Posttraumatic Stress Disorder Symptoms In Children Research Articles

Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma.

Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.

Epigenetic Age Acceleration and Risk for Posttraumatic Stress Disorder following Exposure to Substantiated Child Maltreatment

ABSTRACT Objective: Child maltreatment is among the strongest predictors of posttraumatic stress disorder (PTSD). However, less than 40% of children who have been maltreated are ever diagnosed with PTSD, suggesting that exposure to child maltreatment alone is insufficient to explain this risk. This study examined whether epigenetic age acceleration, a stress-sensitive biomarker derived from DNA methylation, explains variation in PTSD diagnostic status subsequent to child maltreatment. Method: Children and adolescents (N = 70; 65.7% female), 8–15 years of age (M = 12.00, SD = 2.37) and exposed to substantiated child maltreatment within the 12 months prior to study entry, were enrolled. Participants provided epithelial cheek cells via buccal swab for genotyping and quantification of epigenetic age acceleration within a case-control design. PTSD diagnostic status was determined using the Child PTSD Symptoms Scale according to the DSM-IV-TR algorithm. Results: Epigenetic age acceleration predicted current PTSD status, revealing an effect size magnitude in the moderate range, OR = 2.35, 95% CI: 1.22– 4.51, after adjusting for sample demographics, polygenic risk for PTSD, and lifetime exposure to other childhood adversities. Supplemental analyses demonstrated that epigenetic age acceleration was related to a greater severity of PTSD arousal symptoms (r =.29, p =.015). There were no differential effects for child maltreatment subtype on epigenetic age acceleration or PTSD status. Conclusions: The biological embedding of child maltreatment may explain variation in PTSD diagnostic status and serve as a novel approach for informing selective prevention or precision-based therapeutics for those at risk for PTSD.

Effect of Psychodrama on Post-traumatic Stress Disorder Symptoms in Primary School Students Living in Earthquake-stricken Areas

Objectives: This study aims to determine the effectiveness of psychodrama in reducing the symptoms of Post-Traumatic Stress Disorder (PTSD) in primary school students living in earthquake-stricken areas. Methods: This is a quasi-experimental study with pre-test/post-test design using a control group. The study population consists of all male primary school students diagnosed with PTSD living in Salas-e Babajani County, Kermanshah, Iran. Of these, 40 were selected using a purposive sampling method and based on the PTSD criteria, and were then divided into two groups of intervention (n=20) and control (n=20). Research instruments were a diagnostic interview based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria and the PTSD Checklist for DSM5 (PCL-5) questionnaire. Data were analyzed using one-way and multivariate analysis of covariance. Results: Psychodrama reduced the symptoms of PTSD in children with an effect size of 0.51 (P<0.001). Conclusion: Psychodrama is an effective method for reducing the PTSD symptoms and neuropsychological problems. For the generalization of its results, further studies are recommended.

Biological and Environmental Factors Affecting Risk and Resilience among Syrian Refugee Children.

More than 21 million people globally are refugees. More than half of these (>10 million) are children, representing a highly vulnerable population. Most children experience high levels of trauma exposure, including war trauma, as well as substantial migration- and resettlement-related stress. These exposures confer risk for mental health problems, including posttraumatic stress disorder (PTSD), but their relative contributions have not been fully explicated. These effects may be modulated by the developmental timing of trauma and stress exposure: childhood trauma and stress are broadly linked to worse health outcomes across the lifespan, but the developmental specificity of these effects remains uncertain. Refugee children typically experience the trauma leading up to displacement (e.g., civil war) which often lasts for decades, and for some, followed by resettlement. Longitudinal studies that follow children through this process can provide unique insight into how these experiences of trauma, displacement, and resettlement during development impact mechanisms of risk and resilience. They can also elucidate how environmental and physiological factors may modulate the effects of trauma and stress. The present study includes two groups of families (parents and their 7- to 17-year-old children): (1) Syrian and Iraqi refugee families who experienced war-zone trauma before resettling in the United States in ~2016, and (2) Arab immigrant families who did not experience war-zone trauma prior to resettlement in the United States in ~2016. We assessed symptoms of anxiety, depression, and PTSD in refugee and immigrant children and parents. Skin conductance responses, a measure of autonomic response, saliva samples for genetic and epigenetic analyses, and information about social and environmental context, including family structure, resources, and neighborhood quality, were also collected. Refugee participants provided data at three time points spanning ~3 years following resettlement in the United States: Wave 1, within 1 month of resettlement, Wave 2, 12–24 months post resettlement, and Wave 3 planned for 24–36 months resettlement. Immigrant participants will provide data once, within 3–5 years after immigration, matching the age of Wave 1. This comparison group enables us to compare mental health and biomarkers between refugees and immigrants. Results of these comparative analyses will provide insight into the impact of war trauma versus other types of trauma and adversity on biomarkers of child mental health outcomes. Results from the longitudinal analyses will address refugee mental health trajectories over time, and, in children, across development. Initial data from Wave 1 showed high levels of anxiety in refugee children, as well as high levels of PTSD symptoms and anxiety in their parents. Together, results from these comparative and longitudinal analyses will provide insight into multiple aspects of trauma and stress exposure in refugees and immigrants, including how the developmental timing of trauma exposure impacts biomarkers and mental health across development. Our assessment of multiple factors affecting childhood mental health following trauma exposure, including familial, neighborhood and social context following resettlement may identify modifiable targets for interventions to support well-being in refugees.

Posttraumatic Symptoms in 3\u20137 Year Old Trauma-Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress

Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3–7 year old children reported on their child’s symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment.

The Child PTSD Symptom Scale: Psychometric Properties among Earthquake Survivors.

Evidence for a single underlying factor structure of posttraumatic stress disorder (PTSD) in children remains elusive. We assessed the underlying factor structure of the Child PTSD Symptom Scale through exploratory (EFA) and confirmatory factor analyses (CFA) in 570 survivors of the 2015 Gorkha earthquake in Nepal. The EFA suggests that the three-factor DSM-IV model fit these data best. The CFA suggests that while the DSM-IV model adequately fit these data, the four-factor King model fit them better. There was no evidence of differential item functioning by age or gender, and internal consistency of the scale was high. PTSD (overall or by factor) was not correlated with functional impairment. Inconsistent psychometric results across contexts and methodologies suggest that our current theoretical conceptualizations and empirical models of posttraumatic stress are lacking. Future studies must both document the instrument properties to assure internal validity and cross-study comparisons and, bolstered by increased psychometric data and analyses, rework theoretical models of PTSD with improved cross-cultural validity.

The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents

BackgroundMaltreatment by a primary caregiver is an important risk factor for the development of PTSD symptoms. Whereas meta-analyses indicate that parental emotional abuse is one of the most common forms of maltreatment, the impact of emotional abuse on PTSD symptoms and treatment effectiveness is still unclear, especially in children. ObjectiveWe aimed to investigate the impact of parental emotional abuse on PTSD symptom severity and effectiveness of trauma treatment in children and adolescents. MethodIn an outpatient sample (N = 287, mean age = 15.5 years), emotional abuse, index traumatic event, and PTSD symptoms were assessed at baseline. Thereafter, patients received evidence-based treatment for trauma-related symptoms embedded in a broader (systemic) treatment package. In a subsample (n = 130, mean age = 15.3 years) PTSD symptoms were assessed again 6 and 12 months after baseline. ResultsEmotional abuse (rather than any other type of maltreatment) was associated with more severe PTSD symptoms in all symptom clusters. This was independent of whether emotional abuse was reported as index traumatic event or not. Moreover, PTSD symptoms were significantly reduced 6 months after the start of trauma-focused treatment, and emotional abuse was associated with more severe PTSD symptoms over the course of treatment. ConclusionsThese findings underline the detrimental nature of emotional maltreatment in the context of PTSD symptomatology and treatment effectiveness. This calls for routine assessment of parental emotional abuse in the diagnostic phase, even when this is not the reason of referral.

Test of the dynamic interplay between DSM-5 PTSD symptom clusters in children and adolescents

BackgroundRevealing the dynamic interplay between posttraumatic stress disorder (PTSD) symptom clusters has always been an important topic in traumatic stress studies. Based on longitudinal studies, different hypotheses have been proposed to explain PTSD symptom dynamics. But currently, no study have been conducted to test these hypotheses in children and adolescents. MethodsData were derived from a longitudinal study of child and adolescent traumatic event survivors of an explosion accident (N = 659). DSM-5 PTSD symptoms was measured by the PTSD Checklist-5 (PCL-5) at 4, 8, and 13 months after the disaster. Latent difference score (LDS) modeling was used to evaluate the dynamic interplay between clusters. ResultsThe results of LDS model indicated that intrusion level positively predicted subsequent rate of increase for hyperarousal (p = .008) and negative changes in cognitions and mood symptoms (p = .036). Also, intrusion level trended to positively predict subsequent increase rate of avoidance symptoms (p = .059). ConclusionsThis study expands previous knowledge of dynamic relations between symptom clusters during the maintenance and fluctuation of child and adolescent PTSD symptoms. By using new methodology, this study provided novel evidence for the hypothesis that intrusion symptom plays an important role in maintaining other PTSD symptoms.

Posttraumatic Stress Disorder and Posttraumatic Growth: Two Realities among Flood Affected School Going Children in Pakistan

The present study tended to study the relationship between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). It also covers the predictive role of demographic features and flood-related experiences for PTSD and PTG in school children living in the flood-prone area of Southern Punjab, Pakistan. 273 school going children were assessed in 2016 after one year to expose flood. Urdu version of Posttraumatic Growth Inventory for Children –Revised, Child PTSD Symptom Scales and demographic form were used to assessPTG and PTSD respectively in children falling in the age range of 11-17 years. The devastation of the school building and financial loss in form of crop damage were the positive predictors of PTSD. Moreover, living in tents, the experience of homelessness, financial losses, exposure to wounded and dead bodies, education, and occupation of the father were noteworthy indicators of PTG. No relationship was noted between PTSD and PTG. Findings supported the notion that PTSD and PTG can coexist therefore clinical implications and ideas related to preventive planning are discussed.

PTSD symptoms and cortisol stress reactivity in adolescence: Findings from a high adversity cohort in South Africa

BackgroundDysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in the pathophysiology of post-traumatic stress disorder (PTSD). However, there has been little study of HPA stress reactivity in association with PTSD symptoms (PTSS) in children; and there is limited research on PTSD in low and middle-income countries, where trauma exposure is more common and co-occurring stressors more likely. MethodWe assessed the relationship between PTSS and cortisol stress reactivity in children aged 13 years (N = 291) from an impoverished South African community. HPA axis stress reactivity was indexed by salivary cortisol during the Trier Social Stress Test (TSST). ResultsIn regression analyses both trauma exposure and PTSS showed small inverse associations with total cortisol output (area under the curve with respect to ground) during the TSST, but PTSS effects did not withstand correction for covariates. In addition, hierarchical linear modelling (HLM) found that PTSS were associated with alterations in the shape of the profile of cortisol reactivity that were moderated by sex. In girls, PTSS were associated with reduced linear slope but larger quadratic slopes, whereas the opposite pattern was found in boys. Thus, elevated PTSS were associated with overall blunted profiles of cortisol stress reactivity in girls, but a larger quadratic slope in boys reflects a steeper cortisol increase and decline in boys. There was no relationship between trauma exposure (with or without PTSS) and cortisol reactivity profiles in HLM analyses. ConclusionIn children from a high adversity, low and middle income country context, sex specific associations were found between PTSS and cortisol responses to psychosocial stress. Further research should probe HPA axis functioning more comprehensively in such populations to understand the biological associations of PTSS.

A Pilot and Feasibility Randomized Controlled Trial of Dyadic Exposure Therapy and Dyadic Client-Centered Therapy for Posttraumatic Preschool Children and Their Caregivers

Treatment protocols for preschoolers with posttraumatic stress disorder (PTSD), especially following single trauma and medical trauma exposure, are sparse. The co-occurring severity of caregivers’ and children’s posttraumatic symptoms is a robust finding. Consequently, treatment that focuses both on children’s and caregivers’ PTSD symptoms directly is important. The study aims were to evaluate the feasibility of dyadic exposure therapy (DET) and supportive dyadic client-centered therapy (DCCT) and to perform a preliminary analysis of the degree of change in DET and DCCT. Twelve preschoolers (M = 49.25 months, SD = 13.84) with PTSD, their 12 mothers and 9 of their fathers, were randomly assigned to 15 sessions of DET (n = 6) or DCCT (n = 6). All participants completed their respective interventions. Only DET yielded significant improvements on mother-rated measures of child and maternal PTSD symptoms and appraisals. Therapy focused on child-caregiver PTSD symptoms directly may ameliorate the bidirectional effects of symptomatic responses within the traumatized dyad.

Examining the Psychometric Properties of the Child PTSD Symptom Scale Within a Sample of Unaccompanied Immigrant Children in the United States

This study examines: (a) rates of posttraumatic stress disorder (PTSD) in a sample of unaccompanied immigrant children in the United States, and (b) psychometric properties of the Child PTSD Symptom Scale. Caseworkers subcontracted by Lutheran Immigration and Refugee Services originally collected data in 2018 from unaccompanied children from El Salvador, Guatemala, and Honduras who received post-release services in nine states (n = 149). The overall rate of PTSD in the sample was 8.1%; differences by country of origin were observed. Results from an exploratory factor analysis indicate a three-factor model is the best fit for the data. Internal reliability for the total CPSS scale was excellent (α = .93). Implications for practice and future research are also discussed.

Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa

BackgroundWhile intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system. ObjectiveWe used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts. Participants and settingSchool-aged children and their mothers from one domestic violence shelter in each city were invited to participate. MethodsChildren were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1−2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self-reports (n = 21) and mother’s report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention. ResultsAt baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7–8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0–34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours. ConclusionThis pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.

Changes in the Network Structure of Post-traumatic Stress Disorder Symptoms Among Earthquake Exposed Adolescents in China: A 2-Year Longitudinal Study.

Despite considerable studies focused on the symptoms of posttraumatic stress disorder (PTSD), little is understood about how symptoms of PTSD naturalistically change over time. Using network analyses approaches, the current study aimed to understand the nature of the association between PTSD symptoms at different time points among adolescents who experienced an earthquake. This study enrolled 900 youth survivors who completed 3 assessments with the Child PTSD Symptom Scale at 1year, 1.5years, and 2years after the Wenchuan earthquake. A graphical Gaussian model (GGM) was used to investigate how symptom networks changed across these time points and to identify the symptoms that were the most central within the network. Results from GGM indicated that different symptoms were observed to have highest centrality at different time points. Feeling distant or cut off from others, avoid thoughts and feelings about the trauma, and feeling irritable or having angry outbursts appeared as the node with highest centrality at 1year (T1), 1.5years (T2), and 2years (T3) post-earthquake, respectively.

An Innovative Mobile Game for Screening of Pediatric PTSD: a Study in Primary Care Settings.

Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants (n = 49) were children attending primary care appointments between 8 to 12years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency (α = 0.79), was significantly positively correlated to the total CPSS-5-SR (r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR (r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions.

Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity.

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Eye Movement Desensitization Reprocessing for Children and Adolescents With Posttraumatic Stress Disorder: A Systematic Narrative Review

There is currently a limited number of studies into the efficacy of eye movement desensitization reprocessing (EMDR) therapy with children and adolescents with posttraumatic stress disorder (PTSD). The current study utilizes a systematic narrative review of methodologies and findings of previous literature reviews and meta-analyses as well as analyzing randomized control trials (RCTs) conducted from 2002 to 2018. Following initial scoping of the extent of studies, two systematic literature searches were conducted, firstly for literature reviews and secondly for recent RCTs. Nine databases were utilized. Eight reviews and seven RCTs were identified and analyzed for quality of methodology and outcome as measured by impact on PTSD symptoms. EMDR was found to be efficacious in reducing children's PTSD symptoms compared to waitlist conditions, with similar outcomes to cognitive behavior therapy (CBT). EMDR was effective with both single-event trauma as well as cumulative trauma such as sexual abuse. EMDR was equally effective with girls and boys as well as children from different cultures. EMDR achieved medium to large effect sizes. Reductions in PTSD were maintained at 2-, 3-, 6-, and 12-month follow-up. In conclusion, EMDR was consistently found to be an efficacious treatment for children with PTSD. Recommendations are made for future practice and research.

Longitudinal cross-lagged relationships between posttraumatic stress disorder and depression in adolescents following the Yancheng tornado in China.

The aim of this study was to examine the comorbidity and longitudinal cross-lagged relationships between posttraumatic stress disorder (PTSD) and depression among Chinese adolescents after their experience of the Yancheng tornado. A total of 154 adolescents from 2 local middle schools in Yancheng city participated in this longitudinal study. Participants completed the Child PTSD Symptom Scale and the Center Epidemiological Studies of Depression at 6 months (T1), 9 months (T2), and 12 months (T3) after the tornado, respectively. Results include the following: (a) the prevalence of PTSD was 55.84% at T1, 50.00% at T2, and 47.40% at T3; the prevalence of depression was 56.49% at T1, 65.58% at T2, and 66.01% at T3; (b) the comorbidity between PTSD and depression was high, 46.75% at T1, 42.86% at T2, 43.51% at T3; (c) PTSD at T1 significantly predicted depression at T2 (β = 0.42, p < .001), and PTSD at T2 significantly predicted depression at T3 (β = 0.64, p < .001); however, depression cannot significantly predict PTSD at different cross-time points. The results suggest that there is comorbidity between PTSD and depression and that PTSD positively influence the development of depression in adolescents during the early period of the tornado, whereas depression did not predict PTSD. The implications of the results for the psychological services provided to children and youth are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessing Reliability and Validity of the Child PTSD Symptom Scale in Portuguese Adolescents

ObjectiveThis study assessed psychometric properties of a self-reported measure of posttraumatic stress disorder (PTSD) for adolescents based on DSM-5 criteria–the Child PTSD Symptom Scale–Self Report. We tested the internal consistency, test-retest reliability, and convergent validity. MethodThe participants were 317 Portuguese adolescents (53% females) between 13 and 17 years old who had experienced at least one traumatic event or one childhood adversity. A subset of the sample (n=85) completed test-retest measures (interval range between 5 and 7 months). ResultsAnalyses revealed good to excellent internal consistencies, moderate to good agreement test-retest reliability, and good convergent validity. ConclusionsResults supported the use of the CPSS-SR-5 scale as a valid and reliable measure for the identification of PTSD symptoms and probable diagnosis according to DSM-5 criteria in Portuguese adolescents.

Post‐traumatic stress symptoms of children and adolescents exposed to the 2008 Wenchuan Earthquake: A longitudinal study of 5‐HTTLPR genotype main effects and gene–environment interactions

Experiencing disasters causes severe mental disorders, among which post-traumatic stress disorder (PTSD) is the most common. We conducted a longitudinal study to examine the effect of 5-hydroxyl tryptamine transporter gene-linked polymorphic region (5-HTTLPR) genotype on child and adolescent PTSD symptom course after the 2008 Wenchuan Earthquake. We genotyped 963 participants who personally experienced the earthquake. PTSD symptoms were measured by University of California, Los Angeles PTSD reaction index at 2.5, 3.5, 4.5 and 5.5 years after the earthquake, respectively. Latent growth model was utilised to examine the main effect and gene-environment interaction effect of 5-HTTLPR on PTSD's symptom course. 5-HTTLPR genotype predicted initial PTSD symptom severity (β=0.108, p=.019) and rates of symptom recovery (β=-0.120, p=.031) between 2.5 and 5.5 years. Compared with L' allele carriers, those with S'S' genotype showed higher initial symptom severity but also faster recovery rate. 5-HTTLPR genotype only predicted symptom severity at 2.5 years after the earthquake, after controlling for sex, age, ethnicity and trauma severity (β=0.108, p=.019). This is the first evidence of the effect of 5-HTTLPR genotype on child and adolescent PTSD symptoms longitudinally, offering a novel perspective on the effect of 5-HTTLPR on PTSD symptom development following trauma exposure.