PTSD and Coexisting Disorders in Children and Adolescents

Abstract

Significant advances in understanding PTSD and coexisting disorders in children and adolescents have been made  in recent years. Traumatic stress reactions in children and adolescents with PTSD, experience an interaction between a subject, a traumatogenic factor, and social context. This paper aims to review the research in the domain of PTSD in early childhood as well as young people, to synthesis selected recent study with the focus of clinical practice on their focus relevance. We, therefore, will address the finding of the epidemiology of trauma exposure and PTSD and what ties it has to coexisting disorders, do a  critical diagnostic criteria, implications for screening individuals and an assessment of traumatic stress reactions, treatment outcomes including interventions due to coexisting disorders, acute and chronic PTSD dissemination of effective treatment as well as looking at further research of substance abuse that should occur from childhood to adolescents.

We can conclude we more information on PTSD and coexisting disorders with recommendations on clinical practice and suggestions for further research.

Keywords: PTSD, epidemiology, critical, diagnostic, assessment, interventions, treatment

Epidemiology of Trauma Exposure

Contemporary understanding of Complex Trauma

Our contemporary understanding of complex trauma can date back to 40 years ago, and its impact on the development over the course a childhood to adolescent years after a few reviews studies on complex trauma that focused on children to older adolescents 40- 68% of the subjects experienced at least one traumatic event (Scheeringa, Zeanah, & Cohen, 2011). Our understanding of the epidemiology of trauma exposure and psychopathology, as well as the risks for development for children,  will be summarized by research. The impact of trauma can affect the individual over an entire lifespan including three separate but closely related lines of work being (a) adverse childhood experiences or ACES (b) poly-victimization (c) cumulative trauma (Grasso, Greene & Ford, 2013). In recent studies, we have provided an update of recent findings of trauma exposure and the course of PTSD. PTSD is a psychiatric disorder that effects as many as one and every 14 adolescents, and 1 and 20 children before they even begin kindergarten, out of trauma-related disorders PTSD or coexisting disorders were the second and third most costly health problems in the U.S (Ford, Grasso, Elhai & Courtois, 2015). The term trauma comes from the Greek word for "injury" or "wound," it was originally supposed to describe a physical injury, but today we can use that word to describe an " a psychic wound that can cause a traumatic effect."

Stress reactions to PTSD and Coexisting disorders

Diagnosis for PTSD

Before PTSD first officially appeared there were other types of stressors or coexisting disorders that were abnormal or atypical which means it is "outside the range of normal experience" which was categorized at DSM-III-R by the American Psychiatric Association when PTSD appeared in the third DSM as a more detailed specification of a stress reaction. There are three elements or “criteria” for DSM-III-R when it comes to a child or adolescent that has symptoms of distress. The first is a diagnosis of persistent re-experiencing of a traumatic stressor in one or four ways such as memories of a traumatic event, repeated distressed dreams, suddenly acting as if the dramatic event happened again, severe distress when reminded of traumatic events (Ford, Grasso, Elhai & Courtois, 2015). The second symptom is that the child or adolescent will experience three symptoms involving avoidance of reminders such as the ability to feel emotions. The child or adolescent will not express their emotions even if the activities are pleasurable or even show closeness to the ones that they love. The third symptom the individual may have is at least two symptoms of persistent arousal that were not present before such has had difficulty sleeping, anger or outbursts, problems with mental concentration. The duration of that time a child will experience those symptoms at least for 30 days and sometimes there might even a "delayed onset" that may not begin until six months.

Complex PTSD

Many forms of Traumatic Events

When it comes to complex types of disorders, we can put that hand in hand with coexisting disorders. Since PTSD did originate from anxiety disorders, it also is related to depression, substance abuse, panic disorder, OCD and social phobia we can see how they tie to each to each other. In PTSD with children and adolescents, DSM-IV and DSM-IV-TR are based in no small extent of clinician’s observations of the child. Identifying a complex trauma as a distinct subset of traumatic events and this will also affect the child's core self as they try to cope with the events that took place they won't know how to function and will start acting out where the personality and identity will split apart. In this case there can be many forms of coexisting disorders that can come into effect, when a child starts to exhibit these types of actions they can, in turn, result in the child to experience other types of disorders that can span from PTSD because now the child's neurobiology will be affected since every emotion, thought, and action is a personal experience that happens when the changes in the biology of the body. It brings us to the neurobiology disorders and the impact it has on the child's or adolescent's brain.

Neurobiology of Traumatic Stress and Coexisting disorders

The interconnection of body and mind

In every disorder the mind and body are connected every thought, emotion, goals, or intentions is made up of physiological activity in our brain. With PTSD there are many complex changes in a person’s state of mind, and with this disorder, other disorder can form out of it. Such as other anxiety disorders, substance abuse, depression, OCD. With this coexisting disorders that tied in with PTSD traumatic stressors can make them occur, people with PTSD are different from other people because of the of the physical change when there is a radical shift in the brain and body's stress response system. Because other types of disorder occurred out of PTSD, the National Institute of Mental Health launched Research Domain Criteria (RDoc) with the goal of “integrating multiple scientific disciplines in transitional manner to identify ‘fundamental behavioral components’ that plays a role in a number of mental health disorders (Ford, Grasso, Elhai & Courtois, 2015). It can play a role in substance abuse in PTSD individuals because there are coexisting disorders such as depression which sometimes requires pharmacology children can grow a tolerance to the drugs they are given which can sometimes be compared to drugs such as cocaine. Children and adolescents that received drugs to deal with this coexisting disorder are at risk for substance use problems as well as high-risk behaviors (Forunta, Porche, & Padilla, 2018).

Assessment of PTSD and Coexisting disorders

Clinical or Research Determination

Assessment of PTSD is a complexity of traumatic stressors as well as the likelihood of developing traumatic stress disorders. There are different types of assessing who has PTSD such as questionnaires but in-depth clinical trials that can help figure out what other underlying problems there are that are associated with this disorder. With assessments can come to some confusion because almost 50%- 60% of adults, children, and adolescents go through traumatic stressors once in their life's (Ford, Grasso, Elhai & Courtois, 2015). So when they are trying to assess the child or adolescent some of them do not develop PTSD even though they have experienced a stressor in their life. Another way to evaluate people that have PTSD is to look back at patient history to have a better understanding of the individual has had disorders before PTSD or if any tie into this disorder without a careful review it can cause incorrect diagnoses. These incorrect diagnoses are more critical when identifying it in a child because of the changing of presentations with the child's development. In a meta-analysis on children that specified on PTSD symptoms showed that 41 % have difficulty in concentrating will need medicine for that which can cause another disorder which is substance abuse, as well 25 % that suffer from depression, and 23 % that go through some anxiety (Simonelli, 2013). One issue that may occur with PTSD is that it goes by the diagnoses of DSM-IV and for that reason, there can be many alternative diagnostic algorithms and modifications of existing criteria which can span out to other disorders or other behavioral problems.

Treatment of Children and Adolescents

Other Approaches of Treatments

When you're assessing and treating a type of disorder that has many specific symptoms that can associate with other disorders the proper treatment can be a very critical part of that child or adolescents way of living. As mentioned before in this paper that most children and adolescents that have experienced traumatic stressors will not have PTSD that is why the proper assessment should be conducted. In treatment children that are going through PTSD sometimes go have to take medication is part of a  two-prong approach where they can use drugs such as SSRI's which helps regulates the mood, Atypical antidepressants that help messengers in the brain, and anti-anxiety medications.  If we look at PTSD, it combines coexisting disorders all in one disorder that because more damage because, it contains many other disorders. Some disorders include substance abuse because most children start on a low dosage but as they grow up and the PTSD is still present then because of tolerance to the drugs they will need to increase the dosages as they grow older. Increase dosages may cause issues later on for the child, but other forms of therapy can help children and adolescents that are also used in coexisting disorders. Such as cognitive processing therapy which requires 10-12 sessions for adults but has adapted in a more extended format for youth (Ford, Grasso, Elhai & Courtois, 2015). Just like depression and anxiety the therapist wants the child or adolescent to be able to learn how to work with their disorder by trying to understand their triggers as well as being able to explain what they are feeling. Since we are dealing with young people, it is essential that when a young person has a disorder that the parents take part in some of the therapy as well, Child-Parent Psychotherapy which is used in most disorders that young people have is a vital part because its caregiver is still raising the child. In this type of therapy, the CPP therapist helps the parent understand their child an helping the parent understands the impact of traumatic events. When we have children that are going through a disorder that has a combination of other disorders, it’s crucial to understand that because they are tied together, there will be similarities in treatment because you are dealing with multiple disorders. However, like most disorders, it is harder to asses it within young people because most of them are still developing which may cause confusion.

Conclusion

In conclusion defining and applying criteria for PTSD and coexisting diagnoses can answer some critical questions such as how extraordinarily how hard it is to diagnose children and adolescents, the cost of it, the complex condition the suffering of ten million people worldwide. Understanding how and why exposure to specific " traumatic stressors" can cause psychological trauma that creates co-existing disorders that can cause effects to the child and adolescent that have long-term consequences. It is an essential challenge for researchers and clinicians as well as politicians to help out the younger generation who seems to experience traumatic events on a daily basis. As further research continues to grow so will the treatment for PTSD as well as learning how to cope with coexisting disorders that come along with this type of disorder that is PTSD.

Reference

1. Grasso, D., Greene, C., & Ford, J. D. (2013). Cumulative trauma in childhood. Treating complex traumatic stress disorders in children and adolescents: An evidence-based guide, 79-99.
2. Scheeringa M. S, Zeanah C. H, Cohen J. A. PTSD in children and adolescents: towards an empirically based algorithm. Depression and Anxiety. 2011;28:770–782.
3. Ford, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015). Posttraumatic stress disorder: Scientific and professional dimensions. Academic press.
4. Fortuna, L. R., Porche, M. V., & Padilla, A. (2018). A treatment development study of cognitive and mindfulness?based therapy for adolescents with co?occurring post?traumatic stress and substance use disorder. Psychology and Psychotherapy: Theory, Research, and Practice, 91(1), 42-62.
5. Simonelli A. (2013). Posttraumatic stress disorder in early childhood: classification and diagnostic issues. European journal of psychotraumatology, 4, 10.3402/ejpt.v4i0.21357. doi:10.3402/ejpt.v4i0.21357

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