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PTSD Questions & Answers
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Joyce Boaz & Dr. Frank Ochberg, M.D.

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Explaining PTSD to Children.

Q: Dear Frank, What is the best way to explain PTSD to children if they live with a parent who has PTSD? Children and siblings would react differently than a spouse or close friend. Do you take them to a therapist? What else can you do? Since there are so many vets returning I'm sure this is something that affects the family.

A: Dear Joyce, this is a good, tough question. I've explained PTSD and other conditions to kids whose parents were affected, but it is very different from case to case, depending on the age of the child, the personality of the child, the relationship that the child has with that parent and with the other parent, and the rapport that I'm able to establish with the child. It isn't that easy for me to set up an ideal situation for the conversation. I'm thinking of a case quite a few years ago where the mom wanted to be present and she wasn't all that helpful. "Tell the doctor how you feel," she coached, deflating my attempts to be less of a doctor and more of a down-to-Earth friendly adult. I wanted the pre-teen daughter to let me know her fears and concerns, and I had a feeling that the daughter might benefit from counseling. Her mom had been seriously abused as a child and later developed bipolar disorder with deep depressions. Years later the daughter did see me for counseling (age 17) and I was able to help her with her social phobia (unrelated to her mom) and then I could explain her mom's condition.

So let me start answering your question by saying that the best way to explain anything to children is to meet them at their level, discovering what they want to know, and giving clear, honest answers. Young children are not likely to want to know details. They usually want to know that things will turn out well, that strange behavior (eg, withdrawal, crying, anger) is not their fault, and that parents are confident about the future. Some kids are very curious and ask, "Why?" rather frequently, and can be intrusive. A child might ask, "Why does Mommy go to the doctor every week?" Explaining PTSD is not necessarily a helpful response. Ducking the question is not necessarily helpful. Something along the lines of "She learns how to relax and fall asleep at bedtime" could be useful, followed up by, "Do you ever think you would like lessons like that?"

Older children might benefit from hearing the medical facts about PTSD from the non-affected parent: eg, "It is a condition in which troubling memories return when they aren't wanted (therefore it is helpful to ask me, not Daddy, about the accident)." And, "It is a condition that includes feeling irritated, nervous and withdrawn (so it isn't your fault if Daddy seems angry at times)." Of course, add that PTSD gets better with time, that some people would rather not talk about it, that others benefit from talking, at times, and describing how they feel.

Explaining the facts of a trauma can be very difficult for a parent and child. Some family therapists advise getting the family together and being sure everybody understands what happened, all rumors are shared, and everyone ends up on the same page. These therapists are not only interested in explaining PTSD; they want to get a "functional family" working together to help with healing. Some families choose to exclude young children from this process.

If you are concerned about a child's understanding of PTSD, it never hurts to ask. If a child expresses interest in learning more, you can explain symptoms, reasons and remedies in a simple honest way, as long as the child knows about the trauma. For example, "Since Mom was in the car crash, she has bad dreams and sometimes she has a feeling like a bad dream during the day. It is getting better now. She sees a doctor who knows about dreams and knows how to help. Let me know if you have any ideas about helping, too." Obviously, it is much more difficult in cases of sexual assault where the details of the trauma are unspoken. But supportive families with a history of comfort in conversation find ways to get these trauma stories told, destigmatized, and turned into opportunities for healing.

A final word: Explaining PTSD symptoms may be easier and more productive than trying to convey the whole syndrome. Anxiety can be explained as a medical condition in which your heart beats faster (emphasize that this is not dangerous - but that it makes you look like you are afraid and feel like you feel when you are afraid). Depression can be explained as a medical condition in which your ability to feel happy is impaired. You may know that everything is OK, that you should feel happy, but you just are numb and can't fully experience the good feeling. Memory and concentration deficits can be explained, too. I'd stay away from using terms like "thinking disorder" or "brain impairment." But it never hurts to help your child be tolerant of concentration and memory lapses by explaining how this happens when adults are recovering from certain conditions. Then use the words your child understands about these conditions (eg, "bad dreams during the day").

Share ideas that you find effective with your adult friends and family and GFW pen pals. We can all learn together.

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