As the nation marks the first anniversary of Operation Protective Edge, the children of Sderot and the Gaza periphery are still dealing with the conflict’s aftermath.Some 40 percent of the children in Sderot suffer from symptoms of anxiety, fear and PTSD, according to a recent study. Even during wartime, the level of PTSD among children nationwide hovers is somewhere between 7 and 10 percent, Prof. Ruth Pat- Horenczyk explained.Pat-Horenczyk, director of the child and adolescent clinical services unit at the Israel Center for the Treatment of Psychotrauma, at Herzog Memorial Hospital in the capital, discussed her research and understanding of post-traumatic stress disorder (PTSD) in children, in an interview with The Jerusalem Post on Tuesday.“The ongoing situation in Sderot causes PTSD at a rate three or four times greater than that of the rest of the country,” she said.Identifying signs of PTSD is not easy, Pat-Horenczyk. Many parents think and hope that the irregular patterns of behavior that characterize the disorder will fade over time. A professional knowledgeable of children’s development is needed to accurately diagnose the problem, she said.“Children don’t always say things verbally. They don’t always speak about their fears directly. They show it through behavior and their developmental progress,” the psychologist explained.One of the first signs of the disorder is regression, with sufferers reverting to behaviors suitable for a younger child. A toilet-trained youngster may have accidents, use a bottle or a diaper, or start talking like a younger child.Other manifestations can include fears that did not exist before – even if they are not directly related to a triggering event, such as the war – separation anxiety that did not exist before, trouble sleeping and anger issues.“What’s important, first and foremost, is to notice if there is a change in the child’s behavior,” she explained.Other signs can include quieter children speaking out more, outgoing children becoming more introverted, and children playing in a way that shows a preoccupation with the conflict – such as constantly acting out red alerts and hiding from rockets.Other signs can be the development of new fears, shying away from trying new things, increased difficulties in school, or trouble falling asleep at night.Pat-Horenczyk emphasized that to understand the disorder, there needs to be sensitivity to the child’s developmental stage, as at each stage the symptoms will manifest differently.“Schoolchildren have a lot of complaints about pain and somatic pain. They have trouble saying that they are afraid so they speak about it in hidden ways,” she said.Teenagers are more likely to act out in dangerous ways, she said.Although some children are more verbal than others at any stage in their development, there are basic gender differences.“Generally, girls talk more about their anxieties, fears and feelings. Boys tend to show it more through behavioral problems, intensity and aggression – functional problems.”Some children display their fears and anxieties in more indirect ways, such as dreaming about the war, or fears that did not exist before.Some fear using the toilet or taking a shower because of the possibility that a red alert will sound and they will have to run to a bomb shelter.Others link specific places with red alerts, such as the child who did not want to visit her grandmother because during one visit there was a red alert and the place itself now causes anxiety.According to Pat-Horenczyk’s research, the younger the child, the more vulnerable he is to the influence of his parents.“If the situation affects the parents and the mother is depressed or post-traumatic herself, this strongly affects the child,” she explained. A parent who is dealing with her own trauma and anxiety is less capable of calming down her child who is suffering.This is why a lot of the treatment given is to the parents, to help them learn to deal with their own anxieties and fears, and then equip them with the tools to help their children.The programs give the parents tools to use the fear felt by themselves and their children in a constructive way. Playing and having fun is an important part of the process of dealing with the anxiety caused by living near the Gaza Strip.Despite the high levels of anxiety, fear and PTSD among children in Sderot and the Gaza periphery, most of the children and the parents deal with the situation with resilience, according to Pat-Horenczyk – “even the most difficult situations.”Studies conducted in the area over the past 10 years prove the point.“Resilience is the most common reaction. Even among those in the worst situations,” she said.