Children with PTSD display a set of characteristic symptoms that develop following exposure to a traumatic, physically threatening event. Children show many of the same features of PTSD that adults do, although in children the specific expression of each symptom may be slightly different. They re-experience the trauma in various ways, such as via distressing recollections, dreams of the event, or distress at exposure to cues that remind them of the event. Children with PTSD avoid such cues, and generally show increased arousal when exposed to or reminded of the trauma-related cues. Younger children may report more generalized dreams of monsters, of rescuing others, or of threats to self or others. Themes related to the trauma often emerge during play. For example, younger children may repeatedly enact crashes with vehicles. Younger children with PTSD may be unable to verbalise the nature of their fears or the extent of their distress. In such cases, behavioural observation and parental report provide important assessment information.
A related disorder, acute stress disorder, has only been introduced with the publication of the DSM-IV. The features are very similar to those of PTSD but the diagnosis can be made within the first month following trauma (PTSD requires at least one month of persistent disturbance.) Where a child appears to be distressed by a stressful life event but does not meet the full criteria for acute stress disorder or PTSD, he or she may be more likely to meet criteria for an adjustment disorder, which refers to a clearly defined stressor in a child’s life.
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