Abstract
ObjectivePosttraumatic stress disorder (PTSD) is a debilitating condition that when left untreated can have severe lifelong consequences for psychological, social, and occupational functioning. Initial conceptualizations of PTSD were centered on adult presentations. However, the instantiation of developmentally appropriate PTSD in young children (PTSD-YC) criteria, tailored to preschool (6 years old and younger) children, represents an important step toward identifying more young children experiencing distress. This study explored population-level prevalence of PTSD-YC indexed via an alternative algorithm for DSM-IV PTSD (AA-PTSD). MethodRepresentative population data were used to test whether application of AA-PTSD criteria, relative to the DSM-IV PTSD algorithm, increased identification of 5- to 6-year-old children with clinical needs in both the general population (n = 3,202) and among looked after children (ie, in Britain, foster children are called looked after children [more commonly referred to as children in care].) (n = 137), in whom the risk of mental health issues is greater. ResultsNotably, no 5- to 6-year-old children in the general population sample were diagnosed with PTSD using adult-based DSM-IV criteria. In contrast, AA-PTSD prevalence was 0.4% overall, rising to 5.4% in trauma-exposed children. In looked after children, overall PTSD prevalence rose from 1.2% when applying adult-based DSM-IV criteria to 14% when using AA-PTSD criteria. Of trauma-exposed looked after children, 2.7% met criteria for DSM-IV PTSD compared with 57.0% when applying AA-PTSD criteria. In both samples, use of the alternative algorithm to index PTSD-YC criteria markedly increased identification of children experiencing functional impairment owing to symptoms. ConclusionResults demonstrate the utility of the PTSD-YC diagnosis beyond at-risk and treatment-seeking samples. Use of PTSD-YC criteria substantially improves identification of 5- to 6-year-old children burdened by PTSD at the population level.
Highlights
The conceptualization of posttraumatic stress disorder (PTSD) historically has been driven by its clinical presentation in adults.[1]
To elucidate why the different algorithms led to differential rates of identification of PTSD, we examined the number of 5- to 6-year-old children in the general population sample who endorsed at least 1 symptom (AA-PTSD) of criterion C relative to those who endorsed 3 symptoms (DSM-IV)
AA-PTSD 1⁄4 alternative algorithm for DSM-IV PTSD; ADHD1⁄4 attention-deficit/hyperactivity disorder; BAME 1⁄4 Black, Asian, or other minority ethnicity; LAC 1⁄4 looked after children; MDD 1⁄4 major depressive disorder; NOS 1⁄4 disorder not otherwise specified; OCD 1⁄4 obsessive-compulsive disorder
Summary
Posttraumatic stress disorder (PTSD) is a debilitating condition that when left untreated can have severe lifelong consequences for psychological, social, and occupational functioning. Of trauma-exposed looked after children, 2.7% met criteria for DSM-IV PTSD compared with 57.0% when applying AA-PTSD criteria In both samples, use of the alternative algorithm to index PTSDYC criteria markedly increased identification of children experiencing functional impairment owing to symptoms. The review indicated that use of developmentally appropriate PTSDYC criteria in trauma-exposed samples did increase PTSD prevalence estimates in preschool children (and in children up to 8 years of age10) and that the size of the increase ranged from 10% to 50% in studies that compared AA-PTSD or PTSD-YC diagnosis against DSM-IV or DSM-5 (adult-based) criteria. We present exploratory data on AA-PTSD and DSM-IV prevalence estimates across the entire age range of the samples (up to age 18) to provide the relevant context for these decisions
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