Post-traumatic stress disorder and trauma responses — OSCE

Liam is a seven-year-old boy referred by his GP six weeks after a high-speed motor-vehicle crash in which he was a restrained rear-seat passenger. His mother was driving and sustained a fractured femur; Liam was physically uninjured. Since the crash Liam wakes screaming most nights, refuses to get into any car including the school bus, has stopped playing with friends, and his teacher reports he cannot concentrate and has dropped a reading level. He draws pictures of crashed cars repetitively. His mother, who is now using crutches, asks whether Liam 'has PTSD' and whether a counsellor should 'debrief him properly' to prevent it getting worse. During the assessment Liam's mother confides that the crash happened because her partner — who was following in another car — was intoxicated and angry, and that he is still drinking heavily at home.