PTSD in Children and Adolescents

PTSD in Children and Adolescents

• Symptoms: PTSD symptoms vary by age. Younger children may regress developmentally or exhibit age-inappropriate behaviors (e.g., bed-wetting, separation anxiety). Older children might struggle academically, engage in reckless behaviors, or show aggression. Physical symptoms (e.g., stomach aches), and emotional symptoms (e.g., fear, sadness, anger) are also common. Behavioral symptoms (e.g., nightmares, repetitive play re-enacting trauma, aggression) are also observed.

• DSM-5 Symptom Clusters: Diagnostic criteria involve four symptom clusters:

• Intrusion symptoms: Distressing memories, dreams, or flashbacks related to the trauma.

• Avoidance: Avoiding people, places, activities, or situations associated with the trauma.

• Negative alterations in thoughts and moods: Distorted views about the cause of the trauma or negative thoughts & feelings associated with the event.

• Changes in arousal and reactivity: Irritable behavior, exaggerated startle responses, sleep problems, hypervigilance, and difficulty concentrating.

• Sex Differences and Comorbidity: Girls experience PTSD at higher rates starting in school-age and adolescent years, potentially linked to different types of trauma. Younger children show inconsistent results. PTSD often co-occurs with other conditions, such as Oppositional Defiant Disorder (ODD), separation anxiety disorder, depression, anxiety, conduct disorder (CD), and substance use disorders.

• Trauma Factors: PTSD risk increases with factors like pre-trauma stressors (e.g., previous trauma, chronic family problems), peri-trauma factors (perceived threat, injury), and post-trauma factors (disability, poor family functioning, lack of social support). Coping strategies and genetic factors—accounting for about 1/3 of symptom variance—influence likelihood. Females may be genetically more susceptible.

• Adjustment after Trauma: Trauma impacts emotion regulation, alters views of self and others, and causes neurobiological changes:

• Emotion Regulation: Difficulties managing emotions, heightened reactivity, and emotional numbness.

• View of Self and Others: Feelings of worthlessness, guilt, or shame, and distrust of others.

• Neurobiological Changes: Elevated stress responses, impaired memory, and concentration.

• PTSD Outcomes: Potential outcomes include: showing no effects, experiencing temporary symptoms, developing other temporary diagnoses, or experiencing ongoing issues.

• Example outcome - Unintentional Burns: A sizeable minority of young children developed PTSD, with some experiencing a chronic form over six months. Most resolved symptoms, some developed other disorders.

• Specific Trauma Events (e.g., Fort McMurray Wildfire): Presence, witnessing fire, and home destruction were associated with increased PTSD risk, with strongest links for witnessing and losing one's home.

Autism Spectrum Disorder (ASD)

• Core Characteristics: Defined by significant differences in two areas:

• Social Communication & Interaction: Difficulty interacting with others, reduced eye contact, infrequent use of gestures/facial expressions, difficulty understanding/responding to emotions, and a lack of interest in making friends.

• Restricted/Repetitive Behaviors/Interests (RRBs): Fascination with repetitive movements/objects, unusual responses to sensory input, self-stimulatory behaviors (e.g., rocking, hand flapping), and insistence on sameness/routines.

• Associated Characteristics:

• Cognitive: Intellectual disability (30-40%), executive functioning difficulties, challenges with feedback, planning & organization.

• Language: 35-40% do not develop communicative speech; echolalia, pronoun reversal, unusual intonation, concrete language, difficulty with abstract concepts.

• Motor: Difficulties with gross/fine motor skills or coordination.

• Behavioral: Self-injurious behaviors (head-banging, hand-biting) are common, especially if comorbid with intellectual disability.

• Physical/Health: Sleep/eating difficulties, gastrointestinal problems, and seizures (often in adolescence/adulthood).

• Sex Differences/Developmental Changes: Boys are diagnosed 4 times more often than girls. Girls may have fewer RRBs and better language skills. Symptoms persist or evolve in different ways during preschool, school-age, and adolescent years; hyperactivity and self- injury may worsen in adolescence.

• Biological/Environmental Factors: ASD is a biologically-based neurodevelopmental disorder influenced by both genetic predispositions and environmental factors before, during, and after fetal development (e.g., parental age, exposure to medications).

• Early Interventions: Focus on skill development, parental involvement, social/communication skills, individualized approaches, and support through education and speech therapy.

• Longitudinal Studies (Infant Siblings): The recurrence risk in infant siblings of children with ASD is higher, especially if the older sibling is female. Many behavioral markers for ASD emerge around 12 months.

Eating Disorders

• Core Features:

• Anorexia Nervosa (AN): Persistent restriction of food intake (significant weight loss), intense fear of gaining weight, and a distorted body image.

• Bulimia Nervosa (BN): Recurrent episodes of binge eating followed by purging behaviors (vomiting, laxatives) to prevent weight gain. Self-evaluation heavily influenced by weight and shape.

• Binge Eating Disorder (BED): Recurrent binge eating episodes without compensatory behaviors. Characterized by feelings of shame and secrecy.

• Age Differences in Onset: AN (14-18 yrs), BN (14-19 yrs), BED (19+ yrs). Risk factors and stress around these times may manifest as control over eating.

• Comorbidity: AN, BN, and BED often co-occur with depression, anxiety, and substance use disorders. Elevated suicide risk is also associated with each.

• Contributing Factors: Biological, individual, and environmental factors contribute:

• Biological: Limited role in onset, but genetic predispositions exist.

• Individual: Body dissatisfaction, perfectionism, rigid personality, and experiences of child abuse could predispose an individual.

• Environmental: Family emphasis on weight, teasing, media ideals of attractiveness, dieting culture, and social support/peer pressure.

• Course/Outcome: Diets can lead to binge cycles and these cycles to eating disorders, and vice versa. Cross-over between BED and AN is uncommon.

Negative Impact of a Diagnosis

• Autism Spectrum Disorder (ASD):*

• Social Communication and Interaction Deficits: Difficulty forming relationships, limited nonverbal communication, and impaired emotional understanding create barriers to learning, expressing needs, building support networks, and adapting to social environments.

• Restricted and Repetitive Behaviors (RRBs): Inflexible routines, narrow interests, and intense sensory sensitivities prevent adaptability, create distress when routines change, and hinder participation in diverse activities.

• Cognitive and Language Differences: Difficulties with executive functioning, speech development, and self-expression affect academic success, self-esteem, and ability to express needs/seek support.

Sexual Minority and Transgender Youth


*describe the mental health status of sexual minority youth compared to their transgender peers
and cisgender peers

3-4X higher rates depressive disorders and symptoms, suicidality, NSSI behs, higher rates anxiety diagnoses, 3X higher substance use disorders, 2-4X higher rates of ED or general distorted eating, PTSD (probably)

Trans peers; higher rates depressive disorder, suicidality, NSSI, anx disorders (generalized), substance use, eds, ptsd, asd (2-3% in general population but 10% in trans) more physical safety when identity and appearance =
*describe how markers of mental health for sexual minority youth changed over time according
to three BC Adolescent Health Surveys

Some markers improved overtime but still high. Lesbian/gay/bi youth less likely to have attempted suicide. 2008 30%-2018 17%. Binge drinkinf past month; 2008 68% 2018 40%
*describe the Minority Stress Framework

Sexual minority and trans youth experience more and unique stressors related to their identity
*distinguish between distal stressors and proximal stressors

Distal: discrimination, stigma, victimization (further away)

More likely to have lived or live in unstable/unsafe environments and have been or are victimized by family members and/or peers. Teasing, harassment, phys and sex abuse, ¼ of trans youth said they don’t feel safe at home and less than 50% had adult in family that supported them. Verbal and physical victimization may also occur at school, some don’t attend bc afraid. 1/5 avoid school bc scared of being outed or harassment, less than half felt safe (more safe library, less safe lockerroom) more than half don’t report harrassement, and 2/3 who did staff didn’t do anything abt it

Proximal: expectations of rejection, concealment of identity, internalizing negative messages (more internal)

Some sexual minority youth internalize negative messages, expect rejection, and concealtheir sexual orientation. Some trans youth have similar experiences but also differences, a greater body identity mismatch with puberty, inaccurate perception of their gender identity, and policies that affect their rights
*describe two factors that are unique to sexual minority youth and transgender youth

Neither sexual minority youth nor transgender youth are born into a minority community. As a result, validating experiences and group support may not come until later in development. Prejudice and discrimination toward youth persist.

Most social changes and policy changes benefit adults not youth.
*describe coming out for sexual minority youth and transgender youth

Coming out (i.e., disclosing one's identity to others) is also a stressor. Sexual minority youth now disclose this identity during middle adolescence rather than young

Coming out is now more likely while youth are still dependent on parents and are required to attend school. It also coincides with peers regulating status and interactions.

◦            more vulnerable to family rejection, homelessness

◦            hypervigilance, how they’re presenting, interacting w peers. Bc of fear of rejection
*describe the mental health status of bisexual youth versus that of lesbian youth and gay youth

who identify as bisexual are at even higher risk for poor mental health than lesbian/gay youth, related to dual stigma.

• more likely to have suicidal thinking, anempts..

than gay peers

stigma from heterosex. community AND homosex.

- don't belong in eitner group

*identify the protective factor that appears to be key for buffering youth against the negative
effects of minority stressors

Social support is a key protective factor (offset risk posed by minority stressors), it may come from friends, trusted adults (parents accept youth by using chosen name, buy clothes), school resources (inclusive curriculum, policies agsinst bullying), specific communities
*describe the developmental collision hypothesis

collision between youth disclosing their sexual/gender identity and heightened vulnerability to negative responses from peers and adults, both during middle adolescence, contributing to persistence of poorer mental health?

Discrimination-depression or disc-victimization-depression

Developmental Collision Hypothesis (DCH)

They examined these two pathways in three

generations of US A sexual minority youth (1990s,16.2yrs

2000s, and 2010s).

~ 14.2 jrs lover and tower age
*describe how earlier age at disclosure of one’s sexual minority identity was related directly and
indirectly to adolescents’ depressive symptoms

Results: (a) the groups differed on average age at first disclosure; they did not differ on frequency of

LGBT victimization.

Earlier disc. -> fewer depr.

Symp.

(b) Earlier age at disclosure was related directly to fewer depressive symptoms

(c) Earlier age at disclosure was related indirectly to more depressive symptoms through LGBT victimization.

Earlier disc -> Vict -> more depress . sympt.

• (d) These two patterns were found in each of the three generations of adolescents.
*describe how the relationships between earlier age at disclosure of one’s sexual minority
identity and adolescents’ depressive symptoms differed across the three generations of youth

Conclusions: Adolescents' experiences of LGBT-victimization and not an earlier age at disclosure contributes to their mental health vulnerability.

may feel true to

/ themselves

Coming out at a younger age may protect against poorer mental health by enhancing feelings of coherence and providing access to social support.

Select any ONE diagnosis that you think
may have an especially negative impact
on the development of a child or
adolescent. Explain your choice by
describing THREE ways in which the core
characteristics, associated characteristics,
or other aspects of the disorder interfere
with a child’s or adolescent’s
development.

Diagnosis: Autism Spectrum Disorder (ASD) 

### 1. Social Communication and Interaction Deficits 

Autistic individuals often face challenges in understanding and responding to social cues, such as facial expressions, body language, or tone of voice. Examples include: 

- Difficulty forming relationships: Many autistic children struggle to connect with peers, leading to social isolation. This can hinder emotional development and limit opportunities for learning through social play. 

- Limited nonverbal communication: The reduced use of gestures and facial expressions makes it hard for others to interpret their needs or emotions, compounding difficulties in social interaction. 

- Impaired emotional understanding: A lack of understanding of others’ emotions can lead to misunderstandings and conflict, further alienating the child from their social environment. 

These issues may result in a lack of support networks, affecting the child’s mental health and resilience. 

### 2. Restricted and Repetitive Behaviors (RRBs) 

RRBs, such as insistence on sameness or intense interests, can limit a child's ability to engage with diverse activities or adapt to new situations. Examples include: 

- Rigidity in routines: Disruptions to routines can cause distress, leading to meltdowns or withdrawal. This rigidity can make transitioning to school or other environments difficult. 

- Narrow interests: While some focused interests can be strengths, extreme preoccupation with certain topics may reduce opportunities for broader learning and social engagement. 

- Sensory sensitivities: Overwhelming responses to sensory stimuli (e.g., loud noises) can make ordinary environments like classrooms challenging, disrupting academic progress and participation. 

These characteristics can create barriers to inclusion, preventing the child from fully engaging in typical developmental experiences. 

### 3. Cognitive and Language Differences 

ASD is often accompanied by cognitive and language delays, affecting academic performance and self-expression. Examples include: 

- Executive function deficits: Autistic children may struggle with planning, organizing, and adapting to feedback, which are essential for learning and problem-solving. 

- Delayed speech development: Up to 35-40% of autistic children may not develop communicative speech, impacting their ability to express needs or emotions. Those who do may use echolalia or display unusual intonation, which can hinder understanding. 

- Self-injurious behaviors: Cognitive frustration or sensory overload can lead to harmful behaviors, such as head-banging or hand-biting, which further impede development. 

These challenges often require targeted interventions to help the child reach their potential while also mitigating the effects on their self-esteem and confidence. 

Lower prevalence/less common diagnoses; cos, selective mutism, bipolar, asd, ed’s, dmdd

In between common and uncommon (4-8%): depression, fasd, ptsd, cd, sub related, adhd, sld

More common: anxiety (spec. phobia 20%, social anxiety 6-12%, separation anx. 8-10%), ODD

More biological than environmental: asd, cos, bipolar, adhd, sld

Middle: depression, odd/cd, substance use

More environmental: anxiety, eds, ptsd, fasd