Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder, or PTSD for short, is a psychological reaction to an event that a child has experienced as life-threatening or deeply overwhelming. In the ICD-10 diagnostic classification, it is listed under code F43.1. The defining characteristic: the child cannot let go of the experience. The memories return on their own, often suddenly and with full force, as if everything were happening all over again.

PTSD is not a rare exception. In a large U.S. study, about 5 percent of adolescents developed PTSD at some point in their lives, with girls (7.3 percent) affected more frequently than boys (2.2 percent). Important for parents to know: A traumatic event does not lead to PTSD in every child. Many children process stressful experiences over time and with the right support without developing a disorder.

The symptoms can be divided into three groups:

• Re-experiencing: Intrusive images, flashbacks, and nightmares. Younger children under the age of six exhibit this differently. They reenact the event over and over, and their nightmares cannot be clearly linked to the event.
• Avoidance: The child avoids places, people, or conversations that might remind them of the event. Some seem emotionally detached, withdraw from friends, or lose interest in things that used to bring them joy.
• Hyperarousal: Sleep problems, severe startle responses, irritability, outbursts of anger, difficulty concentrating, and constant vigilance.

This is often accompanied by negative thoughts: feelings of guilt, mistrust, and the belief that they are to blame for what happened. In school-aged children, this sometimes manifests as stomachaches, headaches, or declining grades, without the child ever talking about the trauma.

Triggers include events involving a real or perceived risk of death or injury. For children and adolescents, these include physical and sexual abuse, serious accidents, dog bites, and injuries such as burns. For young children, domestic violence plays a major role, especially violence between primary caregivers.

The timeline is crucial for classification. An acute stress reaction begins immediately after the event and subsides within hours to a few days for most people. If symptoms persist for three days to four weeks, experts refer to this as acute stress disorder. Only when symptoms persist for more than a month is PTSD considered. It can also develop with a delay, sometimes not until weeks or months after the trauma.

For children and adolescents, trauma-focused cognitive behavioral therapy (CBT) is considered the best-evidenced approach. The child learns to talk about their experiences, makes sense of them with therapeutic guidance, and gradually reduces their fear of memories. This includes controlled exercises from exposure therapy, in which the child approaches what they have been avoiding within a safe environment.

EMDR (Eye Movement Desensitization and Reprocessing) is considered the second best-studied method; it involves processing distressing memories through guided eye movements. Medication is not the first line of treatment for children. It may be considered as a supplement, for example, in cases of co-occurring anxiety or depression. The earlier appropriate treatment begins, the better the prognosis usually is.

After experiencing trauma, children need, above all, a sense of security and reliability. Structured daily routines, a calm daily rhythm, and a return to familiar routines provide stability. Listen when your child wants to talk, but don’t pressure them. Let them know that their reactions are understandable and that they haven’t done anything wrong.

Psychoeducation for parents helps them better understand the symptoms and respond more calmly in everyday life. Seek professional help if the symptoms persist for more than a month, if daily life is severely affected, or if your child talks about self-harm or thoughts of death. In acute crises, call 112 or contact a child and adolescent psychiatry clinic.

The diagnosis and treatment of PTSD should be handled exclusively by a child and adolescent psychiatry clinic (KJP) or a medical or psychotherapeutic specialist. “Rückenwind” provides coaching and support to you as parents during this time but does not replace diagnostic evaluation or psychotherapy.