The emotional reactions of children who are the victims of, or witnesses to, dog attacks include fear, depression, withdrawal and anger. These problems can occur immediately or sometime after the tragic event. Many such children will develop post traumatic stress disorder ("PTSD") and/or other persistent problems."
Trauma" includes emotional as well as physical experiences and injuries. Emotional injuries are essentially a normal response to an extreme event. Emotional injury involves the creation of emotional memories, which arise through a long lasting effect on structures deep within the brain. The more direct exposure to the traumatic event, the higher the risk for emotional harm.
The "undifferentiated thinking" of children frequently leads them to derive "wrong" conclusions from traumatic events. A child, especially a very young one, attempts to read the environment in order to enhance his comfort and further survival. A traumatic event like a dog bite is often misunderstood as a statement about life in general, that it is uncertain, painful and precarious. Furthermore, such an event might be internalized as a statement about the child himself, that he is somehow "bad" and even responsible for not only his physical pain but even the emotional pain suffered by his parents as a result of the dog attack. These psychic wounds may become significant determinants of the adult personality, so that the dog attack truly affects the child victim for life.
Either being exposed to violence within the home for an extended period of time or exposure to a one-time event like an attack by a dog can cause PTSD in a child. Some scientists believe that younger children are more likely to develop the disorder than older ones. PTSD can develop at any age, including in childhood. Symptoms typically begin within 3 months of a traumatic event, although occasionally they do not begin until years later. Once PTSD occurs, the severity and duration of the illness varies. Some people recover within 6 months, while others suffer much longer.
Emotional reactions to trauma may appear immediately after the dramatic event or days and even weeks later. Rates of PTSD identified in child and adult survivors of violence and disasters vary widely. For example, estimates range from 2% after a natural disaster (tornado), 28% after an episode of terrorism (mass shooting), and 29% after a plane crash. The disorder may arise weeks or months after the traumatic event.
Children and adolescents exposed to a dramatic events frequently lose trust in adults and have fear that the event may occur again. Other reactions vary according to age:
- For children five years of age and younger, typical reactions may include a fear of being separated from the parent, crying, whimpering, screaming, immobility and/or aimless motion, trembling, frightened facial expressions and excessive clinging. Parents may also noticed children returning to behaviors exhibited at earlier ages (these are called regressive behaviors), such as thumb-sucking, bedwetting, and fear of darkness. Children in this age bracket tend to be strongly affected by the parents' reactions to the traumatic event.
- Children six to eleven years old may show extreme withdrawal, disruptive behavior, and/or inability to pay attention. Regressive behaviors, nightmares, sleep problems, irrational fears, inability or refusal to attend school, outbursts of anger and fighting are also common in traumatized children of this age. Also, the child may complain of stomach aches or other bodily symptoms that have no medical basis. School work often suffers. Depression, anxiety, feelings of guilt and emotional numbing or "flatness" are often present as well.
- Adolescents 12 to 17 years old may exhibit responses similar to those of adults, including flashbacks, nightmares, emotional numbing, avoidance of any reminders of the traumatic event, depression, substance abuse, problems with peers, and anti-social behavior. Also common are withdrawal and isolation, physical complaints, suicidal thoughts, school avoidance, academic decline, sleep disturbances, and confusion. The adolescent may feel extreme guilt over his or her failure to prevent injury or loss of life, and may harbor revenge fantasies that interfere with recovery from the trauma.
Some children and adolescents will have prolonged problems after a traumatic event. These potentially chronic conditions include depression and prolonged grief. Another serious and potentially long-lasting problem is post-traumatic stress disorder (PTSD). This condition is diagnosed when the following symptoms have been present for longer than one month:
- Re-experiencing the event through play or in trauma-specific nightmares or flashbacks, or distress over events that resemble or symbolize the trauma.
- Routine avoidance of reminders of the event or a general lack of responsiveness (e.g., diminished interests or a sense of having a foreshortened future).
- Increased sleep disturbances, irritability, poor concentration, startle reaction and regressive behavior.
PTSD may resolve without treatment, but some form of therapy by a mental health professional is often required in order for healing to occur. Fortunately, it is more common for a traumatized child or adolescent to have some of the symptoms of PTSD than to develop the full-blown disorder.
People with PTSD are treated with specialized forms of psychotherapy and sometimes with medications or a combination of the two. One of the forms of psychotherapy shown to be effective is cognitive/behavioral therapy, or CBT. In CBT, the patient is taught methods of overcoming anxiety or depression and modifying undesirable behaviors such as avoidance. The therapist helps the patient examine and re-evaluate beliefs that are interfering with healing, such as the belief that the traumatic event will happen again. Children who undergo CBT are taught to avoid "catastrophizing." For example, they are reassured that dark clouds do not necessarily mean another hurricane, that the fact that someone is angry doesn't necessarily mean that another shooting is imminent, etc.
Play therapy and art therapy also can help younger children to remember the traumatic event safely and express their feelings about it. Other forms of psychotherapy that have been found to help persons with PTSD include group and exposure therapy.
A reasonable period of time for treatment of PTSD is 6 to 12 weeks with occasional follow-up sessions, but treatment may be longer depending on a patient's particular circumstances.
Research has shown that support from family and friends can be an important part of recovery and that involving people in group discussion very soon after a catastrophic event may reduce some of the symptoms of PTSD.
There has been a good deal of research on the use of medications for adults with PTSD, including research on the formation of emotionally charged memories and medications that may help to block the development of symptoms. Medications appear to be useful in reducing overwhelming symptoms of arousal (such as sleep disturbances and an exaggerated startle reflex), intrusive thoughts, and avoidance; reducing accompanying conditions such as depression and panic; and improving impulse control and related behavioral problems. Research is just beginning on the use of medications to treat PTSD in children and adolescents.
There is preliminary evidence that psychotherapy focused on trauma and grief, in combination with selected medications, can be effective in alleviating PTSD symptoms and accompanying depression. More medication treatment research is needed to increase our knowledge of how best to treat children who have PTSD.
Parents' responses to a violent event or disaster strongly influence their children's ability to recover. This is particularly true for mothers of young children. If the mother is depressed or highly anxious, she may need to get emotional support or counseling in order to be able to help her child.
PTSD is often accompanied by depression. In a group of teenage. Depression must be treated along with PTSD in these instances, and early treatment is best.