POSTTRAUMATIC STRESS DISORDER
	Posttraumatic Stress Disorder is a condition from which nearly 10% of  Americans suffer.  It, unlike other afflictions, is associated with a wide variety of circumstances.  Many war veterans suffer from Posttraumatic Stress Disorder.  However, a new group of people are quickly emerging as common suffers of Posttraumatic Stress Disorder-sexually abused children.  Posttraumatic Stress Disorder is a prevalent problem associated with children who are victims of sexual assault.
	Posttraumatic Stress Disorder is classified as an anxiety disorder under the Diagnostic and Statistical Manual of Disorders (DSM-III).  The diagnoses for Posttraumatic Stress Disorder was not formally diagnosed as part of DSM-III until 1980.  According to Famolaro, "the diagnoses of Posttraumatic Stress Disorder requires: (a) experience of a significant traumatic events; (b) re-experiencing of the trauma in one of several different thought, emotional, or behavioral forms; (d) persistent symptoms of increased arousal, Particularly when exposedto stimuli concretely or symbolically reminiscent of the trauma; (e) symptoms lasting at least one month.  (Famolaro, Maternal and Child Posttraumatic... 28)".
	Children are now becoming realized as significant sufferers of Posttraumatic Stress Disorder.  Posttraumatic Stress Disorder is particularly bad for children under the age of 11, because they lack many of the skills needed to protect themselves.  Furthermore, this vulnerability is enhanced when the child is exposed to any maltreatment.  According to recent studies, "Posttraumatic Stress Disorder is a common sequella of severe or chronic maltreatment of children, particularly among sexually maltreated children ( Famularo, Symptom Differences... 28)".  Posttraumatic Stress Disorder can be caused if the child is exposed to just one traumatic episode (rape, witnessing a violent crime, physical abuse); However, the child will become more susceptible to Posttraumatic Stress Disorder if the maltreatment continues.  Moreover, a child is most likely to suffer from symptoms associated with Posttraumatic Stress Disorder when sexual assault is involved(28).
	Because children have not yet developed cognitively emotionally and are very immature, they are likely candidates to develop symptoms related to Posttraumatic Stress Disorder.  As a   child matures he/she becomes better equipped to deal with and prevent contributing factors to the eventual suffering from Posttraumatic Stress Disorder.  Up to age two, young children can recreate stressful events and even imagine such events recurring; However, the mind is not developed enough to identify, anticipate, or prevent future traumatic occurrences.  At age three, children cannot, "distance themselves, in time, appreciate roles and differences in behavior, access situation, or adopt nonegocentric causality (Saigh 189)".  This flaw opens them up to the impact of trauma because the child cannot anticipate and protect themselves.  By age four,  children have the ability to protect themselves by avoiding traumatic encounters. They also have the ability to suppress their anxiety when it becomes difficult to cope with.  Because children do not have this ability any earlier they are vulnerable to physical and sexual assault. Children continue as such until they become concrete operational at about age six or seven (190).
	Children who have been sexually abused develop many of the syndromes associated with Posttraumatic Stress Disorder, some of which are, the inability to establish normal relationships with adults and peers, to make a normal transition from adolescence to adulthood, as well as to develop skills required to progress in school.  However, this was not the case with all sexually assaulted children.  Walder states, "not all those so exposed will develop a Posttraumatic Stress Disorder reaction; some may have a certain "hardiness" that helps them cope without any noticeable residual effects while others may have a severe psychological reaction that renders them unable to function (Walker 130)."     
     Knowledge of sexual assaults has recently become more common.  Random surveys of adults indicate that approximately 28% of women and 16% of men were victims of sexual abuse before the age of sixteen (Valentier 455).  The nature of the abuse stretched from fondling to sexual intercourse committed by an adult that was five years older than the victim (Wolf et al).  Women are more often the victims of child sexual assault then men.  According to John B. Murry, women are the victims of child hood sexual abuse at a ratio of 10:1 over men (Murry 658).  Furthermore, children of lower income families are also common victims of sexual assault.  But,  as Murry points out, sexual abuse occurs in all types of families regardless of their income; and, sexual assaults are usually committed by a member of the family.  It is difficult to get an accurate record of the actual number of children that have been sexually abused.  Many cases never come to light and because of differences in definitions of sexual assault, some cases are missed.(658).
        Researchers have begun to explore the concept of Posttraumatic Stress Disorder with children and adults that were victims of sexual assault.  Many times people associate particular events with particular stimuli.  For example, certain orders, colors, sounds, and people can trigger a memory of a past event.  This is more true for victims of sexual assault.  According to Wolf, Sas, and Wekerle, "traumatic episodes become associated with particular eliciting stimuli and can lead to maladaptive or a typical reactions. Such conditioning can play an important role in the formation of children's adjustment disorders subsequent to sexual abuse (Wolf et al 38)."  Because people do not anticipate an abusive episode there are usually things the victim can not control.  Sexual abuse is just such a stressful event that will produce a form of a coping reaction.  Because children are impressionable the perpetrator may consult, threaten of confuse the child to confession.  Child victims of child sexual assault are also tortured by nightmares, recurring images of the event and troubling  memories.  "Based on interviews with children who have been exploited by adults through sex rings and pornography, 65 of 60 children reported intrusive thoughts, flashbacks, and nightmares.  Physical symptoms (eg.  Somatic complaints, sleep problems, excessive crying) and greater social withdraw and distrust of others were also noted among a sizeable proportion of this sample (Wolf et al 39)."
        Posttraumatic Stress Disorder is diagnosed with the Posttraumatic Stress Disorder Symptom Checklist.  The test consists of a list of 43 "adjustment problems" with 23 items spanning the range of symptoms characterizing Posttraumatic Stress Disorder as defined in the DSM-III Categories for Posttraumatic Stress Disorder.  Participants were considered Posttraumatic Stress Disorder positive if they indicated on the test that they had reexperienced the traumatic event, became avoident, and had increased arousal.  The test also indicated whether or not the participant had a "moderate problem" or "partial" Posttraumatic Stress Disorder (Rowan 55)."  In one study using the PTSD symptom checklist on 42 sexually abused children, 64% of the participants were considered PSD"positive", with another 19% meeting the criteria for "partial" PTSD(56)."
        The sample of nighty children comprised of 21 boys and 69 girls.  The average age was 12.4 years old.  Based on the most severe forms of abuse reported by these children, 52.2% had alleged sexual touching (including fondling of genitals, masturbation, 34.4% reported oral, anal, or vaginal intercourse with the offender, 10% reported attempted or simulated intercourse, and the remaining 3,3% reported being the victim of indecent exposure.  Out of the sample, 44.7% had been abused only once, 32.9% of the sample were abused two to ten times, 7.1% were abused ten to twenty times, and 15.3% more than  twenty times.  Almost all alleged perpetrators were persons known to the child, 54.4% were non-family members, 25.6% were abused by a parent or stepparent, 20% were abused by a member of the extended family or a stranger (Findelnor 1406).
        The results of the test indicated that of the ninety children tested, 44 showed positive signs of PTSD and 46 did not.  Of the 44 children testing positive, 49.8% self-reported showing total fear, 53.2% indicated fears of abuse, 57.7% showed anxiety ,and 59.3% felt depressed.  Guilt and self-blame were also diagnosed at 25% and 11% respectively.  Parents of the 44 children that tested positive, 64.2% internalized their anxiety while 61.5% externalized (140).
        In a separate study done by Famularo, he evaluated a test group for both acute and chronic PTSD.  Sexually abused children which had an onset of symptoms within six months of the abuse and a duration of symptoms lasting longer than six months were diagnosed as having acute PTSD.  Conversely, sexually abused children with symptoms lasting longer thatn six months were diagnosed with chronic PTSD.  Twenty-four of the 28 sexually  abused children tested showed evidence of either acute or chronic symptoms of PTSD.  Of this group 3.1% had recurrent intrusive recollections and 3.33% recreated the trauma in their play.  2.61% experienced nightmares, 3.33% of the group acted as if the event were occurring.
        Distress of exposure to symbolic real re-exposure was experienced by 2.1% of the children.  3.49% of the victims avoided thoughts related to the event and activities that arouse recollections of the event.  Furthermore, 1.8% of the children could not recall aspects of the trauma.  3.2% demonstrated a diminished interest in games and recreational activities.  16.3% of those tested suffered regression.  Of these victims, 3.14% detached and estranged themselves from others.  Sadly, 2.61% of these traumatized children exhibited and expressed the belief that their lives would be short.  While 2.9% felt that life was going to be difficult and long(144).
        Until recently, sexually abused children were never studied for symptoms of PTSD.  As the aforementioned case studies suggest, it as a problem that deserves attention.  These children do suffer the symptoms of PTSD and should be diagnosed and treated accordingly.  This could be difficult as many instances of sexual abuse remain unreported; however, their problems are real and deserve the help that further research could facilitate.