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. Depression must
be treated along with PTSD in these instances, and early treatment is
best.
If you or someone you care for has been injured in a dog
bite attack contact our office anytime at
800-437-2571 for a free, no obligation Consult with an
experienced dog bite attorney or use our convenient
Free Case Evaluation submission form
