PTSD in Children Below the Age of 6 Years

Abstract

Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).

Population Prevalence of the Posttraumatic Stress Disorder Subtype for Young Children in Nationwide Surveys of the British General Population and of Children in Care

“…10 We therefore, a priori, decided to extend the age range for our analyses up to 8 years (see below). However, interestingly, in both survey samples the AA-PTSD algorithm in fact identified far greater numbers of children across the entire younger age range than the DSM algorithm (see Figure 2), as has been suggested in prior studies with at-risk samples, 3,10 and captured up to nine times as many of the youth with functional Key differences between those identified with AA-PTSD and DSM-IV. Again, no children in the general population sample were diagnosed using DSM-IV, preventing comparison of the two diagnostic criteria.…”

“…As DSM-5 criteria for PTSD-YC were unpublished at the time of the included surveys, we applied the Alternative Algorithm (AA; 2 ) which was derived to index the necessary PTSD-YC symptoms from DSM-IV-based interview items. AA and DSM-5 criteria for PTSD-YC are conceptually comparable as the DSM-5 criteria were directly derived from the AA prototype 3 (see Table S1, available online, for detailed mapping across the criteria). The only symptom indexed by the DSM-5 criteria that cannot be J o u r n a l P r e -p r o o f detected by AA is increased frequency of negative emotional states, although a restricted range of (particularly positive) affect is assessed as are all other aspects of Criterion C. PTSD-YC diagnosis does not significantly differ between use of AA or DSM-5, 2 validating use of the AA to index PTSD-YC.…”

“…1 However, the establishment of Scheeringa and colleagues' developmentally-appropriate 'Alternative Algorithm' (AA) for DSM-IV PTSD 2 meant that, for the first time, we could identify and begin to understand the syndrome within young children under six years old. [2][3] This early work led the DSM-5 4 to introduce a sub-diagnosis of PTSD for young children aged 6 years and younger (PTSD-YC), comprising a developmentally-tailored symptom profile derived closely from the Alternative Algorithm 2 (see Table S1, available online for full diagnostic criteria).…”

Age-related effects of the COVID-19 pandemic on mental health of children and adolescents

“…Further, studies suggest that very young children are a uniquely vulnerable group to experience adverse and traumatic events, to react to them in a particular distressing way and to suffer from detrimental long-term effects on their development. This is due to their rapid emotional and physiological development and their strong dependency on their caregivers as the primary source of their coping socialization and to protect them physically as well as emotionally (Dalton, Rapa, & Stein, 2020;De Young & Landolt, 2018;Russell et al, 2020). Taken together, these potential risks for children and adolescents make them a vulnerable group at each age, which should be given research priority (Golberstein, Wen, & Miller, 2020;Holmes et al, 2020).…”

Survival states as indicators of learning performance and biological stress in refugee children: a cross-sectional study with a comparison group

“…It is particularly challenging to apply diagnostic criteria during early childhood because of rapid developmental changes and the interdependence of very young children with the primary caregiver [ 14 ]. Due to limited self-reflective and verbal abilities, symptoms of children under 6 years are often assessed by parent rating [ 15 , 16 ]. A correlation between the mothers’ and the children’s symptomatology concerning PTSD [ 11 , 13 – 15 ] has been shown as well as an underestimation of PTSD symptom load in parent rating, especially concerning internalized symptoms [ 16 , 17 ].…”