Pharmacotherapy for Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) in Children and Adolescents

Abstract

Exposure to physical trauma has always caused profound and enduring changes in human cognition, emotion and behavior and with this, the need for appropriate treatment. However only recently a persisting triad of symptoms– re–experiencing, avoidance, and hyperarousal – crystallized as the core psychological reactions to trauma. This triad was designated Posttraumatic Stress disorder (PTSD). PTSD was formally recognized as a psychiatric diagnosis in 1980 with the publication of the DSM III and it was not until 1987, and the DSM III–R, that the disorder was recognized in children. The diagnosis of Acute Stress disorder (ASD) was introduced even more recently, with the publication of DSM–IV in 1994. Unlike PTSD, which is diagnosed at least four weeks after the trauma, acute stress disorder is diagnosed two days to four weeks after the trauma. Acute stress disorder also differs from PTSD in that it is explicitly conceived as a dissociative response to trauma and it will have the ability to predict later PTSD. Concerns are still raised as to the validity of both diagnoses as they apply to children. This, together with the tendency of adults in the child’s surroundings to “let sleeping dogs lie,” make the traumatic stress disorders of childhood underdiagnosed, understudied, and as a result—not always optimally treated. It is estimated that 70% of adults and 40% of teenagers have undergone a trauma which could result in the development of PTSD according to the DSM. Life time prevalence of PTSD is estimated to be 8%. In children the numbers vary widely (according to type of trauma and method of diagnosis)—10%–100% of children who have undergone trauma will go on to develop PTSD. In a survey of current practice among psychiatrists and nonmedical therapists, Cohen et al. found that although only 17% of psychiatrists said they preferred psychotropic medications to psychotherapy, the majority (95%) prescribed medications for the disorder, thus emphasizing the importance of guidelines for medication use in this disorder.