Post Traumatic Stress Disorder (PTSD) | Diagnosis & Treatments

How is post-traumatic stress disorder diagnosed?

Here at Boston Children’s Hospital, a psychiatrist, psychologist, social worker, or other mental health clinician will make the diagnosis after a comprehensive assessment — a series of interviews — with you and your child. During the interviews, the clinician will ask about:

  • the traumatic experience your child suffered or witnessed
  • your child’s symptoms
  • your child’s school, social, and medical histories
  • your family’s medical and mental health history

Together with the mental health clinician, you will arrive at a formulation or explanation of your child’s PTSD symptoms, which will lead directly to a mutually agreed-upon treatment plan.

If my child is diagnosed with PTSD, what happens next?

Your child’s mental health clinician will explain the diagnosis and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child, and your family. The plan may include one or more of the following therapies:

  • psychotherapy (“talk therapy”) for the child
  • psychotherapy for the family
  • in some cases, a combination of therapy and medication

It’s essential to seek professional treatment for your child as soon as PTSD symptoms emerge. The disorder responds very well to therapies delivered by qualified mental health clinicians, but if left untreated, can cause longstanding emotional distress, relationship problems and academic failures for your child. These difficulties can continue well into adulthood if they are not properly addressed.

Psychotherapy

Psychotherapy, or “talk therapy,” is the mainstay of mental health treatment at Boston Children’s. Psychotherapy will teach a child with PTSD-specific coping strategies, including learning how to:

  • identify feelings of fear
  • manage fear and anxiety with relaxation techniques and self-soothing activities
  • talk (or play-act, for very young children) through the traumatic event to release and understand buried feelings
  • think about the traumatic event in ways that do not involve self-blame or guilt
  • plan what to do if another traumatic event should occur
  • restore trust in others and build hope for the future

If your child is very young, you will usually participate in the psychotherapy sessions alongside him. Family psychotherapy is also available to help all members of the family who have been impacted by the traumatic experience.

Trauma Systems Therapy (TST)

Boston Children’s Hospital clinicians have developed a therapeutic approach called Trauma Systems Therapy (TST). This treatment recognizes that a child’s traumatic stress often boils down to two factors:

  • the child is unable to control his emotional or behavioral state
  • the child is not receiving sufficient support from his surrounding environment to help him regulate these feelings

Our psychiatrists and psychologists have used TST to train other clinicians, as well as providers in health and community agencies, to:

  • recognize when a child is struggling with loss of emotional control tied to a trauma
  • take steps to address the problems in the child’s environment that continue to trigger these feelings

TST also teaches children themselves to develop skills for keeping emotional control during times of stress.

Medication

If a child is feeling severe anxiety, fear, and hopelessness, medication can be a useful addition to her psychotherapy for PTSD. Antidepressant or anti-anxiety medications can help the child feel calmer, more in control, and ready to apply the coping strategies she is learning in therapy.

Medication is not a “standalone” treatment; Boston Children’s always considers it part of a two-prong approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic is devoted to helping children, families, and clinicians decide whether medication might be a useful part of treatment.

Commonly prescribed antidepressant medications include:

SSRIs (selective serotonin reuptake inhibitors, which adjust the levels of serotonin — a chemical that regulates mood — in the brain)

  • Celexa
  • Lexapro
  • Luvox
  • Prozac
  • Zoloft

Atypical antidepressants (drugs that impact both serotonin and other chemical messengers in the brain)

  • Cymbalta
  • Desyrel
  • Effexor
  • Remeron
  • Serzone
  • Wellbutrin

Commonly prescribed anti-anxiety medications include:

  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Diazepam (Valium)
  • Clonazepam (Klonopin)
  • Diphenhydramine (Benadryl)
  • Hydroxizine (Vistaril)

Less commonly prescribed medications that can also treat fear and anxiety include:

  • Buspirone (BuSpar)
  • Zolpidem (Ambien)

Learn more about psychiatric medications.

No single medication is effective in all children. Families should expect a trial-and-error process that can last weeks, or even months, as doctors find the drug regimen that works best.

Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:

Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

If your child is prescribed any medication during treatment for PTSD, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for. Our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to the medication, and are always here to address any concerns you may have.

Coping and support

The ups and downs experienced by a child — and family — living with the aftermath of a traumatic event can be frightening, draining, and hard to understand. In addition to the information provided here, you may find comfort and support from the following resources:

Patient and family resources at Children’s

Our Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child’s particular condition and take part in their care. All patients, families, and health professionals are welcome to use the center’s services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

Our Department of Spiritual Care (chaplaincy) a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members — representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions — who will listen to you, pray with you and help you observe your own faith practices during your child’s treatment.

The Psychiatry Consultation Service provides several services, including:

  • short-term therapy for children admitted to one of our inpatient units
  • parent and sibling consultations
  • teaching healthy coping skills for the whole family
  • educating members of the medical treatment team about the relationship between physical illness and psychological distress

The Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital — as well as their families — understand and cope with their feelings about:

  • being sick
  • facing uncomfortable procedures
  • handling pain
  • taking medication
  • preparing for surgery
  • changes in friendships and family relationships
  • managing school while dealing with an illness
  • grief and loss

Our Integrative Therapies Team provides a number of services for hospitalized children, their families, and their caregivers, including:

  • massage therapy
  • acupuncture
  • yoga
  • therapeutic touch

Visit our “For Patients and Families” page for everything you need to know about:

  • getting to Boston Children’s
  • finding accommodations
  • navigating the hospital experience

Helpful links

Please note that neither Boston Children’s Hospital nor the Department of Psychiatry and Behavioral Sciences unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.