Of the 74 million children and adolescents in the United States, 30 percent to 50 percent will experience at least one traumatic event by their 18th birthdays. Such events include sexual abuse, physical abuse, domestic violence, community and school violence, medical trauma, motor vehicle accidents, acts of terrorism, natural disasters, suicides and other traumatic losses. Typically, children are exposed to more than a single traumatic event. Prevalence rates of post-traumatic stress disorder among youth vary, with increased rates in urban neighborhoods with high levels of poverty and crime. As many as 85 percent of children in poor, urban neighborhoods have witnessed violence, and up to 66 percent have been hurt personally. Although seldom reported, children probably comprise a substantial proportion of the nearly 2.5 billion people affected worldwide by natural disasters in the past decade alone.
Almost all children and adolescents express some kind of distress or behavioral change in the acute phase of recovery from a traumatic event. Reactions include feelings of horror, terror, and helplessness, development of new fears, separation anxiety, sleep disturbance, sadness, loss of interest in normal activities, reduced concentration and decline in schoolwork. Most children and adolescents who develop trauma-related psychological symptoms are not identified, and consequently do not receive any help. Research on PTSD and trauma among youth is relatively new but has increased markedly in the past 20 years. However, many treatments for traumatized children have not been empirically studied. Ethnically and culturally informed and sensitive interventions that consider contexts, identity and traditions have also received little attention (see "The smallest survivors").
To begin addressing these issues, I formed a Presidential Task Force on PTSD and Trauma of Children and Adolescents to:
Identify the key contributions psychological science has made to our understanding of PTSD in youth.
Identify what we know and need to know regarding the development, treatment and prevention of PTSD.
Make recommendations to guide future research, practice and public policy.
Plan for the dissemination of materials to the public, caregivers, policy-makers and government agencies.
We were extraordinarily fortunate to have a dream team of task force members who have made major contributions to the topic including: Chair Annette M. La Greca, PhD, of the University of Miami; Beth Boyd, PhD, of the University of South Dakota; Lisa H. Jaycox, PhD, of the RAND Corporation; Anthony P. Mannarino, PhD, of Allegheny General Hospital; Nancy Kassam-Adams, PhD, of Children's Hospital of Philadelphia; Wendy K. Silverman, PhD, of Florida International University; Farris Tuma, ScD, of NIMH; and Marleen Wong, PhD, of the University of Southern California. APA staff, including Mary Campbell, Efua Andoh, Diane Elmore, PhD, MPH, and Nancy Smith-Crawford, optimized the productivity and innovativeness of the group.
The task force is generating products for multiple audiences. For the public, it is creating a booklet detailing issues surrounding trauma and PTSD in children and adolescents. To help APA staff educate policy-makers, the task force is drafting a briefing sheet on the impact PTSD has on children and the importance of funding for research, services, education and training. For the media and policy-makers, the task force is preparing a list of PTSD experts who can respond to media queries, testify at congressional hearings and participate in federal agency briefings. For psychologists, the group will develop a one-page summary of tips for working with children and adolescents after trauma. And, to promote further PTSD research, APA has issued a call for empirical papers and scholarly reviews that identify next steps for research, prevention and treatment. Papers that clear the review process will be published in a special section of the Journal of Consulting and Clinical Psychology. The task force will meet this month to incorporate feedback from many APA members, finalize products and develop dissemination strategies so our message will reach a broad, multidisciplinary audience worldwide.
PTSD and trauma among children, adolescents and adults are global problems; few receive any treatment, and ethnically and culturally informed and evidence-based treatments are especially rare. The task force's accomplishments are not only significant in their own right but also could serve as a valuable base for international partnerships to address a global problem, ensuring a broad relevance of psychological work across nations, cultures and contexts, and making a palpable difference in the lives of children everywhere.