Violent Aftershocks

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t-traumatic stress disorder (PTSD) is usually associated with grownup veterans of wars or terrorist attacks, but doctors have known for some time that children and adolescents are particularly vulnerable to the long-term psychological scarring that can follow a close encounter with extreme violence. In that respect, there was news both bad and good last week about PTSD and children. The bad news is that the incidence of PTSD in children is higher in the U.S. than we might have expected. The good news is that effective techniques have been developed to identify — and treat — those who are most at risk.

First, the numbers: a study in the August issue of the Journal of Consulting and Clinical Psychology reports that in a survey of 4,023 American adolescents (ages 12 to 17), nearly 4% of the boys and more than 6% of the girls had experienced symptoms of PTSD during the preceding six months — surprisingly high percentages for a snapshot study of this kind. Among the most common triggers were sexual or physical assaults, but just witnessing a violent act was often enough. Nearly three-quarters of those who met the criteria for PTSD had also experienced major depression, substance abuse or substance dependence.

In a separate study, published in the Journal of the American Medical Association (J.A.M.A.), researchers from the Children's Hospital of Philadelphia reported on a simple screening test to evaluate children after an accident or injury. By asking a series of questions such as "Did you think you might die?" and "Was there a time you didn't know where your parents were?" doctors were able to quickly identify the children most likely to develop PTSD and require further treatment.

Treatment techniques have also improved. The same issue of J.A.M.A. reported on a school-based program developed by scientists at the Rand Corp. in Santa Monica, Calif., and tested on 126 sixth-graders in two economically disadvantaged schools in East Los Angeles. After 10 sessions, students in the program, most of whom had experienced or witnessed violence involving guns or knives, had significantly fewer symptoms of PTSD than children who got no treatment.

Dr. Gupta is a neurosurgeon and CNN medical correspondent