to 21 percent from a car accident. The risk surges if the survivor has been attacked by another person: the numbers go up to 20 to 50 percent after an assault, rape, or mass murder. These are wide ranges, due to differences in the nature and severity of the trauma, each person’s coping skills, and other risk factors. Prior trauma, or existing struggles with depression or drug abuse, drastically increase the risk. And much of our response is determined by how we perceive the event. “The way two people experience and perceive the exact same trauma can be totally different,” said Dr. Alyse Ley. “Even if they saw the same thing, they can have a very different experience of that event.” Dr. Ley specializes in child and adolescent trauma, and is the director of the child and adolescent psychiatry fellowship program at Michigan State University.
About half the people treated for ASD are eventually diagnosed with PTSD, and the other half improve enough in that first month to avoid it. While it’s optimal to get treatment as early as possible, the one-month milestone is a good marker for parents or friends to observe. At that point, the afflicted survivor with full-blown PTSD needs more sophisticated help than loved ones can generally provide.
And there are additional conditions to watch for. “Individuals who have experienced a trauma injury may also develop panic disorders, major depressive disorder, substance abuse, and anxiety disorders,” Dr. Ley said. “Often if you have one, you have the other—sometimes the disorders have overlapping symptoms and are difficult to tease apart.” Major depressive disorder is serious, and extremely common in trauma survivors. “So what a parent is really going to want to watch for is a change in the child, in their behavior and their functioning,” Dr. Ley said. “And major depression is not just a sad mood—it affects your entire body. It affects your sleep, your appetite, your feelings about yourself, feelings of guilt and worthlessness. Their energy level is affected. Suicidal ideation is also extraordinarily common in a person who has major depression.” Weight change is also a major marker of depression, but it can look different in adolescents who are still growing. A loss of appetite might lead to failure to make expected weight gains, or to dropping off the growth curve. “Children and adolescents who have been traumatized need to be monitored for depression and anxiety, as well as PTSD,” Dr. Ley said.
The long-term consequences can be heightened for adolescents, because these symptoms can alter their cognitive development. “There’s a negative filter across everything you do and see and how you view people and yourself in relationships,” Dr. Ley said. “Untreated PTSD can change the developmental trajectory. The goal of the therapist is to get the young person back on track with developmental milestones and coping skills.”
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I met Dr. Ley at the three-day Academy of Critical Incident Analysis (ACIA) conference on the Las Vegas shooting in early May, along with two survivors, Chris and Jenny Babij. We discussed the MFOL kids at length. Chris and Jenny had experienced their attack side by side, but completely differently. They had been standing right in front of the Route 91 music festival stage, so hundreds of people were taken down by gunfire all around them. Chris was badly wounded in the shoulder, and he’d tripped as they fled the grounds. Jenny was running just ahead and did not discover until too late that he was gone. They were separated until the morning, and Jenny was wracked by guilt for “abandoning” him, despite her relentless attempts to reach him. Chis lay on a gurney within the chaos of an overwhelmed ER awaiting treatment for several hours. Over and over, a custodian rolled a bucket by to mop up all the fresh blood. So much blood. A triage nurse came by with three color-coded tags: Chris was tagged as non-life-threatening, which meant he had to wait. He said he didn’t mind. He had seen so many people in a horrible state. It was actually a great comfort to get tagged, he said. It meant he was in the system, would not be forgotten, and would be treated after the people in danger of dying.
Four months into their recovery, Parkland rattled Chris and Jenny Babij—enough to impede their progress temporarily. They were awed by the MFOL kids but concerned. Recovery had been their primary pursuit, advancing at a pace that worked for them. Chris was just then preparing to return to work.