PTSD Case Summary
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​PTSD Case Summary

  • Max is a boy nearly four years of age who lived with his family in Battery Park City, across the street from the World Trade Center.

  • Prior to 9/11, he had already experienced numerous traumatic events including surgeries for a chronic condition and hospitalization for a minor burn.

  • In December 2001 Max saw his pediatrician for the first time in several months and presented with vomiting and poor appetite.

  • To further assess his condition, the pediatrician asked Max's mother to complete the PSC-17, a shortened version of the PSC-35 with subscales for internalizing, attention, and externalizing problems.

  • Max had an overall positive score on PSC-17 and a positive score for internalizing problems.

  • Since 9/11, Max has reverted to wearing diapers at night, wearing his shoes all the time, has become increasingly introverted and stopped wanting to go to school, although he enjoyed going to school in the past.

  • Over time, pediatric visits grew more frequent as Max continued to experience stomachaches and difficulty breathing despite normal physical exams.

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Key Teaching Points

  • It is important to help families distinguish between normal reactions to traumatic events and those trauma-related symptoms that persist and may be in need of intervention.

  • Using a "sick visit" to identify what has been happening emotionally and behaviorally with a child might offer distinct opportunities to elicit key events in families' lives.

  • The need for mental health referral can be a sensitive issue for a family. The literature indicates that about 50% of children referred to a mental health professional do not keep their appointments. Pediatricians play a central role in the well-being of children and families in emotional distress by providing reassurance, securing the appointment, and arranging follow-up in primary care. In addition, primary care physicians are important sources of guidance and continuing support.

  • Parents can play a significant role in addressing symptoms of PTSD by reassuring a child that he/she is safe. Helping to reestablish routines and encouraging the child to hold onto toys my help allay some fears.

  • Parents should also be encouraged to speak with their child's teacher about ways to offer support and reassurance in the classroom.

  • While this case exemplifies a situation where there is a need for referral outside the primary care setting, eliciting the trauma history and the use of the PSC-17 as a screening tool did help guide the clinician's thinking. Identifying symptoms in the domains of internalizing (internal feelings of sadness, fear, distress), externalizing (outward behavior), and attention behaviors may be helpful in understanding how they relate to the clinical picture. Those findings may also be useful to the mental health specialist in his or her initial assessment. 

View the prevalence, symtoms, diagnosis, treatment and psychopharmacology of PTSD.                    
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