SALT LAKE CITY — With trauma in children, there are no hard and fast rules for how traumatizing an event will be. There is no system to gauge the severity, such as a DEFCON 4 or "code orange" traumatic event.

Two people can go through the same event and one will develop symptoms of post-traumatic stress disorder while the other will not. The key is the perception, emotions and physical sensations of the person going through it.

This is where children get the short end of the stick. People believe that the event was not "bad enough" to create PTSD symptoms in a child. If the child has little to no language, he is unable to express his distress. The event can be a sibling picking on him, being bullied at school, riding in an ambulance, going to the hospital, or anything in-between that causes the child anguish.

1. Changes in bathroom routine

If your child has been potty trained for months and suddenly starts to have accidents again, we need to question the change. Most children do not regress unless something has either changed in their lives (new sibling, divorce, etc.) or they have experienced emotional discomfort.

2. Quick change in emotion

This one is hard because quick-changing emotion is the definition of a child. What we are looking for is a change that is different than in the past. This is where the caregiver's power of observation comes into play. A therapist or medical provider won't be able to detect this one on their own. You need to voice your concerns.

3. Changes in vocalization/selective mutism

Negative changes in verbalization are a huge red flag and a form of developmental regression. Medical providers need to know about this right away so they can do various testing to make sure it is not a medical issue. If nothing seems to be wrong in that avenue, a mental health therapist should be seen.

4. Questions about death, being alone, being hurt, hopelessness and pain

These questions will come up naturally as children are curious. However, if these questions are the bulk of the questioning, then you need to look at why this is coming up now. The best way to handle this is to answer as honest and open as possible for the age group. Children are great at finding misconnecting information, and that will only perpetuate the questioning further. If you feel that they are too focused on these subjects and are unable to break away from the issue, it is time to seek assistance.

5. Aggression, irritably and/or anger

These aspects come from the lack of language. When we don't know how to describe the emotions that are inside, we go to the easiest emotion to express — anger (adults are guilty of this as well). So while pushing people away may be the worst way to get the help we need, it may be the only way we get any help at all.

6. Odd play behaviors

All children will pretend play some brutal themes at times, like crashing cars or dinosaurs eating people. But when the themes become reoccurring, overly violent, or the child is acting out a concerning event, it is time to explore it further. It is important not to shame or scold your child because playing is how children learn. So inquiring about what they are doing and where they might have seen it will become invaluable clues as to their emotional stress level.

7. Memory loss or distortions

Medical providers and personnel need to be informed that your child has memory loss or distortions. They will make sure there is nothing wrong physically and that it may have a cognitive/emotional root. Memory loss or distortions can arise for multiple reasons, including a highly emotional response to an event, someone telling your child not to tell, or your child specifically blocking the memory.

8. Concentration problems

This may not be obvious right away and it can come in two different forms. Either the child is full of thoughts related to the trauma and can't return focus to what he should be paying attention to, or his brain is bouncing from thought to thought so fast the overstimulation makes processing information difficult. Either way, this can have long-term consequences academically and socially, and can ultimately undermine your child's self-worth.

9. Increased sexual behaviors

The first question I get when parents report that their child is increasing sexual behaviors or masturbation is if their child was sexually abused. This may be the case, and with proper assessment this can be explored. However, the child may be using this bodily function to get endorphins to try to make himself feel better. This is not a place for shame or guilt but should be seen as a coping skill.

10. Physical symptoms

If your child is having tummy aches or headaches every time you are about to go to a specific place, it would be helpful to observe or ask why the child doesn't want to go there. Medical professionals should always be consulted first to determine if there is a physical reason behind the symptoms. The mind has the ability to create physical problems, so the symptoms may not be a conscious decision on the child's part, and don't assume the child is creating it to "just be difficult."

If your child has any of these signs, it does not mean he or she has PTSD. However, it is an indication of distress and should be investigated by the caregiver, therapist and/or medical provider. It is important to keep an open mind when discussing these aspects, and it is a wonderful opportunity to grow and gain better coping skills for the future.

For more information on PTSD in children, check out the websites for the National Center for PTSD, the PTSD Alliance, and the National Institute of Mental Health.

Jessie Shepherd, MA, ACMHC, specializes in assisting children, adolescents and parents to overcome life's challenges. She is the director of youth services at Life Stone Counseling Center. Learn more at lifestonecenter.com.

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