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https://www.samhsa.gov/child-trauma/recognizing-and-treating-child-traumatic-stress#signs Recognizing and Treating Child Traumatic Stress Learn about the signs of traumatic stress, its impact on children, treatment options, and how families and caregivers can help. Types of Traumatic Events Childhood traumatic stress occurs when violent or dangerous events overwhelm a child’s or adolescent’s ability to cope. Traumatic events may include: Neglect and psychological, physical, or sexual abuse Natural disasters, terrorism, and community and school violence Witnessing or experiencing intimate partner violence Commercial sexual exploitation Serious accidents, life-threatening illness, or sudden or violent loss of a loved one Refugee and war experiences Military family-related stressors, such as parental deployment, loss, or injury In one nationally representative sample of young people ages 12 to 17: 8% reported a lifetime prevalence of sexual assault 17% reported physical assault 39% reported witnessing violence Also, many reported experiencing multiple and repeated traumatic events. It is important to learn how traumatic events affect children. The more you know, the more you will understand the reasons for certain behaviors and emotions and be better prepared to help children and their families cope. Learn more about the types of trauma and violence and types of disasters. Signs of Child Traumatic Stress The signs of traumatic stress are different in each child. Young children react differently than older children. Preschool Children Fearing separation from parents or caregivers Crying and/or screaming a lot Eating poorly and losing weight Having nightmares Elementary School Children Becoming anxious or fearful Feeling guilt or shame Having a hard time concentrating Having difficulty sleeping Middle and High School Children Feeling depressed or alone Developing eating disorders and self-harming behaviors Beginning to abuse alcohol or drugs Becoming sexually active For some children, these reactions can interfere with daily life and their ability to function and interact with others. Impact of Child Traumatic Stress The impact of child traumatic stress can last well beyond childhood. In fact, research shows that child trauma survivors are more likely to have: Learning problems, including lower grades and more suspensions and expulsions Increased use of health services, including mental health services Increased involvement with the child welfare and juvenile justice systems Long term health problems, such as diabetes and heart disease Trauma is a risk factor for nearly all behavioral health and substance use disorders. What Families and Caregivers Can Do to Help Not all children experience child traumatic stress after experiencing a traumatic event, but those who do can recover. With proper support, many children are able to adapt to and overcome such experiences. As a family member or other caring adult, you can play an important role. Remember to: Assure the child that he or she is safe. Talk about the measures you are taking to get the child help and keep him or her safe at home and school. Explain to the child that he or she is not responsible for what happened. Children often blame themselves for events, even those events that are completely out of their control. Be patient. There is no correct timetable for healing. Some children will recover quickly. Others recover more slowly. Try to be supportive and reassure the child that he or she does not need to feel guilty or bad about any feelings or thoughts. Review NCTSI’s learning materials for parents and caregivers, educators and school personnel, health professionals, and others. Treatment for Child Traumatic Stress Even with the support of family members and others, some children do not recover on their own. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope with the impact of traumatic events and move toward recovery. Effective treatments like trauma-focused cognitive behavioral therapies are available. There are a number of evidence-based and promising practices to address child traumatic stress. Each child’s treatment depends on the nature, timing, and amount of exposure to a trauma. Review Effective Treatments for Youth Trauma – 2004 (PDF | 55 KB) at the National Child Traumatic Stress Network (link is external). Families and caregivers should ask their pediatrician, family physician, school counselor, or clergy member for a referral to a mental health professional and discuss available treatment options. More Ways to Find Help Many U.S. agencies and other groups offer research and support related to child traumatic stress. Government Websites Division of Violence Prevention and Adverse Childhood Experiences (ACE) Study at CDC Office for Victims of Crime at the Department of Justice National Center for PTSD at the Department of Veterans Affairs Pediatric Trauma and Critical Illness Branch at the National Institute of Child Health and Human Development Coping With Traumatic Events at the National Institute of Mental Health Other Organizations American Professional Society on the Abuse of Children (link is external) Children’s Mental Health Report at the Child Mind Institute (link is external) HealTorture.org (link is external) International Society for Traumatic Stress Studies (link is external) National Children's Advocacy Center (link is external) Sidran Institute (link is external) ================================================================= How to Talk About Mental Health Do you need help starting a conversation with your child about mental health? Try leading with these questions. Make sure you actively listen to your child’s response. Can you tell me more about what is happening? How you are feeling? Have you had feelings like this in the past? Sometimes you need to talk to an adult about your feelings. I’m here to listen. How can I help you feel better? Do you feel like you want to talk to someone else about your problem? I’m worried about your safety. Can you tell me if you have thoughts about harming yourself or others? When talking about mental health problems with your child you should: Communicate in a straightforward manner Speak at a level that is appropriate to a child or adolescent’s age and development level (preschool children need fewer details than teenagers) Discuss the topic when your child feels safe and comfortable Watch for reactions during the discussion and slow down or back up if your child becomes confused or looks upset Listen openly and let your child tell you about his or her feelings and worries ======================================================================== https://youth.gov/youth-topics/youth-mental-health/warning-signs Warning Signs If a youth has a constellation of risk factors, it is important to seek assistance for the young person and his or her family. If a family member or friend is concerned, discussing the issue with another family member, friend, spiritual counselor, family pediatrician, or primary doctor could be helpful. Signs and behaviors to look for include, among others: Marked fall in school performance Poor grades in school despite trying very hard Severe worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age Frequent physical complaints Marked changes in sleeping and/or eating habits Extreme difficulties in concentrating that get in the way at school or at home Sexual acting out Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death Severe mood swings Strong worries or anxieties that get in the way of daily life, such as at school or socializing Repeated use of alcohol and/or drugs1 Learn more about promoting, preventing, and treating mental health issues. 1 American Academy of Child and Adolescent Psychiatry, 2011 ============================================================================ https://www.samhsa.gov/find-treatment Seek immediate assistance if you think your child is in danger of harming themselves or others. You can call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255). Suicide Prevention Lifeline 1-800-273-TALK (8255) TTY: 1-800-799-4889 Website: www.suicidepreventionlifeline.org (link is external) 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. Your call is routed to the nearest crisis center in the national network of more than 150 crisis centers. SAMHSA's National Helpline 1-800-662-HELP (4357) TTY: 1-800-487-4889 Website: www.samhsa.gov/find-help/national-helpline Also known as, the Treatment Referral Routing Service, this Helpline provides 24-hour free and confidential treatment referral and information about mental and/or substance use disorders, prevention, and recovery in English and Spanish. Disaster Distress Helpline 1-800-985-5990 Website: www.samhsa.gov/find-help/disaster-distress-helpline Stress, anxiety, and other depression-like symptoms are common reactions after any natural or human-caused disaster. Call this toll-free number to be connected to the nearest crisis center for information, support, and counseling. Veteran's Crisis Line 1-800-273-TALK (8255) TTY: 1-800-799-4889 Website: www.veteranscrisisline.net (link is external) Connects veterans in crisis (and their families and friends) with qualified, caring Department of Veterans Affairs responders through a confidential, toll-free hotline, online chat, or text. ============================================================================== If your child is in need of community mental health services you can find help in your area. Give Feedback here @ depressionforums.org and: U.S. Department of Health & Human Services, 200 Independence Avenue, S.W. Washington, D.C. 20201 -
As a parent or caregiver, you want the best for your children or other dependents. You may be concerned or have questions about certain behaviors they exhibit and how to ensure they get help. What to Look For It is important to be aware of behaviors that your child may be struggling. You can play a critical role in knowing when your child may need help. Consult with a school counselor, school nurse, mental health provider, or another health care professional if your child shows one or more of the following behaviors: Feeling very sad or withdrawn for more than two weeks Seriously trying to harm or **** himself or herself, or making plans to do so Experiencing sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing Getting in many fights or wanting to hurt others Showing severe out-of-control behavior that can hurt oneself or others Not eating, throwing up, or using laxatives to make himself or herself lose weight Having intense worries or fears that get in the way of daily activities Experiencing extreme difficulty controlling behavior, putting himself or herself in physical danger or causing problems in school Using drugs or alcohol repeatedly Having severe mood swings that cause problems in relationships Showing drastic changes in behavior or personality Because children often can’t understand difficult situations on their own, you should pay particular attention if they experience: Loss of a loved one Divorce or separation of their parents Any major transition – new home, new school, etc. Traumatic life experiences, like living through a natural disaster Teasing or bullying Difficulties in school or with classmates Sen. Gordon Smith encourages others to "bring mental health issues out of the shadows." What to Do If you are concerned your child’s behaviors, it is important to get appropriate care. You should: Talk to your child's doctor, school nurse, or another health care provider and seek further information about the behaviors or symptoms that worry you Ask your child’s primary care physician if your child needs further evaluation by a specialist with experience in child behavioral problems Ask if your child’s specialist is experienced in treating the problems you are observing Talk to your medical provider about any medication and treatment plans How to Talk About Mental Health Do you need help starting a conversation with your child about mental health? Try leading with these questions. Make sure you actively listen to your child’s response. Can you tell me more about what is happening? How you are feeling?Have you had feelings like this in the past? Sometimes you need to talk to an adult about your feelings. I’m here to listen. How can I help you feel better? Do you feel like you want to talk to someone else about your problem? I’m worried about your safety. Can you tell me if you have thoughts about harming yourself or others? When talking about mental health problems with your child you should: Communicate in a straightforward manner Speak at a level that is appropriate to a child or adolescent’s age and development level (preschool children need fewer details than teenagers) Discuss the topic when your child feels safe and comfortable Watch for reactions during the discussion and slow down or back up if your child becomes confused or looks upset Listen openly and let your child tell you about his or her feelings and worries Glenn Close talks about her family's experience with mental health problems, and the importance of talking and learning about mental health issues. "I challenge every American family to no longer whisper about mental illness behind closed doors," she said. Learn More about Supporting Your Children There are many resources for parents and caregivers who want to know more about children’s mental health. Learn more about: Recognizing mental health problems in children exit disclaimer icon, how they are affected, and what you can do Diagnosing and treating children with mental health problems exit disclaimer icon Talking to children and youth after a disaster or traumatic event exit disclaimer icon (PDF – 796 KB) http://store.samhsa.gov/shin/content/SMA12-4732/SMA12-4732.pdf Get Help for Your Child Get Immediate Help People often don’t get the mental health services they need because they don’t know where to start. Talk to your primary care doctor or another health professional about mental health problems. Ask them to connect you with the right mental health services. If you do not have a health professional who is able to assist you, use these resources to find help for yourself, your friends, your family, or your students Seek immediate assistance if you think your child is in danger of harming themselves or others. You can call a crisis line or the National Suicide Prevention Line at 1.800.273.TALK (8255). SAMHSA Treatment Referral Helpline – 1‑877‑SAMHSA7 (1‑877‑726‑4727) Get general information on mental health and locate treatment services in your area. Speak to a live person, Monday through Friday from 8 a.m. to 8 p.m. EST. If your child is in need of community mental health services you can find help in your area. Give Feedback here @ depressionforums.org and: U.S. Department of Health & Human Services, 200 Independence Avenue, S.W. Washington, D.C. 20201
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Today in JAMA Pediatrics, researchers from The Children's Hospital of Philadelphia's (CHOP) PolicyLab published the largest study to date documenting the significant risks to children's health associated with prescription antipsychotics, a powerful a class of medications used to treat mental and behavioral health disorders. The results suggest that initiating antipsychotics may elevate a child's risk not only for significant weight gain, but also for type II diabetes by nearly 50 percent; moreover, among children who are also receiving antidepressants, the risk may double. Previous PolicyLab research showed that one in three youth receiving antidepressants in the Medicaid program were receiving an antipsychotic at the same time. Traditionally, antipsychotics have been narrowly prescribed to children with a diagnosis of schizophrenia or bipolar disorder, or to those with significant developmental delays who were displaying aggressive behaviors that were potentially injurious to themselves or others. However, in recent years, these medications are increasingly being prescribed in the absence of strong supporting safety and efficacy data to treat healthier children and adolescents with disruptive behaviors, such as those who are diagnosed with attention deficit hyperactivity disorder (ADHD). The new study, which used national Medicaid data on more than 1.3 million youth ages 10 to 18 with a mental health diagnosis from the Centers for Medicare and Medicaid Services, must be interpreted in the context of emerging evidence that Medicaid-enrolled children are far more likely than privately insured children to be prescribed antipsychotic medications. Overall, over 25 percent of Medicaid-enrolled children receiving prescription medications for behavioral problems were prescribed antipsychotics by 2008, largely for less severe disorders. "With such vast numbers of children being exposed to these medications, the implications for potential long-lasting harm can be jarring," said David Rubin, MD, MSCE, the study's lead author and co-director of PolicyLab at CHOP. Nevertheless, Rubin and his co-authors remain cautious in over-reacting to these findings. The baseline risk for diabetes among youth who were not exposed to antipsychotics in the study was only 1 in 400, rising to 1 in 260 among those initiating antipsychotics, and at most to 1 in 200 among those who initiated antipsychotics while they were simultaneously receiving antidepressants. "Although these findings should certainly give us pause," Dr. Rubin added, "we should not reflexively over-react to them. Rather, we need to incorporate these new revelations about the risk for diabetes into a more thoughtful consideration of the true risks and benefits of prescribing an antipsychotic to a child. Yes, we should try, by all means possible, to minimize the numbers of children and adolescents exposed to these powerful medications. But for some children in immediate crisis, we must also concede that the benefit of the antipsychotic for acute management may still outweigh the risk." The study's authors recommend that clinicians and families who are making medication decisions periodically revisit the treatment strategy to address challenging behaviors. For example, when planning to prescribe antipsychotics to a child, professional organizations recommend beginning cautiously with the lowest dose possible, while strictly monitoring for early evidence of weight gain or abnormal lab tests that often predict later onset of diabetes. Dr. Rubin, who is also an attending pediatrician at CHOP, notes, "Once a child is on the antipsychotic drug, a plan should be agreed upon and periodically revisited to see whether or not an evidence-based counseling service, such as trauma-focused cognitive therapy, could address underlying emotional trauma, which is often the root cause for the behavior. That same periodic review would also seek to transition the child off the antipsychotic as soon as possible, once these problems are more suitably addressed. " Ultimately, say Rubin and his co-authors, the prescription of antipsychotics to children and adolescents is likely to continue, reflecting a growing demand to address very challenging behaviors in children "At the end of the day, the approach to the individual child who is in crisis is still a case-by-case decision between a family and the treating provider," said Dr. Rubin. "We can only hope that those decisions are made in full recognition of our findings, and that for some children, alternatives to these powerful medications--such as counseling or other supportive services, will be considered first." Source:Children's Hospital of Philadelphia
