy shown to be effective in treating depression. Treatments can also include a variety of ways to help the child feel less stressed and be healthier like nutritious food, physical activity, sufficient sleep, predictable routines, and social support.

Obsessive Compulsive Disorder (OCD)

Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don't actually make sense. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away.

For example, some children might worry if they don't wear certain clothes, eat certain food, or even sit at the exact spot in the car or in the classroom... These thoughts are called obsessions. The repetitive behaviors (like hand washing, keeping things in order, checking something over and over) or mental acts (like counting, repeating words silently, avoiding….) are called compulsions.

Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset.

Symptoms

Having OCD means having obsessions, compulsions, or both. Examples of obsessive or compulsive behaviors include:

  • Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.
  • Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud).
  • Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over).
  • Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.

A common myth is that OCD means being really neat and orderly. Sometimes, OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over, rather than on being organized. Obsessions and compulsions can also change over time.

Diagnosis
The first step is to talk with a healthcare provider to arrange an evaluation. A comprehensive evaluation by a mental health professional will determine if the anxiety or distress involves memories of a traumatic event that actually happened, or if the fears are based on other thoughts or beliefs. The mental health professional should also determine whether someone with OCD has a current or past tic disorder. Anxiety or depression and disruptive behaviors may also occur with OCD.

Treatment

Treatments can include behavior therapy. Behavior therapy, specifically Cognitive-Behavioral Therapy (CBT), helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior.

Behavior therapy for OCD can involve gradually exposing children to their fears in a safe setting; this helps them learn that bad things do not really occur when they don't do the behavior, which eventually decreases their anxiety. Behavior therapy alone can be effective, but some children and adolescents are treated with a combination of behavior therapy and medication.

Families and schools can help children manage stress by being part of the therapy process and learning how to respond supportively without accidentally making obsessions or compulsions more likely to happen again.

Oppositional Defiant Disorder (ODD)

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as caregivers, family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Signs and symptoms

  • Often being angry or losing one's temper.
  • Often arguing with adults or refusing to comply with adults' rules or requests.
  • Often resentful or spiteful.
  • Deliberately annoying others or becoming annoyed with others.
  • Often blaming other people for one's own mistakes or misbehavior.
Diagnosis
Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. The first step is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional is needed to get the right diagnosis.

Treatment

For younger children, the treatment with the strongest evidence is behavior therapy training* for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for children younger than 6 years of age. The review found enough evidence to recommend parent training in behavior therapy as a good treatment option for children under 6 with ADHD symptoms and for disruptive behavior, in general. The review also identified four programs for parents of young children with ADHD that reduced symptoms and problem behaviors related to ADHD:

  • Triple P (Positive Parenting Program).
  • Incredible Years Parenting Program.
  • Parent-Child Interaction Therapy.
  • New Forest Parenting Program .

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental health condition that is triggered by a terrifying event. All children experienced stressful events which can affect them both emotionally and physically. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as witnessing domestic violence in the family, accidents or natural disaster, physical, emotional or sexual abuse, childhood neglect, grief and loss (threatened death of a close family member or friend),will be affected long-term. Children could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with Post Traumatic Stress Disorder (PTSD).

Signs and symptoms

  • Easily startled by noises or unexpected touch.
  • Easily distracted, disorganized.
  • Doesn't seem to listen.
  • Hyperactive, restless.
  • Difficulty concentrating and learning in school.
  • Feeling of guilt, shame, anxiety.
  • Irritability, quick to anger.
  • Difficult sleeping, nightmare and flashbacks.
  • Tendency to isolate oneself or feelings of detachment (dissociation).
  • Difficult trusting and/or feelings of betrayal.
  • Diminished interest in everyday activities.
  • Acting helpless, hopeless or withdrawn.
  • Headaches, backaches, stomachaches, ect…
  • More susceptible to colds and illnesses.
  • Sudden sweating and/or heart palpitations.
  • Constipation or diarrhea.
These symptoms must be present for at least 2 weeks
Diagnosis

The first step is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families will be needed.

A very highly skilled child psychotherapist will be able to distinguish a child with Post Traumatic Stress Disorder (PTSD) versus Attention Deficit Hyperactivity Disorder (ADHD).

Here is the guide for clinicians on overlapping symptoms of ADHD and PTSD. Click to enlarge and see detailed information.

Treatment

Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and minimizing the change of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play or write about the stressful event can be done with the child and the family.

Child Parent Psychotherapy (CPP) is the evidence based intervention model for children under 6 years old. This treatment is to support and strengthen caregiver-child relationship and assist child to process the trauma and restore child's mental health

Children's Mental Health information adapted from the U.S. Centers for Disease Control and Prevention, “Children's Mental Health" program (https://www.cdc.gov/childrensmentalhealth/)