Acute stress disorder in children: causes, symptoms, diagnosis, treatment

Acute stress disorder (ASD) is a brief period (about 1 month) of intrusive memories and nightmares, withdrawal, avoidance, and anxiety that occurs within 1 month of a traumatic event.

Posttraumatic stress disorder (PTSD) is characterized by recurrent, intrusive recollections of an exceptionally intense traumatic event that persist for more than 1 month and are accompanied by emotional dullness and numbness, as well as insomnia and increased autonomic excitability. Diagnosis is based on history and examination. Treatment includes behavioral therapy, SSRIs, and antiadrenergic drugs.

Because of differences in temperament and resilience to stressors, not all children who experience severe trauma will develop the disorder. Traumatic events that often cause these disorders include assault, rape, car accidents, dog attacks, and trauma (especially burns). In young children, the most common cause of PTSD is domestic violence.

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Symptoms of Acute Stress Disorder in Children

Acute stress disorder and posttraumatic stress disorder are closely related and differ primarily in the duration of symptoms; acute stress disorder is diagnosed within 1 month of the traumatic event, while posttraumatic stress disorder is diagnosed only if more than 1 month has passed since the traumatic event and symptoms persist. A child with acute stress disorder is also likely to be in a dazed state and may seem disconnected from everyday reality.

Intrusive memories cause such children to relive the traumatic event. The most severe type of intrusive memory is a “flashback” - vivid, realistic images of what happened, when the child seems to find himself again in the traumatic situation. They can be spontaneous, but are most often provoked by something related to the original event. For example, the sight of a dog can cause a “flashback” and a return to the already experienced situation of a dog attack. During such episodes, the child may be terrified and not perceive the surroundings, desperately trying to hide or run away; he may temporarily lose touch with reality and believe that he is in real danger. Some children have nightmares. With other types of experiences (for example, obsessive thoughts, mental images, memories), the child is aware of what is happening and does not lose touch with reality, although he may be under severe stress.

Emotional dullness and numbness include a group of symptoms such as a general lack of interest, social withdrawal, and a subjective feeling of being numb. The child may develop a pessimistic view of the future, such as “I won’t live to see 20.”

Symptoms of hyperarousal include anxiety, extreme fearfulness, and an inability to relax. Sleep may be interrupted and complicated by frequent nightmares.

The diagnosis of acute stress disorder and posttraumatic stress disorder is based on a history of a traumatic event that results in re-experiencing, emotional numbness, and hyperarousal. These symptoms must be severe enough to cause impairment or distress. In some cases, symptoms of posttraumatic stress disorder may appear months or even years after the traumatic event.

Prognosis and treatment of acute stress disorder in children

The prognosis for acute stress disorder is significantly better than for posttraumatic stress disorder, but in either case it is improved by early treatment. The severity of the trauma associated with physical injury and the child and family members' ability to recover from the trauma influence the outcome.

SSRIs are often used to reduce emotional numbness and re-immersion, but are less effective for hyperarousal. Antiadrenergic drugs (eg, clonidine, guanfacine, prazosin) may be effective for hyperarousal symptoms, but there is only preliminary evidence to support this. Supportive psychotherapy may be effective in children with traumatic sequelae, such as burn deformities. Behavioural therapy may be useful in systematically reducing susceptibility to triggers that trigger symptoms.