![]() For comparison, the rates in the 7-to-10 age group were 3.9% by parent report, 22.9% by child report, and 29.2% by combined report. Again, it seems implausible that children who have so many PTSD symptoms and impairment should be unable to receive a DSM-IV diagnosis.įourth, this is the first published study of acute stress disorder in preschool children the authors found a rate of 1.6% in this age group, which is substantially lower than rates found in older populations. Those diagnosed with the alternative criteria had a mean of 11.6 DSM-IV symptoms (by combined parent and child reports). They found a rate of diagnosis of 18.8% by the alternative criteria, compared with 2.1% by DSM-IV criteria. ![]() Given speculation about potentially permanent alterations in the developing brain from early traumas, these preliminary data deserve attention.Ī third contribution is Meiser-Stedman and colleagues’ inquiry into the developmental appropriateness of DSM-IV criteria for children 7- to 10-year-olds theirs is only the second study to compare alternative and DSM-IV criteria for PTSD in the 7-to-10 age group. Unremitting PTSD takes on new salience in early childhood, a time of uniquely rapid brain development. In another study, 70% of 30 children 6–11 years old were still in the moderate to severe category of posttraumatic stress symptoms 21 months after surviving Hurricane Andrew (9). Similarly, a prospective study of 808 Australian schoolchildren (mean age=8.2 years) showed no decrease in stress symptoms 26 months after a destructive bushfire (8). In contrast to adult studies, which typically show approximately 50% of patients improving naturally to some degree (6), the first prospective longitudinal study of PTSD in preschool children showed that the mean severity did not decrease over a 2-year period (7). This finding adds to preliminary longitudinal research suggesting that PTSD in children may be more unremitting than PTSD in adults. These predictive validity data are another important reason for making developmental modifications in DSM criteria. showed that 69% of the children diagnosed with the alternative criteria 2–4 weeks after the trauma retained the diagnosis 6 months later. Second, in a prospective design, Meiser-Stedman et al. ![]() A mean of 10.0 symptoms is higher than in most adults diagnosed with PTSD (5), and as prior studies have concluded, it seems implausible that children who have so many PTSD symptoms and impairment are unable to receive a DSM-IV diagnosis. The mean number of DSM-IV symptoms in children diagnosed with the alternative criteria was 10.0, indicating that these children were severely symptomatic even though fewer criteria were necessary to make a diagnosis using the alternative criteria. The rate of PTSD diagnosis by the alternative criteria was 10.0%, compared with 1.7% by the DSM-IV criteria. At least six contributions of this study are worth highlighting.įirst, this is one of the larger studies to date on this issue. (4) assessed 60 children 2–6 years old and 49 children 7–10 years old 2–4 weeks after traumatic motor vehicle accidents and again 6 months later on both the DSM-IV criteria and the alternative criteria. Note that lowering the threshold for criterion C has been suggested even for adults, because highly symptomatic and impaired adults could not be given the diagnosis if they had only two criterion C symptoms (3). Criterion C includes either symptoms that are highly internalized and difficult to detect if they are present in young children with emerging verbal capacities (e.g., avoidance of internal thoughts or feelings) or symptoms that are developmentally implausible at this age (e.g., sense of a foreshortened future). Consensus was reached among experts to modify wording and to lower the requirement for criterion C (numbing and avoidance items) from three of seven symptoms to just one (2). The proposed alternative criteria include modifications in wording for four symptoms to make them developmentally sensitive to young children without changing the essence of the symptoms ( Table 1 ). ![]() However, an empirically derived alternative set of criteria for preschool children appears valid for reliably diagnosing PTSD. Can preschool children develop posttraumatic stress disorder (PTSD)? If so, are the DSM-IV criteria developmentally sensitive enough to diagnose the disorder in this group? Nine studies have addressed these questions, finding consistently that the answer to the former question is yes, and to the latter, no (1).
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