Article2006

Factors Affecting the Diagnosis and Prediction of PTSD Symptomatology in Children and Adolescents

Michael S. Scheeringa · Mary Jo Wright · Charles H. Zeanah

262 citations0/0 files storedAmerican Journal of Psychiatry

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Posttraumatic Stress Disorder Research Child and Adolescent Psychosocial and Emotional Development Child Abuse and Trauma

Abstract

OBJECTIVE: In a cohort that spanned all of childhood and suffered equivalent types of traumas, the authors examined diagnostic validity and risk factors for posttraumatic stress disorder (PTSD). For older children, parent-child agreement was investigated. METHOD: Sixty-two children ages 0-18 years who were hospitalized with injuries were assessed 2 months later for PTSD. Mothers were interviewed, and concurrent interviews were conducted with 24 adolescents. RESULTS: Children did not attain the DSM-IV threshold of three criterion C items until age 7. The 0-6-year-old group had significantly fewer criterion C symptoms (mean=0.43) than the 12-18-year-olds (mean=1.17). The impact of altering thresholds for criteria C and D was examined. Older children reported symptoms meeting criterion B significantly more often (79.2%) than parents (45.8%). Combined parent-child reports yielded significantly more symptoms and higher rates for criteria B, C, and D (almost a twofold increase) and for the overall diagnosis (37.5%) than parent report alone (4.2%). This 8.9-fold increase in diagnosis from combined reports suggests that the diagnostic rates for children who cannot make self-reports may greatly underestimate the true numbers. The interaction between pretrauma externalizing behavior and witnessing a threat to a caregiver had a significant effect on the total number of PTSD symptoms. CONCLUSIONS: These findings provide additional support for lowering the requirement of three criterion C symptoms for preschool children and raise questions about the appropriateness of this threshold for prepubertal children. The validity of studies that do not assess symptoms with combined parent and child reports is limited.

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References

2000Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.1983Manual for the Child: Behavior Checklist and Revised Child Behavior Profile 2003Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.2013Child's Conception of the World 2003Child witnesses to domestic violence: A meta-analytic review.2001A Meta-Analysis of the Published Research on the Effects of Child Sexual Abuse 1998Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both)2003New Findings on Alternative Criteria for PTSD in Preschool Children

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