A Look at Acute Stress Disorder and PTSD

In the wake of an upsetting event, children and adolescents can be expected to react in ways that concern parents. The good news is that these reactions — which can include a return or “regression” to earlier behaviors in young kids, changes in eating or sleeping habits, physical complaints, social withdrawal — are typical of young people who have been through a very stressful experience.

Most kids return to their regular selves after a time, and natural recovery times tend to depend on how close, both physically and emotionally, the child was to the event. But some kids can’t recover on their own, and we call this child traumatic stress — when the exposure overwhelms their ability to cope with what they have experienced.

There are two disorders that mental health professionals can diagnose and treat in young people after a traumatic event: acute stress disorder (ASD) and post-traumatic stress disorder (PTSD). The key to both of these disorders is not unusual symptoms, since all of the symptoms are part of a typical response to a disruptive event. The key is that these symptoms are severe enough to impair a child’s ability to function in day-to-day life.

ASD and PTSD are essentially on a spectrum. The shared symptoms include:

• Foggy, dazed, detached demeanor, difficulty remembering parts of the event
• Intrusive thoughts and/or distress when reminded about the traumatic event
• Avoidance of reminders of the traumatic event
• Anxiety or hyperarousal
• Difficulty with basic tasks (school, friendships)

ASD can be diagnosed 2 to 3 days after the event is over, and is a disorder of short-term reactions to trauma. PTSD can be diagnosed beginning one month after the event, and represents chronic, long-term maladaptive coping.

But the time criteria are not that cut and dry, cautions Child Mind Institute trauma response group leader Jamie Howard, PhD. “The lasting effects of a traumatic event might continue for many families,” she says, and after an upsetting event parents and community members should be on the lookout for symptoms of traumatic stress well into the future.

Finally, even if a child or adolescent doesn’t have a traumatic response to an event, changes in routine or displacement from home can still produce impairing symptoms. After a significant life change, professionals can diagnose adjustment disorder, which is defined by impairing symptoms including anxiety or depressed mood, trouble sleeping, regular crying spells, and school refusal. In adjustment disorder these reactions are much more intense than would typically be expected.