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PTSD in Children and Adolescents

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38 Questions

What percentage of youths are exposed to a traumatic event at some point in childhood?


How many clusters of symptoms are typical of PTSD?


What is the lifetime prevalence of PTSD in adults?


What type of event can be classified as a traumatic event?

All of the above

What percentage of refugees from war torn countries meet diagnostic criteria for PTSD?


What is a common associated feature of PTSD?

Both A and B

What is the prevalence of PTSD among youths exposed to single-incident traumatic events?


What is the prevalence of PTSD for single-incident household accidents?


What is a characteristic of PTSD symptoms?

They may take time to emerge after the traumatic event

What is a requirement for a diagnosis of PTSD?

The event must have occurred to the person or a close family member/friend

What happens to symptoms of PTSD over time in many children?

They decrease over time, but many still meet criteria for PTSD

What is the significance of the specifier 'with dissociative symptoms' in a PTSD diagnosis?

It is an optional specifier for clinicians to add to the diagnosis

What is a potential long-term consequence of PTSD in youth?

Development of depression and suicidal ideation

What is the approach used to understand the emergence of PTSD?

Risk and resilience approach

What percentage of children who experience a traumatic event will develop PTSD?


What is the potential benefit of early treatment for PTSD?

It can prevent long-term problems

What is the main drawback of EMDR as a treatment for PTSD?

The mechanism by which it reduces PTSD is unknown

What is the role of parents and caregivers in the lives of children?

To provide protection, nurturance, and direction

What is a common issue faced by children in orphanages?

High child to caregiver ratio

What is the estimated number of youths who have no parents or primary caregivers?

15 million

What is a common consequence of reactive attachment disorder?

Emotionally withdrawn behavior towards caregiver

What is the typical amount of playtime per day for children in orphanages?

3.5 hours

What is the primary reason for the effectiveness of EMDR in reducing PTSD symptoms?

Saccadic eye movements

What is the typical environment for children in orphanages?

All of the above

What is the primary goal of the Attachment and Behavioral Catch-up (ABC) treatment?

To cultivate nurturance, improve synchrony, and reduce intrusive, frightening behavior in parents

What is the recommended caregiver-to-child ratio for treating Disinhibited Social Engaging Disorder (DSED)?

Low caregiver-to-child ratio

What is the benefit of early adoption for institutionalized children?

Decreased risk of DSED

What is a common outcome of the ABC treatment?

Higher rates of secure attachment

What is the primary focus of the ABC treatment?

Improving parenting styles

What type of model may infants develop based on their experiences with caregivers?

A model based on attachment security or insecurity

What is the primary factor that influences the development of attachments in infants during the sensitive period?

The biological predisposition of the infant

What is maltreatment a broad category of?

Physical, psychological, and sexual abuse and neglect

What is the characteristic of infants with Reactive Attachment Disorder (RAD)?

They do not form any close attachment to any caregiver

What is the recommended approach for treating infants with Reactive Attachment Disorder (RAD)?

10 1-hr sessions of Attachment and Behavioral Catch-up (ABC) with the parent and child

Why do parents record instances of child resistance to care in the ABC treatment?

To identify ways to offer sensitive care

What is the primary difference between an experience-expectant process and an experience-dependent process?

The influence of external stimuli on development

At what age do most attachments form in infants?

6-12 months

What is a common consequence of the absence of a clear attachment relationship in infants?

Listlessness, withdrawn, and sad behaviors

Study Notes

PTSD in Older Children and Adolescents

  • Children are at high risk for physical maltreatment, sexual victimization, and physical or emotional neglect.
  • As many as 30% of youths are exposed to a traumatic event at some point in childhood, and about ⅓ of these children will develop PTSD.
  • PTSD is defined by a characteristic set of behavioral, emotional, and physiological symptoms that emerge following exposure to a serious or life-threatening event.
  • The four clusters of symptoms are:
    • Intrusive symptoms associated with the trauma
    • Avoiding stimuli associated with the trauma
    • A negative alteration in the person's feelings or thoughts
    • Alteration in physical arousal or reactivity
  • Traumatic event: a psychosocial stressor that involves actual or threatened death, serious physical injury, or sexual violation.
  • PTSD usually greatly interferes with all aspects of a person's life and functioning.

Associated Features and Prevalence

  • Associated features: depersonalization (feeling detached from one's own body or mental processes) and derealization (thoughts and feelings that one's surroundings aren't real).
  • Lifetime prevalence of adults: about 8%, with girls more likely to develop PTSD than boys.
  • Pediatric prevalence: 40-60% of refugees from war-torn countries, chronic victims of physical or sexual abuse, and children who are repeatedly exposed to domestic violence meet diagnostic criteria for PTSD.
  • Prevalence among youths exposed to single-incident traumatic events: around 25-30%.
  • Prevalence for single-incident household accidents: between 14-26%.

PTSD Course and Comorbidity

  • PTSD can persist over time, although symptoms may decrease.
  • Many youth who recover from PTSD continue to show subthreshold PTSD symptoms and problems with depression and anxiety.
  • Early treatment might prevent long-term problems or facilitate the recovery of PTSD once it emerges.
  • PTSD can trigger the development of other psychiatric disorders, such as depression and suicidal ideation.

What Predicts the Emergence of PTSD?

  • Risk and resilience approach: risk factors increase the likelihood that children will develop a particular disorder, whereas resilience factors buffer children from the potentially harmful effects of risk.
  • EMDR has been shown to yield benefits in fewer sessions than TF-CBT, but the mechanism by which it reduces PTSD is unknown.

Role of Parents and Caregivers

  • Protection, nurturance, direction, and attachment are essential for children's development.
  • Children find it difficult to cope with their surroundings without their parents or primary caregivers.
  • 15 million youths have no parents or primary caregivers, and many are raised in orphanages with high child-to-caregiver ratios, leading to neglect and abuse.

Reactive Attachment Disorder (RAD)

  • RAD is most commonly seen in children from orphanages or foster homes, or severely neglected homes.
  • Lack of developmentally appropriate care from parents or caregivers leads to inhibited, emotionally withdrawn behavior toward caregivers.
  • Children may form working models of themselves and their caregivers, which can be secure, insecure, or disorganized.
  • Experience-expectant process: babies form attachments to caregivers during the sensitive period (6-12 months).
  • Experience-dependent process: development is dependent on the duration, nature, and quality of the environment.

Treatment for Reactive Attachment Disorder (RAD)

  • Attachment and Behavioral Catch-up (ABC): a 10-session program that cultivates nurturance, improves synchrony, and reduces intrusive behavior in parents.
  • Benefits: higher rates of secure attachment, improved psychological stress response, and improved regulation of negative emotions.

Treatment for Disinhibited Social Engagement Disorder (DSED)

  • Trained caregivers who provide specific, sensitive care can promote more positive emotions, more initiation to play, and more initiation to attach to caregivers.
  • Low caregiver-to-child ratio and early adoption for institutionalized children can decrease DSED symptoms.

This quiz covers the risks and prevalence of PTSD in older children and adolescents, including symptoms and statistics. Learn about the impact of traumatic events on children's mental health.

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