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Acute stress disorder in children: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Acute stress disorder (OCD) is a short period (about 1 month) of obsessive memories and nightmarish dreams, alienation, avoidance and anxiety that occurred within 1 month after a traumatic event.
Post-traumatic stress disorder (PTSD) is characterized by repeated, intrusive experiences in the form of memories of an exceptionally severe traumatic event that persists for more than 1 month and are accompanied by emotional dullness and numbness, as well as insomnia and increased autonomic excitability. The diagnosis is based on anamnestic data and survey results. Treatment includes behavioral therapy, SSRI and anti-adrenergic drugs.
Because of differences in temperament and resistance to stress factors, not all children who are in a serious traumatic situation develop frustration. Traumatic events that often cause these disorders include assault, rape, car accidents, dog attack, and injuries (especially burns). In young children, domestic violence is the most common cause of post-traumatic stress disorder.
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Symptoms of acute stress disorder in children
Acute stress disorder and post-traumatic stress disorder are closely related and differ primarily in the duration of the symptoms; Acute stress disorder is diagnosed within 1 month after a traumatic event, and post-traumatic stress disorder only if after a traumatic event more than 1 month has passed and the symptoms persist. Also, a child with acute stress disorder, as a rule, is in a state of stupefaction and may seem fenced off from everyday reality.
Obsessive memories cause such children to experience a traumatic event again. The most severe kind of obsessive memories is "flashback" - vivid realistic images of what happened when the child appears to be in a traumatic situation again. They can be spontaneous, but most often provoked by something related to the original event. For example, the sight of a dog can trigger a "flashback" and return to an already experienced dog attack situation. During such episodes, the child may be terrified and not perceive the environment, desperately trying to hide or run away; he can temporarily lose touch with reality and believe that he is in real danger. Some children have nightmares. In other ways of experiencing (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 blunting and stunnedness include a group of symptoms, such as a general lack of interest, social isolation, and a subjective sense of stupor. The child may have a pessimistic vision of the future, for example, "I will not live to be 20 years old."
Symptoms of hyperexcitability include a feeling of anxiety, excessive fearfulness, inability to relax. Sleep can be intermittent and complicated by frequent nightmares.
Diagnosis of acute stress disorder and post-traumatic stress disorder is based on the presence in the anamnesis of a traumatic event, after which there were repeated experiences, emotional deafness and hyperexcitability. These symptoms should be sufficiently pronounced to cause disruption or distress. In some cases, symptoms of post-traumatic stress disorder can occur in months and even years after a traumatic event.
Prognosis and treatment of acute stress disorder in children
The prognosis for acute stress disorder is significantly better than in posttraumatic stress disorder, but in any case it improves with early treatment. The severity of the injury associated with physical injuries, as well as the ability of the child and his family to recover from injury, affect the outcome.
Often, to reduce emotional stun and re-immersion, SSRI is used, but they are less effective in hyperexcitability. Antiadrenergic drugs (eg, clonidine, guanfacine, prazosin) may be effective in the symptoms of hyperexcitability, but there is only preliminary evidence to support this. Supportive psychotherapy can be effective in children with trauma consequences, for example deformity after burns. Behavioral therapy can be useful for systematically reducing susceptibility to the effects of factors that trigger the onset of symptoms.