50.1 Additional, Alternative Avoidant Cluster Symptoms for the Diagnosis of PTSD in Children

Abstract

This study sought to explore developmentally sensitive avoidant cluster symptoms for children. Abused children (N = 119; mean age = 9.96 years; SD = 1.67) were recruited in a southern state; 65.5% were female, 68.9% were White, and 31.1% were Black. Data were collected in an NIMH study (5-RO1MH49784-04). Informed consent and assent were completed by parents and children. The Abuse Dimensions Inventory (ADI) measures severity of physical and sexual abuse. Data collection for this NIMH study began prior to the release of the DSM-IV, so the Diagnostic Interview for Children and Adolescents—Revised (DICA-R) was utilized for the assessment of PTSD and social anxiety disorder (SAD). The Child Dissociative Checklist (CDC) is a screening measure to access dissociative symptoms based on ratings by caregivers. The CDC mean was 6.93 (SD = 6.54). For the creation of developmentally sensitive, avoidant symptoms, using the DICA-R, if a parent endorsed symptoms that met the criteria for SAD, then the diagnosis of SAD was counted as one avoidant symptom. For dissociation, the CDC was used with a cutoff greater than 12 to establish an alternative avoidant symptom. Of the 119 children, the percentage meeting the threshold set by DSM-III-R was identified for each cluster based on child and parent interviews: Reexperiencing (child: 84.9%; parent: 67.2%); Arousal (child: 84.9%; parent: 66.3%); Avoidance (child: 76.5%; parent: 58.1%); and Positive Diagnosis (child: 62.2%; parent: 31.1%). The percentage of children meeting the threshold of 3, but using the 2 additional symptoms (SAD and CDC) as developmental equivalents for avoidance, was identified based on child and parent interviews: Child PTSD (child: 66.7%; parent: 43.9%); Child PTSD + SAD (child: 78.2%; parent: 53.6%); Child PTSD + CDC (child: 78.0%; parent: 56.0%); Child PTSD + SAD + CDC (child: 89.5%; parent: 75.7%). The developmentally sensitive avoidant criteria resulted in higher rates of PTSD. It is plausible that clinging to a safe parent served the function of reducing distress (reexperiencing and arousal). Similarly, dissociative symptoms may reduce distress. The study limitations included: 1) it was a retrospective analysis of study data that used DSM-III-R criteria; 2) it was conducted in one southern state; and 3) variables used for alternative SAD and dissociative symptoms were available in a subset (N = 66) of the sample.