- D Simons,
- W R Silveira
- Correspondence to: Dr Silveira.
- Accepted 16 November 1993
Post-traumatic stress disorder in children is now well documented,1 although as recently as 1985 Garmezy and Rutter argued against the need for a diagnostic category, particularly as amnesia, psychic numbing, and intrusive flashbacks had not been reported in child survivors of disasters.2
On Hallowe'en (31 October) 1992 a programme with the title Ghostwatch was shown on television. Four months later two 10 year old boys were referred separately by their general practitioners to the child psychiatry unit at our hospital. Post-traumatic stress disorder was diagnosed, based on the criteria in the International Classification of Disease, tenth revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). We report here these two cases.
This boy had been frightened by Ghostwatch and had refused to watch the ending. He subsequently expressed fear of ghosts, witches, and the dark, constantly talking about them and seeking reassurance. He suffered panic attacks, refused to go upstairs alone, and slept with the bedroom light on. He had nightmares and daytime flashbacks and banged his head to remove thoughts of ghosts. He became increasingly clingy and was reluctant to go to school or to allow his mother to go out without him.
His parents had separated when he was 4 years old, and he had a close relationship with his mother. His early development had been normal, although he was described as a sensitive child and a worrier. He was admitted to the hospital's child and family unit as his mother could no longer cope with his behaviour at home. A behavioural programme was established: he began to keep a diary of flashbacks; his mother was helped to regain control in their relationship; and both were discouraged from discussing ghosts and his fears. On discharge eight weeks later he was happier and confident and free of symptoms.
Immediately after watching Ghostwatch this child, also described as a worrier, had complained of being frightened. He had felt sick, and cried easily, and refused to go into his bedroom, complaining of someone watching him there. He was consequently allowd to sleep in his parents' room, where he talked excessively about his fears; his parents were drawn into a discussion and had to reassure him repeatedly throughout the night.
He was seen in the outpatient clinic. A behavioural programme was established, whereby he was encouraged to sleep in his own room with brief comforting when afraid and to ignore any discussion about the programme. After three appointments at weekly intervals, with telephone conversations in between, the situation had improved: he was sleeping in his own room and the whole family seemed more relaxed.
Post-traumatic stress disorder was diagnosed in our two patients on the basis of the criteria in the ICD-10 and DSM-III-R. The symptoms also corresponded to those described by Yule and Edwin3: sleep disturbances with problems settling down to sleep; waking at night; nightmares; fear of the dark and of sleeping alone; difficulties in concentrating; impaired memory; persistent intrusive thoughts and images of the traumatic event; raised levels of anxiety; panic attacks; separation anxiety and clinging behaviour; and depressed mood and irritability. The trauma in our two cases had been caused by the television programme the boys had watched. Post-traumatic stress disorder due to watching a television programme has not been reported previously, although Saigh reported on an 11 year old girl in Lebanon who developed the disorder after being told of the war related death of her uncle.4
The treatment in both our cases specifically addressed the children's preoccupations and anxieties. Behavioural and cognitive strategies including relaxation techniques and the management of anxiety were used, rather than an eclectic approach being taken as McFarlane suggested.5 Although both boys had anxiety traits and overdependent relationships, risk factors for the development of post-traumatic stress disorder in children remain inconclusive.