Le psychotraumatisme chez l’enfant et l’adolescent : donnés actuelles et perspectives

Abstract

Exposure to a traumatic event is frequent in children and adolescents with the prevalence of Posttraumatic Stress Disorder (PTSD) probably being underestimated in this age group. PTSD is associated with distress and interference that can range from minor disruptions in the child's or adolescent's life, to severe and debilitating consequences impacting their development. Reactions to trauma exposure are defined according to their timeframe : peri-traumatic reactions (lastingminutes to hours), Acute Stress Disorder (ASD; between two days and one month) and PTSD (when symptoms persist more than one month). While a variety of symptoms are described in children and adolescents in response to trauma exposure and constitute the spectrum of reactions to trauma, PTSD is characterized by the association of three core symptoms: 1) re-experiencing the traumatic event in the form of vivid intrusive memories, flashbacks, or nightmares; 2) avoidance of thoughts and memories of the event; 3) persistent perceptions of heightened current threat, for example associated to hypervigilance or enhanced reactivity and exaggerated startle response. In the DSM-5, ASD and PTSD are distinct from anxiety disorders and obsessive-compulsive disorders, and included in a distinct category are Trauma and Stressor-Related Disorders. More recently, the ICD-11 adopted Complex PTSD as a new diagnostic category, which requires meeting the ICD-1 PTSD symptoms and three clusters that represent disturbances in self-organization (affect dysregulation, negative self-concept and disturbances in relationships), bridging the gap between trauma-related disorders and other complex developmental disorders including borderline personality disorder. Emerging evidence suggests that Individual Psychological Debriefing within the first three months of a traumatic event may increase the risk for PTSD in children and adolescents, and caution is warranted. Among the many existing interventions and programs for PTSD, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a time-limited therapy that combines exposure, cognitive processive remodeling and enhancement of coping skills, is the most empirically validated for PTSD. Eye Movement Desensitization and Reprocessing (EMDR), an integrative psychotherapy based on bilateral brain stimulation through side-to-side eye movements or hand tapping, has also recently been found to be effective in children and adolescents. Although significant advances have recently been made, more research focusing on the understanding of the underlying mechanism and the risk factors of trauma and stressor-related disorders in children and adolescents as well as the implementation of evidence-based and accessible interventions is definitely warranted.