Children are considered exceptionally vulnerable to trauma. The American Psychological Association (APA) estimates that up to 85% of children will witness some form of community violence before they reach adulthood — and as many as 66% of children will be victims of trauma. The APA also estimates that 25% to 43% of children will experience sexual abuse.

Like adults, the way children react to trauma will vary considerably. Many factors come into play, including the child’s cognitive and emotional development levels, family dynamic, socioeconomic status, race or ethnicity, religious background and pre-existing medical, behavioral or psychological conditions.

Arguably the most critical factor is age. Children six and under are highly susceptible to the after-effects of trauma, due to their low development levels. Symptoms of trauma among kids six and younger include:

Enuresis, or bed-wetting, after they have been potty-trained

Chronic nightmares

Unfounded fears toward relatively innocuous things

Trouble speaking or expressing themselves verbally

A tendency to obsess over — even re-enact — the traumatic event

Uncharacteristic clinginess or dependency on their parents and other adults

Many children between kindergarten and middle school age who witness or experience a will constantly feel afraid. These persistent fears can lead to anxiety, as well as disengagement toward everyday activities. Children in this age group often struggle in school, and may see their grades suffer as a result. They may also become less interested in hobbies and activities they once enjoyed. Like their younger counterparts, they may also be inclined to obsess over the event and feel the need to constantly discuss it. Feelings of guilt, self-blame, and anger are also common.

For many teenagers, traumatic events represent unwanted attention from peers, teachers, coaches, and other important people in their lives. As a result, they may insulate themselves from school and social activities. Acting out is also fairly common, often in the form of angry outbursts and/or disruptive behavior. In some cases, self-harm may also occur. And because they are at an age of greater independence, they may express a desire to seek revenge or retribution on whomever they blame for the traumatic event.
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Diagnosing PTSD in children can prove challenging because the symptomatic criteria closely aligns with depression, anxiety disorders, and other mental health issues common in children and adolescents. In order to receive a PTSD diagnosis, a child must have “experienced, witnessed, or learned of a traumatic event, defined as one that is terrifying, shocking, and potentially threatening to life, safety, or physical integrity of self or others”. Beyond that, the symptomatic criteria for PTSD in children is slightly different from that of adults. This criteria includes the following symptoms for a period of at least one month:

At least one re-experiencing event. In exceptionally young children, this may include recreating the event during playtime. They often have nightmares on a regular basis, and in rare cases may experience hallucinations. They may also exhibit severe stress whenever details of the event are mentioned.

At least three avoidant or numbing symptoms. These often involve stubborn refusal to revisit, or even acknowledge, the traumatic event, as well as any associated people, places, or objects. Children may have a hard time remembering the event. They may also exhibit disinterest in their favorite activities, and detachment from their friends and loved ones. In some cases, they may indicate fears they will die soon, or that something bad will happen to them in the near future.

At least two hyperarousal symptoms. For many children and adolescents, excessive alertness and vigilance is a common after-effect of trauma. As a result, many struggle to concentrate in school and experience trouble sleeping. Angry or emotional outbursts often take place, as well.