Posttraumatic Stress Disorder in Children

Abstract

In the past ten years, there has been increasing recognition that children who have been exposed to traumatic events can, like traumaexposed adults, develop post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD) first appeared in the DSM-III in 1980. The impetus for the development of this diagnostic category arose primarily from the need to account for the characteristic array of symptoms displayed by Vietnam veterans in the United States, and as such PTSD was conceptualized around traumatized adults. However, since that time there has been increasing recognition that children, too, can develop severe and debilitating reactions to traumatization.Studies indicate that children can develop PTSD after exposure to a range of traumatic stressors, including violent crime, sexual abuse, natural disasters, and war. Where relatively standardized assessment methods have been used, the incidence of PTSD among child survivors of specific disasters ranges from 30 to 60% (1,2). As yet there are no epidemiological studies of the prevalence of PTSD among children in the general population; however, community studies in the United States have consistently indicated that around 40% of high school students have experienced some form of domestic or community violence, and between 3 and 6% have PTSD (3,4).High rates of trauma exposure and evidence of PTSD among child populations suggest that mental health practitioners worldwide need to be able to recognize those posttraumatic reactions in children that require intervention, and offer timeous and effective treatments. This is particularly critical given the substantial challenges that post-traumatic stress poses to the healthy physical, cognitive and emotional development of children and adolescents (5). DIAGNOSIS AND ASSESSMENTThe DSM-IV-TR describes three symptom clusters in PTSD: persistent re-experiencing of the trauma (e.g., intrusive memories and flashback experiences, often triggered by exposure to traumatic reminders, and recurring traumarelated nightmares); avoidance of traumatic reminders (including places, people, and conversations) and a general numbing of emotional responsiveness; and chronic physiological hyperarousal, including sleep disturbances, poor concentration, and hypervigilance to threat. The DSM notes that, in children, re-experiencing may occur through repetitive play involving trauma-related themes, rather than through memories, and nightmares may have generalized, rather than trauma-specific, content. Following a traumatic experience, it is normal and expectable for children and adults to exhibit some intrusive, avoidance and hyperarousal symptoms, which remit spontaneously within a few days or weeks. In order to meet the PTSD diagnosis, at least one re-experiencing symptom, three avoidance/numbing symptoms and two hyperarousal symptoms should be present for at least one month, and must cause significant distress or functional impairment. When symptom duration is less than one month, a diagnosis of acute stress disorder (ASD) is made.