Children with PTSD live in constant tension. They are considered stupid at school, and it’s cortisol that keeps them from learning

Children too?

Yes.

But we have always attributed PTSD, or post-traumatic stress disorder, to adults.

The disorder is usually associated with soldiers returning from missions abroad. Less frequently with civilians. And few people really think that PTSD can affect a child or teenager. As a result, we underestimate their suffering. We think, ‘How can a ten-year-old be traumatised?’. They can. What’s more, for many of my patients it is their traumatic childhood that is the cause of the problems that follow them into adulthood.

What triggers trauma in them?

The same as for adults. It is always triggered by an event involving a sense of threat to health or life. It can be experienced directly or witnessed.

However, we divide traumatic events into two types. The first concerns non-human-induced situations, such as fires, floods, natural and construction disasters. And people are responsible for type two. We are talking about everything that no one of any age should experience from another person: psychological, physical, sexual violence, acts of terror, abduction, captivity, prison. The statistics are merciless. Trauma is most often caused by a person. The longer it lasts, the greater the chances of it having serious consequences in the future.

Is it easier to get it today?

I would not have said that until a few weeks ago. But now there is a war in Ukraine. Across our border, children and young people experience threats to both their health and their lives. In the school where I worked as a psychologist until recently, I met Ukrainian students. They would come to my office and ask worriedly: ‘Do we have anything to be afraid of?’. Some of them knew the war only from television. But others had families who stayed in Ukraine. For example, relatives of one of the students were killed in the bombing. And the brothers of another went to the front. These children are now accompanied by a constant sense of anxiety.

And Polish children?

Most of them see the war on television. One does not acquire trauma from this, unless the messages were about their loved ones. In addition, it is not yet possible to speak of any post-traumatic stress disorder, as the symptoms from the traumatic event must have lasted for at least a month.

So what are the first symptoms of PTSD?

Children or teenagers often feel misunderstood. They feel different, ‘damaged’ by what they have experienced. They first withdraw, distancing themselves from family and loved ones. Parents explain their behaviour as adolescence, youth rebellion. They also consider it to be an unhappy love. They treat the first symptoms of PTSD as a developmental norm. This makes them overlook the other problems. Such as? For example, a child stops enjoying life. Or they give up their current hobby, sport. They slowly retreat from the world and enclose themselves in their shell.

That sounds like depression.

This is what parents say. That is why they do not go with their child to psychotraumatologists first, but to psychiatrists or to the psychological-educational counselling centre. Unfortunately, post-traumatic stress disorder is rarely diagnosed in young people. Sometimes doctors working with children prefer to talk to their parents. It is adults who are asked about what is happening to the child. And yet they do not know what is inside their heads. They can only talk about what they see. That is, that the son or daughter plays truant from school, lacks the strength to get out of bed, does not talk to friends. For some psychiatrists, this is enough. They diagnose depression and then prescribe medication.

What else do your parents tell you?

First: ‘The child avoids school’. And then: ‘Please change them’. They rarely suspect post-traumatic stress disorder. However, sometimes some of them knew very well what was happening to the child. However, they wanted to hide it.

Why?

Because they themselves were the cause of the PTSD. They beat the child, psychologically abused them, raped them or sexually abused them in other ways. Sometimes they also allowed their friends, neighbours to do this without standing up for their son or daughter. When they found out in my office that they had contributed to the child’s trauma, they accused me of being unprofessional. They accused everyone around them, never themselves. Of course, there were some among them who beat their chests. Sometimes they also apologise to their children. But they treated this ‘sorry’ as an absolution. They thought one word would offset all the suffering of the young person. Apologising after 15 years of beating does not work like a magic wand.

Sometimes parents try to explain their behaviour by their own childhood experiences. They say that they were also beaten and somehow grew up to be decent people. Never mind that they use violence against children... Unfortunately, this type of violence is still belittled today and considered as an educational measure. Interestingly, no one is in any doubt that hitting, slapping, jerking an adult or calling them names is a crime.

What do children with PTSD think about themselves?

The younger ones seem to think that something is wrong with them. They have a sense of guilt that adults have forced them into. Older ones, on the other hand, look to the internet for an explanation of their condition. Because of this, they sometimes suspect post-traumatic stress disorder in themselves. I remember a boy from secondary school who, upon hearing the diagnosis, chuckled: ‘Fuck, I thought so’.

Regardless of age, children with PTSD replay distressing situations in their head. They have unwanted thoughts about what they have experienced. They seem to be daydreaming or feel all the bodily reactions that accompanied them during the traumatic event. They often have trouble sleeping because they are afraid to close their eyes for fear of nightmares.

Younger children often talk about their feelings through drawing. Once my patient drew a family of ducklings. Just ducks standing around. I asked if she could tell me about them. ‘They don’t have parents’, she explained. And why is that? ‘Because daddy killed mummy. Fortunately, there was an auntie duck in the family. She adopted the rest of the ducks. This one is called Kasia and this one is called Martusia’. The patient was only eight years old. The bird names matched her siblings perfectly.

And older children? They prefer writing to drawing. In their notebooks I read: ‘I am nobody’, ‘I am rubbish’, ‘I am a whore’. They also write similar things on their skin, self-harming.

That is, we have the reproduction of trauma. Anything else?

Stimulation. They are triggered by a trigger factor associated with a traumatic event. Imagine that a girl saw her father beating her mother. Tomato soup was heating on the stove at the time. The smell can then be associated with the situation, causing fear or helplessness, which will seem completely absurd to those around the child.

When young people experience violence, the tone of voice is very often the trigger. ‘Get up!’, ‘Immediately!’, ‘How dare you!’ – teachers sometimes get angry, thus creating an authoritarian atmosphere. They do not understand that a traumatised child perceives their behaviour as an attack and starts to defend themselves.

Before children with PTSD can be diagnosed, they therefore face a host of problems.

When they come to me, sometimes they already have a probation officer, a demoralisation case or a stay in an institution behind them. However, the facility does not always solve their problems. Some educators seek to subjugate children through iron discipline, and violence also happens. Such forced obedience is associated by young people with PTSD with trauma. And the circle closes. They start protesting, which involves fighting. The facility cannot cope with their aggression. Consequently, the court intervenes. Young people are then ordered to go to a youth education centre. And if even this does not help – to a correctional institution. Discipline that is supposed to cure, therefore, works in reverse.

Reconstruction and agitation are not the end of the symptoms, however. Children suffering from PTSD try to avoid anything related to trauma. But at a young age, you can’t get away from abusive parents so easily. Or from a school where peers bully, humiliate and the staff do not react. Since avoiding trauma is so difficult, children or teenagers often resort to the simplest solution – the phone.

Cognitive problems are also important symptoms. These include problems with concentration, memory. Children with PTSD live under constant stress. As a result, they often have elevated cortisol levels. This hormone damages their hippocampus, the part of the brain responsible for learning and remembering. This is where their problems at school stem from. They cannot concentrate in class, they forget what the teacher has said. Some educators consider such students to be stupid, vulgar, lazy. They try to motivate them, but in an inappropriate way – threatening them with Ds and detention. This is when children with PTSD block themselves. They do not recall anything, even though they have learned everything. Consequently, they end up in psychological-educational counselling centres. There they get the diagnosis of developmental dyslexia or ADHD.

That is why, at the school where I was a psychologist until recently, I tried to inform teachers about specific teenagers suffering from post-traumatic stress disorder. Because their knowledge should be tested in a different way.

How?

If they are afraid to approach the board, let them stay at their desk. If they have difficulty speaking, a test of choice will suffice. This will reduce their anxiety. The problem is that everything I have told you is just the tip of the iceberg.

How so?

Trauma has different faces. Type one trauma is the mildest form of PTSD. It is associated with a one-off event, for example a traffic accident, rape, beating. In type two, things get more complicated. Here the threat to health or life lasts longer. It is therefore most difficult to work with children who are born into a traumatising environment. They do not know what it is like to live without fear, without pain, without hurt. You could say that they are shaped by trauma. Through it, their limbic system, which regulates emotions in the brain, develops differently. The world seems monstrous and threatening to them.

Even someone’s kindness?

Yes, it is as incomprehensible as a foreign language. The atmosphere of calm paradoxically makes them anxious. When things get too good, they expect the worst. If evil does not come, however, they sometimes provoke it themselves. Why? Because for children with PTSD, it’s a familiar world. They know what to do when an adult yells or starts beating them.

Sometimes symptoms of type two trauma do not appear until adolescence or adulthood. This causes them to be attributed to other problems. It is then like with a pit-bull on a strong leash – sooner or later it will break free anyway.

Then what?

There will be symptoms of complex post-traumatic stress disorder. This is the effect of type two trauma, the so-called PTSD complex, which includes slightly different symptoms. One of them concerns changes in the regulation of feelings. Children explode with anger or cry when least expected. They do not control their emotions. They attack peers and sometimes teachers. They mutilate themselves out of guilt, cutting their skin, burning it with cigarettes. They punish themselves with draconian diets and exercise. In this way they try to regain control of their bodies. They have damaged self-esteem because they are constantly beaten and humiliated at home, and the school often wants to get rid of them. Who gives them a reason to live? No one! So they have suicidal thoughts, which they sometimes finalise.

Another group of symptoms – changes in concentration and awareness. My young patients who experience them feel disconnected from their emotions. They say: ‘What I experience is a film’, ‘My body is not mine’. Sometimes they develop trauma-induced amnesia or even hypermnesia, allowing them to recreate any detail of the traumatic event.

The third group of symptoms concerns changes in relationships with others. Children with type two trauma are unlikely to trust anyone. However, if they do break through, they usually enter into a relationship with people who resemble their abusers. Then they take on the role of victim. An example? If a teenager has been forced into prostitution, they may also choose to engage in it later. Their head strives for the status quo. They seek the familiar. Some children choose yet another path – they become perpetrators. I was beaten so I will beat too. Because whoever uses violence – they explain to themselves – has power and a sense of control.

Complex PTSD also include somatic symptoms. We are talking about recurrent dizziness, fainting, abdominal pain, diarrhoea, vomiting, nausea, high or low blood pressure, chest pains, nose bleeds, breathing problems, allergies, skin inflammations. We are often unable to determine the cause of these symptoms. And they are there and they make life difficult for the child. They hammer them even harder into feeling different from everyone else. The last group of symptoms? Changes in the value system. They make a young person feel hopeless. They do not believe in themselves or others. They think they are surrounded by blackness, emptiness.

And you know what is surprising? Despite having so many clear symptoms, children with PTSD often are not referred to specialists.

The reason?

Parents again. They do not consent to the treatment of underage children because it will come out that they have harmed them. That’s why they hide for as long as they can. It is my professional duty to intervene in such situations. Sometimes it is necessary to quickly put the whole support network in place: probation officers, the family court, the social welfare centre and the police. If necessary, we look for a new legal guardian for the child. Preferably an adult they trust. Of course, we still have to look after them and take care of their basic needs: food, drink, hygiene or sleep. This young person needs to be assured that there will be no beating or rapes the next day.

The child then breaks off the relationship with the parent?

Often not.

Why?

Because they love them. Through PTSD, they are excellent observers of emotions and always submit to their parent’s moods. The parent replaces their partner. All just to be loved. Therefore, even if they suffer because of their mother or father, they will only blame themselves.

So a child with PTSD is like a seismograph of emotions?

Definitely. Due to a high cortisol level, they live in standby mode. Any reaction from an adult, signals from their body can make them feel threatened. And they sense them the best in the world. Similarly, they also sense social stimuli. A child or adolescent with PTSD is afraid of the expectations of those around them. They are the harshest judge for themselves. They have been hearing all their lives: ‘Everyone has normal children but me!’, ‘I regret having given birth to you!’. No wonder they then hate themselves. They hate because their parent, the most important person in the world, tells them so. Do you know what power their words carry? I once had a patient whose mother and father called him a retard. By the age of three he thought it was his name.

You are probably the first person children with PTSD confide in about their feelings.

Sometimes. But in the office they cry first. They are like a punctured balloon from which emotions pour out. I always tell them then that tears are okay. Even though I often get mad and would like to deal appropriately with the perpetrators of their harm, I have to react with stoic calm. And that’s because when children with PTSD see agitation, panic, sadness in an adult, they become fearful.

Tears are followed by a stage of anger. First at themselves, then at their parents. Finally, there is annoyance at everyone around – colleagues who ridiculed; neighbours who never came to help. Here, too, I tell them that anger is okay. Not everyone believes this. They still think: ‘It’s not the world that’s wrong, it’s me’.

However, it is important to remember that there are different disorders. Therefore, when a child with PTSD comes to individual psychotherapy, the treatment must be carefully tailored to the child. Sometimes it is the case that they do not need any complex therapy. Crisis intervention is enough for them, a few meetings in the office where they learn what is happening to them, where the PTSD came from and that the trauma is not their fault. This is particularly helpful for teenagers who, because of their age, have a deeper insight into themselves. Some of them come to me for another visit and announce: ‘Thank you very much for your support. But I understand and embrace everything now. If something happens, I give you my word that I will come’.

Although I do psychotherapy for a living, I have to say one thing: there is no better sentence I can hear. Because trauma is precisely about regaining agency over it.

MENTAL SUPPORT FOR CHILDREN IN UKRAINIAN AND POLISH:
800 12 12 – Children’s helpline of the Children’s Ombudsman
116 111 – Helpline for Children and Young People

Anna Jastrzębska – psychotraumatologist, crisis intervener, psychologist, educator, rescuer. She works with children, adolescents and men suffering from post-traumatic disorders. Founder of FORTIOR – Fundacja dla Wielu [Foundation for Many], where, among other things, she coordinates the ‘Medics on the Street‘ project. Called ‘Mother‘ by its members and charges

Author: Łukasz Pilip

Illustrated by Marta Frej

The text was published in „Wysokie Obcasy” a magazine of „Gazeta Wyborcza” on 26 March 2022