cumstances may not be able to identify onset of symptomatology. Avoidant behavior may
be associated with restricted play or explor atory behavior in youn g children; reduced par-
ticipation in new activities in school-age children; or reluctance to pursue developmental op-
portunities in adolescents (e.g ., dating, driving). Older children and adolescents may judge
themselves as cowardly. Adolescents may harb or beliefs of being changed in ways that
make them socially undesirable and estrange them from peers (e.g., “Now I’ll never fit in”)
and lose aspirations for the future. Irritable or aggressive behavior in children and adoles-
cents can interfere with peer relationships and sch ool behavior. Reckless behavior may lead
to accidental injury to self or  others, thrill-seeking, or high-risk behaviors. Individuals who
continue to experience PTSD into older ad ulthood may express fe wer symptoms of hy-
perarousal, avoidance, and ne gative cognitions and mood compared with younger adults
with PTSD, although adults ex posed to traumatic events duri ng later life may display more
avoidance, hyperarousal, sleep problems, and crying spells than do younger adults exposed
to the same traumatic events. In older individu als, the disorder is associated with negative
health perceptions, primary care ut ilization, and suicidal ideation.
Risk and Prognostic Factors
Risk (and protective) factors are generally divided into pretraumatic , peritraumatic, and
posttraumatic factors. 
Pretraumatic factors
Temperamental. These include childhood emotional prob lems by age 6 years (e.g., prior
traumatic exposure, externalizing or anxiety problems) and prior me ntal disorders (e.g.,
panic disorder, depressive disorder, PTSD, or obsessive-compulsive disorder [OCD]).