Abstract
BackgroundBoth the DSM-5 algorithm for posttraumatic stress disorder (PTSD) in children 6 years and younger and Scheeringa’s alternative PTSD algorithm (PTSD-AA) aim to be more developmentally sensitive for young children than the DSM-IV PTSD algorithm. However, very few studies compared the three algorithms simultaneously. The current study explores diagnostic outcomes of the three algorithms in young child survivors of accidental trauma.MethodsParents of 98 young children (0–7 years) involved in an accident between 2006 and 2012 participated in a semi-structured telephone interview. Child posttraumatic stress symptoms (PTSS) were measured with the Anxiety Disorders Interview Schedule for DSM-IV-Child Version (ADIS-C/P), complemented with items from the Diagnostic Infant and Preschool Assessment (DIPA). Descriptive statistics were used to analyze the characteristics of the children, accident related information and PTS symptoms. We compared the three PTSD algorithms in order to explore the diagnostic outcomes.ResultsA total of 9 of the children (9.2 %) showed substantial PTSS. Of these children 2 met the criteria of all three algorithms, 7 met both the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm, and 2 did not fully meet any of the algorithms (subsyndromal PTSD).ConclusionsFor young children, the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm appear to be better suited than the previous DSM-IV algorithm. It remains important that clinicians pay attention to children with subsyndromal PTSD.
Highlights
Both the DSM-5 algorithm for posttraumatic stress disorder (PTSD) in children 6 years and younger and Scheeringa’s alternative PTSD algorithm (PTSD-AA) aim to be more developmentally sensitive for young children than the DSM-IV PTSD algorithm
In accordance with the PTSD-AA algorithm, criterion A2 was left out from the DSM-5. This criterion was considered redundant for the development of PTSD, because research showed that this criterion is common after experiencing a traumatic event and has little influence on the number of people who qualify for PTSD following a traumatic event [10]
Our findings indicate that both the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm appear to be more sensitive for young children than the DSM-IV algorithm
Summary
Both the DSM-5 algorithm for posttraumatic stress disorder (PTSD) in children 6 years and younger and Scheeringa’s alternative PTSD algorithm (PTSD-AA) aim to be more developmentally sensitive for young children than the DSM-IV PTSD algorithm. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [1] includes a subtype for posttraumatic stress disorder (PTSD) in children 6 years and younger. In order to improve the identification of PTSD in young children, Scheeringa and colleagues, proposed alternative PTSD criteria for young children [4] This alternative algorithm (PTSD-AA) focused on behavioral symptoms instead of thoughts and feelings, and included the following changes to the DSM-IV criteria. The threshold to meet the avoidance/numbing criterion was lowered from 3 to 1 symptom [6] These changes have been incorporated in the DSM-5 subtype for children 6 years and younger, in addition to the following (unrelated to the PTSD-AA proposal): First, criterion C avoidance/numbing has been split into “Persistent avoidance of stimuli” and “Negative alterations in cognitions”.
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