Thandi was only eleven years old when a family friend raped her. She was too scared to tell anyone about what happened because the rapist had threatened to kill her if she did so.
However, a few weeks after the traumatic event her parents started noticing changes in her behaviour. At night she had terrible dreams about the rape and would often wake up screaming. Even during the day she couldn’t keep the memories of the rape out of her mind. She started avoiding walking past the house where it happened because it would trigger repetitive memories about the event. She became overly anxious and had difficulty concentrating at school. Soon she began to withdraw socially and started mixing with a bad crowd. She felt as though her emotions were numb and her future was bleak.
Thandi is displaying typical symptoms of a youngster suffering from Post Traumatic Stress Disorder (PTSD). This disorder is defined as forms of psychological symptoms and dysfunction that begin after experiencing, witnessing or participating in an overwhelmingly traumatic and frightening event. Children are often exposed to trauma as a result of physical or sexual assault or abuse, family and community violence, experiencing or witnessing severe accidents, natural (e.g.: earthquake) or man-made disasters, life-threatening illnesses or war.
Although no conclusive statistics are available regarding the incidence of PTSD in the South African population, surveys in America have shown that at least 1.3% of Americans will suffer from this disorder at some point in their lifetime whilst another 6 to 15% will experience some of the symptoms of this disorder.
Though the symptoms of PTSD often occur soon after the event, the disorder itself can surface several months or even years later. The most common signs and symptoms of the disorder include recurrent intrusive memories or dreams of the traumatic event, avoidance of thoughts, situations and people associated with the trauma, decreased interest in usual activities, feelings of detachment from others, and difficulty concentrating and falling asleep.
A youngster’s age also affects how he/she will respond to a traumatic event. In very young children, PTSD symptoms may surface as repeated nightmares of monsters and dreams of death, bedwetting, belief in omens, emotional numbness, physical symptoms such as stomach aches and headaches, repetitive play, refusal to go to school and “clinging” behaviour. Adolescents, on the other hand, may display symptoms of PTSD by more indirect means such as arguing with parents and showing a marked decline in schoolwork and performance.
Many studies have shown that there is a connection between children’s exposure to traumatic events and psychological problems. Besides developing full-scale PTSD, children also develop problems with peer relationships, relationships within the family, self-esteem, school behaviour and performance, emotional development, depression and anger, substance abuse and guilt. These problems often occur with other psychiatric disorders such as attention-deficit disorder, eating disorder, panic, phobias and separation anxiety disorder.
In South Africa, community violence is a particularly worrying factor that is impacting negatively on a large number of vulnerable youths. A recent study in Khayelitsha* examined sixty youths - of whom 95% had been exposed to indirect violence and 56% to direct violence. Thirteen youngsters out of this sample group met the criteria for PTSD allowing the researchers to conclude that community violence increases the likelihood of children developing PTSD. Another study by Annelene Trand and Dan Stein found that 10% of inpatients in a child psychiatry unit at Tygerberg Hospital had a primary diagnosis of PTSD.
Once PTSD has been diagnosed, there is effective treatment that is available. Treatment for children generally involves “talking therapies” such as cognitive behavioural therapy, family therapy or brief psychotherapy. In some cases a psychiatrist can also prescribe medication. The therapist aims to help the child recall the traumatic events in a safe environment and deal with negative emotions such as grief, guilt, anger, depression, anxiety and behavioural disturbances. The child’s family life, peer relationships and school performance should also be addressed in therapy. Sometimes it is useful for sufferers to work together with others who have undergone similar traumatic experiences.
The prognosis for PTSD differs from individual to individual. A lot depends on the type and extent of trauma a sufferer has undergone. Some sufferers can experience a speedy return to healthy functioning whilst others experience debilitating relapses. An early diagnosis and an effective treatment course can go a long way in helping children to overcome the impact of traumatic events.
Four steps in helping a child with PTSD:
Step 1: Explain the PTSD symptoms to the child and that these horrible feelings and thoughts will go away with time.
Step 2: Let the child know that feelings of guilt are normal and that they will also pass with time.
Step 3: Encourage the child to talk about the traumatic event as much as possible. Detail is important - what did they think, feel and fear during the trauma?
Step 4: Supply the child with a lot of support and security. Be patient with him/her bearing in mind that recovery from trauma is a process. Encourage the child to take things slowly and gradually.