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Trauma (Post Traumatic Stress Disorder)

Post-Traumatic Stress Disorder (PTSD) can happen after a serious traumatic incident or many traumatic events. Any event or incident can be considered traumatic if it is very upsetting, scary, shocking or causes physical or emotional harm directly (to them) or indirectly (to someone else). As people cope and manage with situations differently, people will experience traumatic situations differently and will cope differently. Not everyone who experiences a traumatic event will experience psychological trauma (or PTSD). People who are traumatised and experiencing PTSD may experience symptoms such as:

  • Flashbacks (this is when a person may feel or act as though a traumatic event is happening again).
  • Nightmares.
  • Anxiety and feeling ‘on edge’.
  • Up and down emotions (such as feeling tearful, irritable or numb)

Complex PTSD is a more serious reaction to a long-lasting traumatic experience, for example abuse, neglect or frequent violence.

Top Tips:

  1. It is important to remember that everyone copes with things differently. If you are struggling to cope after a traumatic event, it is important to let someone know and get help, support and advice. Talk to someone you trust such as a parent, carer, teacher or your GP.
  2. There are many strategies and techniques to help you cope with flashbacks and anxiety. Visit the Youth Anxiety BC website and check the anxiety help section on this website
  3. Some people find it helpful to keep a log of when they experience trauma symptoms (such as flashbacks) to notice if there are patterns or triggers (things or situations that are more likely to make a flashback happen). If you notice patterns or triggers, this might help you to make a plan of how to manage these situations if they come up.
  4. Having hobbies and interests and spending time with friends can be really helpful when you are experiencing symptoms of trauma as they can be a good distraction. Try to plan regular time to do activities and see friends.
  5. Available literature: A therapeutic treasure box for working with children and adolescents with developmental trauma by Dr Karen Treisman

Downloads:

CAMHS Trauma Referral Guidance

 What we do, what we don’t do and what you can do if you are worried about your child

Difficult, upsetting or traumatic events and experiences happen to young people. Here’s a guide to help you know how best to support your young person if they are experiencing or have experienced a traumatic event. This is not an exhaustive list; young people will experience other types of distress and symptoms which may not be included on this guide:

Green 

Coping/ needs support; These are experiences that most young people will have from time to time.

Type and nature of distress

It is common for children and young people to experience or situations which are distressing, confusing or frightening as they develop through childhood and adolescence. The typical events of this nature that children and young people experience tend to be situation specific, short term and can be managed with the love and support of parents/ carers. Examples of situations that may cause/ contribute to a young person feeling distressed might be:

  • Adjusting to changes (such as a new school)
  • Friendships or relationship issues
  • Episodes of being teased or bullied (including being or feeling left out or excluded)
  • Being physically poorly or in pain
  • Family breakdown or conflict
  • Grief or loss (of a pet, family member or friend)
  • Accidents (e.g., breaking an arm)
  • Unexpected events
  • Watching age/ developmentally inappropriate material (e.g., films, games)

What you might see or a young person might report

  • Being clingy and not wanting to be separated from a parent/ carer
  • Not wanting to be left alone
  • Seeking verbal reassurance and checking things are ok
  • Not wanting to go to school
  • Avoidance of seeing friends or doing activities they ordinarily enjoy
  • Having mild sleep disturbance (e.g., bad dreams or difficulties getting to sleep)
  • Feeling tired or appearing lethargic and unmotivated and disinterested
  • Appearing withdrawn and less communicative
  • May appear more challenging or oppositional/ argumentative
  • Crying
  • In young children you may see a slight regression in behaviour such as wetting/ soiling

Things to try, support and next steps

  • Normalise that feeling upset, confused, angry, down are natural and understandable responses to a difficult or distressing events and that these feelings may last a while
  • Activity helps; encourage a young person to do a range of tasks and activities including one they need to do such as school work to fun things.
  • Keep a routine and have enjoyable and pleasurable things planned; familiarity and predictability are important
  • Use distraction techniques, here are some strategies to try;

A-Z of coping strategies: https://youtu.be/5EXpkVw3fh

How to make and use a coping box: https://youtu.be/OyfgodSSdV4

  • Role model and demonstrate that you can do things even when you’re feeling sad
  • Be compassionate by validating how a young person is feeling
  • Be calm and consistent in your language and behaviour and responses
  • Support a young person to problem solve any obvious triggers
  • Allow a young person to express and communicate how they are feeling. Some young people struggle to do this verbally- they may prefer to use non-verbal methods such as drawing, painting, making music etc.
  • Watch our parent/ carer workshop on Coping and Resilience Skills here: This film is to be uploaded

Other resources:

  • Stuff That Sucks, by Ben Sedley
  • Everyday Parenting With Love And Security, by Kim Golding
  • Conversations That Matter, by Margo Sunderland
  • What Every Parent Needs To Know; Love, Nurture And Play With Your Child, by Margo Sunderland
  • Why Can’t My Child Behave? Empathic Parenting Strategies That Work For Adoptive And Foster Families, by Amber Elliot
  • A-Z of Therapeutic Parenting Strategies, by Sarah Naish
  • A Therapeutic Treasure Box For Working With Children And Adolescents With Developmental Trauma, by Dr Karen Triesman
  • Helping Children Who Bottle Up Their Feelings, by Margo Sunderland
  • The Thriving Adolescent: Using Acceptance And Commitment Therapy And Positive Psychology To Help Teens Manage Emotions, Achieve Goals And Build Connection, by Louise Hayes

 

Amber 

Needs help; These are challenges that some young people experience and may need some support with.

Type and nature of distress

The degree to which a young person reacts to a difficult or distressing event lasts longer than a couple of days/ weeks and causes the young person distress or might have some mild impact on their ability to cope with everyday life such as going to or coping at school, seeing friends or taking part in leisure activities. Examples of situations or events that may cause/ contribute to a young person feeling distressed might be:

  • Being routinely teased or bullied (including being or feeling left out or excluded)
  • Grief or loss (including romantic relationships ending)
  • Witness or experience of conflict (at home or school)
  • Witness or experiencing an accident or injury
  • Family and relationship stressors (family breakdown parent/ sibling ill-health, financial or social stressors)

What you might see or a young person might report

As well as the features in Green, the following might also be present:

  • Disrupted sleep (difficulties getting to or staying asleep, waking very early in the morning and not being able to get back to sleep)
  • Seeking physical or verbal seeking reassurance or wanting to withdrawn from social contact and communication
  • Resistance to doing things; appearing unmotivated and disinterested
  • Emotionally labile; frequent changes of emotion, more sensitive (e.g., irritable, upset, confused)
  • May seem more on-edge or jumpy at times at other times may seem to be ‘in their own world/ day dream type state’
  • Overthinking and appearing preoccupied or concerned by the triggering event- more aware of anything related to the triggering event
  • Thoughts or urges to harm self or some thoughts to end life; some infrequent or superficial (not requiring medical attention) self-harm may occur. Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

Things to try, support and next steps

As well as the steps in Green the following might be helpful:

  • Support your young person to access self-help resources including:
  • The following videos:

How to support a young person with anxiety: https://youtu.be/LMFQHABnH1M 

How to support a young person with depression/ in crisis/ who engages in self-harm: https://youtu.be/qBAZQVjSmQU

  • Watch videos of our parent/ carer workshop on:

How to support coping in crisis here: https://youtu.be/qBAZQVjSmQU

How to support a young person with anxiety: https://youtu.be/LMFQHABnH1M

  • Share concerns with your child’s school/ college
  • See your child’s GP
  • Access pastoral support from school
  • Consider accessing help from a local counselling service
  • Seek advice, guidance and support from Young Minds Parent Helpline: 08088025544
  • Depending on the context and/ or the origins of the distress being experienced, other services may be helpful e.g., family guidance if there is family breakdown or conflict, bereavement services. 

Other Resources:

  • The Simple Guide to Child Trauma, by Betsy de Thierry
  • Trauma Is Really Strange, by Steve Haines

 

Red 

Needs Specialist Treatment or a Crisis Response; These are difficulties that cause a significant impact and a young person may need specialist support.

Type and nature of distress

Young people are displaying signs of trauma/ Post Traumatic Stress Disorder. These difficulties cause significant distress to a young person and significantly disrupt daily coping such as school/ college, socialising and even self-care activities (e.g., sleep, bathing, eating). Despite trying advice in the green and amber stages, the young person still experiences trauma symptoms at least 1 month after the traumatic event. Examples of situations that may cause/ contribute to a young person feeling low in mood or depressed:

  • Severe/ chronic bullying or abuse (including neglect, emotional, physical, sexual)
  • Social or family financial stressors (such as family breakdown, conflict or parental/ sibling ill-health)
  • Grief or loss
  • Witnessing or experiencing a traumatic event
  • Witness or experiencing an accident or injury
  • Overwhelmed by pressures and stressors including individual factors e.g., health, social factors e.g., relationships, occupational factors e.g., school/ college and environment e.g., living circumstances

What you might see or a young person might report

As well as the features in Green and Amber, the following might also be present:

  • Flashbacks of the traumatic event (sudden/ unexpected memories or recalling aspects of the traumatic event without warning or trying)
  • Children may re-enact the traumatic event repeatedly in their play
  • Disrupted sleep; nightmares/ night terrors (that may or may not be linked to the traumatic event)
  • Hypervigilance to threat and danger
  • Isolating self from friends and family
  • Episodes where young person appears non-reactive/ shut down/ in a day-dream type state
  • Poor memory or recall as well as periods of confusion or feeling spaced out- may report things not feeling real
  • Withdrawn and uncommunicative or not wanting to be left alone at all- this may seem uncharacteristic or age inappropriate for some teenagers
  • Refusal to leave the house or attend/ take part in activities such as school, hobbies, interests, seeing friends
  • Significant impact on health and wellbeing such as not sleeping or eating for a sustained period of time. May show signs of physical compromise as a result.
  • Appearing uncaring or unbothered about people or activities they previously would have cared about- may not honour commitments or responsibilities which is uncharacteristic
  • May on occasion becoming agitated, distressed, oppositional or aggressive towards others
  • Reactive and impulsive behaviour such as running away which may place them or others in danger
  • Feeling hopeless about the future- not being able to see a future and appearing to give up on dreams, goals and hopes
  • Thoughts, feelings, urges, plans or intent to harm self or end their life or harm others. Please note that not all young people who engage in self-harm behaviour are depressed or suicidal. There are many reasons why a young person may engage in self-harm behaviour.

Things to try, support and next steps

As well as the steps in Green and Amber the following might be helpful:

  • Speak with your child’s GP
  • Speak with the School Nursing Team
  • Depending on the context and/ or the origins of the distress being experienced, other services may be helpful. There may be a role for other services such as Children’s Services or other statutory or voluntary organisations that can support if there are clear triggers for anxiety e.g., abuse, domestic violence, bullying, being a young carer etc.
  • Seek advice, guidance and support from Young Minds Parent Helpline: 08088025544
  • Consider making a self-referral to a CAMHS Service
  • If your young person is at risk of harm, please make this clear when making the referral

Other Resources:

  • The Simple Guide To Child Trauma: What It Is And How To Help, by de Tierry, Betsy de, Emma Reeves et al.,

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