Review articleTraumatic Stress and Posttraumatic Stress Disorder in Youth: Recent Research Findings on Clinical Impact, Assessment, and Treatment
Section snippets
Methodology of Search
Research literature on the impact of traumatic stress in adolescents was reviewed after a systematic search of PubMed and PsycInfo. Articles included in the review were those published since 1995 and in English. Articles' reference lists were also reviewed manually to identify additional studies of importance.
Neurobiological Impact of Childhood Traumatic Stress
Childhood trauma can have a broad impact on mental health. Many traumatized children experience brief symptoms of depression, anxiety, or developmental regression but return to baseline quickly, whereas others suffer long-standing PTSD and other psychiatric syndromes, from internalizing symptoms such as depression and anxiety to externalizing symptoms such as behavioral problems. The cause of this diversity of outcomes is not fully understood. The growing field of developmental traumatology
Manifestations of Traumatic Stress in Adolescent Mental Health
Clinicians must be vigilant for different manifestations of traumatic stress in adolescents. Immediately after trauma, many adolescents will manifest transient symptoms of acute stress disorder. These self-limited (<4 weeks by definition) and often fluctuating symptoms include anxiety, insomnia, numbing, dissociation (altered consciousness including reduced awareness or amnesia), detachment, reexperiencing, and avoidance. Although many adolescents recover from these symptoms, in some, it
Assessment of Traumatic Stress in Adolescents
Given the breadth of psychiatric and behavioral sequelae of trauma, it can feel daunting to clinicians. In reality, clinicians specializing in adolescent medicine already possess skills and tools for assessment of depression, substance use, suicidality, and psychosis. Specific questioning about trauma and PTSD symptoms is necessary, as traumatized adolescents are unlikely to volunteer this information, and evidence suggests that PTSD is often missed in routine examinations [27], [70], [71].
Treatment of Traumatic Stress in Adolescents: Psychotherapy
The first step of any treatment for traumatic stress is to ensure that the teen is safe, including consulting and collaborating with safe family members, community resources, and child protective services when needed. Partnership with home-based services, either mandated by child protective services or independently contracted, may be necessary to ensure the child's safety [72]. In some situations, such as countries experiencing war or neighborhoods with intractable community violence, absolute
Treatment of Traumatic Stress in Adolescents: Psychopharmacology
Although the efficacy of psychotherapy for child traumatic stress and PTSD has been well documented, there is little evidence for the effectiveness of pharmacotherapy for posttraumatic symptoms. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy for adult PTSD, but evidence is lacking for their use in adolescents. Only sertraline and fluoxetine have been tested in randomized controlled trials for adolescent PTSD, and they were found to be no more effective than
Discussion and Summary
The effects of traumatic stress in adolescents can be profound, and clinicians specializing in adolescent medicine are often at the front lines of recognizing affected youth. Once a traumatized teen is identified, clinicians should establish safety, educate the child and his caregivers about the impact of traumatic stress on emotional and physical health and behavior, and provide support and counseling. Clinicians should also discuss with families effective treatment options, acknowledge the
Acknowledgments
The authors thank Andrew Clark, Karen Hacker, Lisa Kotler, and Lois Flaherty for their thoughtful and insightful comments and Sarah Reinfeld for her research assistance. The authors affirm that they have listed everyone who contributed to the development of this manuscript.
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