When Children Are Battle Scarred: PTSD In Children. Signs & Symptoms
By Nadia Khan
Updated December 31, 2018
Reviewer Melinda Santa
Upon hearing the phrase post-traumatic stress disorder, most people's frame of reference is combat related PTSD, sometimes called shell-shock, or battle fatigue. The symptoms are the same or similar in both children and adults, but often more difficult to detect in children as they manifest in different ways. Identifying the symptoms is especially difficult in younger children who cannot vocalize or are confused about what is happening to them ("PTSD in Children and Teens - PTSD," n.d.).
Additionally, sometimes behaviors in younger children of the pre-school to kindergarten years are dismissed as quirkiness, or often mistaken for possible signs of ADHD or even autism (Rosner, Arnold, Groh, & Hagl, 2012). Children ages three and up are generally with care-givers or teachers seven to 10 hours per day, and sometimes even longer. That means that oftentimes the daycare worker, preschool, or grade school teacher is the first line of defense in saving a child from continued abuse, and getting help for post-traumatic stress symptoms, in its early stages, before it follows the child into adulthood (Cloitre et al., 2009).
Teachers as Reporters
Teachers along with other child services professionals in all 50 states are what is known as mandated reporters. What this means is that if a teacher suspects child abuse is occurring in a home, or anywhere, that he or she is required to report these suspicions to the local child protection agency, social services office. The social service provider is generally called the Department of Children and Families. The teacher is not required to call the police, the office of child protection will conduct an investigation upon receiving the report, and at that time it is completely out of the teacher's hands, and responsibility.
Some schools simplify it even further for teachers, by allowing them to use the school's counseling office or administration as a conduit for reporting. However, this extra step means valuable time lost in reporting and action. Teachers are required to report, how they report is generally up to the school district. No teacher will ever or should ever get into trouble for making a direct report. It may be primarily due to the inconsistencies of protocol that some teachers do not report. Even though a failure to report could result in job loss and the revocation of their teaching license, teachers have failed to report, often due to the complexity (Kenny, 2004), or a lack of confidence in their own skill set. The simpler the procedures are, the more comfortable, and confident teachers will feel in making the necessary call or filling the necessary forms out online. Too many stop-gaps, create dangerous gaps in time for children of abuse.
Failure to Report, Failing a Child
According to Alvarez, Kenny, Donohue, and Carpin (2004), there are many reasons teachers fail to report; one is they second guess themselves. However, training literature admonishes that teachers are not investigators, they are merely reporters (Alvarez, Donohue, Kenny, Cavanagh, & Romero, 2005). It is only their duty to report a suspicion and provide reasoning for this suspicion. Sometimes children will confide in their teacher, or the teacher may hear a child re-enacting an act of abuse in play or even in conversations with peers.
This would be the easiest to report, for there is verbalized evidence. However, many teachers will dismiss what they have been told or overheard as the child seeking attention or having an overactive imagination. It is not the teacher's job to make such dangerous assumptions. The only call the teacher should make at this point is the one to report what has been heard or seen.
Teachers should not have to second guess themselves in situations where a child's safety and possibly even life is at stake. They should be provided ongoing training throughout the school year, and additional workshops made available in the summer months. Teachers are not mental health professionals, they are not social workers (Kesner & Robinson, 2002); however, mental health and social services agencies should provide training and information to teachers, administration, and other staff who work directly with children. Even though teachers are not investigators, training on the proper questions to ask is beneficial to teachers who are faced with the two common scenarios of being told or overhearing (Brubacher, Powell, Skouteris, & Guadagno, 2015), and the most ambiguous of all, the unspoken signals.
Knowing the Tells, Even When Children Do Not Tell
Abuse does not always manifest in a visible bruise or laceration. Children who are sexually abused may exhibit their symptoms in behaviors (Dervishi, 2015), as do children of emotional abuse. Additionally, children who witness abuse may experience post-traumatic stress when witnessing the abuse of one parent onto the other, or of a sibling (Schultz & Harris, 2012). The most overlooked symptoms in children and adults are those related to PTSD. These are often dismissed as quirks in children, and mental illness in adults. While PTSD does fall under the diagnostic criteria for mental disorders, it is not organic. It is a result of emotional, mental, and often physical trauma.
Again, and this cannot be iterated enough: It is not the teacher's job to be sure, it is the teacher's job to report the suspicion. A suspicion of child abuse or neglect is all the evidence needed to report (Alvarez et al., 2004).
The signs and symptoms of PTSD are easy to recognize, once properly introduced. Post-traumatic stress disorder is the manifestation of symptoms related to psychological trauma that is directly related to having been the victim of or witness to something that was so devastating at the time, the individual relives it and is especially sensitive to certain triggers ("PTSD in Children and Teens - PTSD," n.d.).
If a person was witness to a shooting. The color red from the memory of seeing blood can result in nausea, or a car backfiring can cause the person to begin trembling or duck for cover. This individual is likely to avoid the area the shooting took place, or will have an anniversary reaction and simply not leave the house on the anniversary day; even if it is a day of the week.
With children, things are not so cut and dried. Any or all of these could be signs of abuse or PTSD.
- Flinching or drawing back when approached
- Withdrawn, keeps to self
- Refuses to talk about family or home life - when he or she does, it is in elaborate glowing terms.
- Crying without obvious provocation
- Easy to anger
- Starts fights with peers
- Trembles at the mention of parents (or another abuser)
- Loss of appetite
- Bruises/ marks on body
- Does not play
- Poor grades
- Disheveled appearance
- Poor hygiene
Children under the age of six are especially difficult to read regarding signs of abuse or abuse-related PTSD. According to the Anxiety and Depression Association of America, ADAA (n.d.) the following signs and symptoms are most prevalent in this age group
The presence of one or more of the following:
- sudden and repeated reactions to memories of the traumatic event, in books conversations, etc. - sometimes manifested in play-acting or artwork
- tells of having bad dreams when asked why he or she is sleepy at school
- blanking out, reacting as if the event is recurring
- reacting in a psychologically distressed manner to external stimuli
- Physiological manifestations - wetting pants, stomach complaints, or other physical ailments.
- complaints of pain in the bodily target of abuse, even when no signs are present
One of the following related to traumatic events:
- avoidance of any reminders such as:
- activities, places, or physical reminders
- people, conversations, or interpersonal situations that arouse recollections
- loss or decreased interest or participation in class or playground activities
- Withdrawn, isolative behavior
- flat or constricted affect, lack of emotions
Two or more of the following:
- prone to irritable, angry, or aggressive behavior, including extreme temper tantrums
- hypervigilance may start fights with peers, feels protective of smaller peers
- jumps, shouts out at a loud noise or even being approached
- difficulty concentrating - needs to have directions repeated, does not seem able to focus on, or follow directions
- restless, refuses to take naps *afraid to go to sleep
Young children especially may experience PTSD as the result of seeing violence in the home or witnessing violence around the home, the neighborhood, or school (Schultz & Harris, 2012). Even when children grow up in a violent home, it is never normal to them; it is not normal to the psyche.
Sexual Abuse and PTSD
All too many children are victims of sexual abuse by a family member, neighbor, or close friend of the family, these also may result in PTSD manifestations (Cohen, Deblinger, Mannarino, & Steer, n.d.), displaying some or all of the same symptoms as above, but may also
- act or speak in a sexually suggestive manner
- be overly eager to please, or earn favor
- walk as if the private areas are sore
- have increased need to go to the bathroom
- ask questions about reproduction or sexually transmitted diseases
The Simple Ways Teachers Can Help
Watching children at play, listening to their conversations, closely observing their drawings, and reading with a critical eye their writing assignments, especially narrative and poetry writing - are all extremely important. All too often teachers pack up their grading at the end of the day or the weekend into a satchel and along with it, a cry for help.
With all that teachers have to do each day, a good practice is to have the students place assignments on the desk directly in front of the teacher, or for the teacher to pick them up from each child. A five-second perusal is all it takes to catch words or images that could be critical to the content. Titles are especially telling. With older students, in fifth through high school grades, paying attention to the topics they choose to write about when given independent writing assignments, pays off. If a student wishes to research child molestation or sexual abuse, don't deter that student, but be aware that there may be more than curiosity behind the choice.
NOTE: The assignment must be retained, and a report must be filed. Make an appointment for the child with the school counselor. Reporting does not mean keeping them out of the loop. Counselors and other need to know faculty and staff should always be alerted.
Teachers should not call the parents. That is not the teacher's job.
Teachers are in a precarious position when it comes to mandated reporting (Alvarez et al., 2004). They at times worry that it will make things worse for the child at home, or they have concerns that if the child has manufactured a story that it will cause unnecessary legal trouble and embarrassment for the family. Again, it cannot be stressed enough, none of that is as important as making sure a child is safe. Teachers lose more than sleep over failure to report abuse; they lose their jobs and their teaching licenses. The worst-case scenario is they lose a child.
A teacher's job is incredibly stressful, knowing the responsibility day in and day out as a mandated reporter is especially so. Teachers often teach in a vacuum, and their days are filled with other people's children, and then their own. This leaves little time for personal alone time, or simply to breathe. Teachers, just like mental health professionals, should have a therapist to talk with regarding the stressors they experience. Stressors not only interfere with teacher's mental health and personal life but also in how they conduct themselves in their professional lives. Good decision making comes easier when people have an outlet for their stress.
Alvarez, K. M., Donohue, B., Kenny, M. C., Cavanagh, N., & Romero, V. (2005). The process and consequences of reporting child maltreatment: A brief overview for professionals in the mental health field. Aggression and Violent Behavior, 10(3), 311-331. https://doi.org/10.1016/j.avb.2004.03.001
Alvarez, K. M., Kenny, M. C., Donohue, B., & Carpin, K. M. (2004). Why are professionals failing to initiate mandated reports of child maltreatment, and are there any empirically based training programs to assist professionals in the reporting process? Aggression and Violent Behavior, 9(5), 563-578. https://doi.org/10.1016/j.avb.2003.07.001
Brubacher, S. P., Powell, M., Skouteris, H., & Guadagno, B. (2015). The effects of e-simulation interview training on teachers' use of open-ended questions. Child Abuse & Neglect, 43, 95-103. https://doi.org/10.1016/j.chiabu.2015.02.004
Cloitre, M., Stolbach, B. C., Herman, J. L., Kolk, B. van der, Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399-408. https://doi.org/10.1002/jts.20444
COHEN, J. A., DEBLINGER, E., MANNARINO, A. P., & STEER, R. A. (n.d.). With Sexual Abuse-Related PTSD Symptoms. Retrieved from https://tfcbt.org/wp-content/uploads/2014/07/multisite-randomized-controlled-trial-for-children-with-sa-related-ptsd-symptoms.pdf
Dervishi, E. (2015). Post Traumatic Stress Disorder in Children Sexual Abuse. Academic Journal of Interdisciplinary Studies. https://doi.org/10.5901/ajis.2015.v4n3s1p455
Kenny, M. C. (2004). Teachers' attitudes toward and knowledge of child maltreatment. Child Abuse & Neglect, 28(12), 1311-1319. https://doi.org/10.1016/j.chiabu.2004.06.010
Retrieved March 28, 2017, from https://www.ptsd.va.gov/public/family/ptsd-children-adolescents.asp
PTSD Symptoms in Children Age Six and Younger | Anxiety and Depression Association of America, ADAA. (n.d.). Retrieved March 28, 2017, from https://www.adaa.org/living-with-anxiety/children/posttraumatic-stress-disorder-ptsd/symptoms
Rosner, R., Arnold, J., Groh, E.-M., & Hagl, M. (2012). Predicting PTSD from the Child Behavior Checklist: Data from a field study with children and adolescents in foster care. Children and Youth Services Review, 34(9), 1689-1694. https://doi.org/10.1016/j.childyouth.2012.04.019
Schultz, D. B.-P., & Harris, R. (2012). Journal of Interpersonal. Retrieved from https://www.researchgate.net/profile/Dana_Schultz/publication/233984471_How_Much_Does_How_Much_Matter_Assessing_the_Relationship_Between_Children's_Lifetime_Exposure_to_Violence_and_Trauma_Symptoms_Behavior_Problems_and_Parenting_Stress/links/5693a90e08ae425c6895f20f.pdf