New findings on alternative criteria for PTSD in preschool children

Michael S Scheeringa, Charles H Zeanah, Leann Myers, Frank W Putnam
Journal of the American Academy of Child and Adolescent Psychiatry 2003, 42 (5): 561-70

OBJECTIVE: An alternative set of criteria for posttraumatic stress disorder (PTSD) for preschool children was analyzed for validity.

METHOD: Sixty-two traumatized children and 63 healthy controls, aged 20 months through 6 years, were assessed. The traumatic experiences included motor vehicle collisions, accidental injuries, abuse, and witnessing violence. The number of symptoms required for clusters C and D and the utility of proposed symptoms were systematically analyzed.

RESULTS: No cases met the DSM-IV algorithm for PTSD. Cluster B was endorsed 67.9% of the time. The proportion of cases meeting the cluster C threshold was 2% when three symptoms were required, 11% when two symptoms were required, and 39% when one symptom was required. The rate of cluster D was 45% when two symptoms were required and 73% when one symptom was required. Four novel symptoms did not substantially add to the diagnostic validity of the criteria. The optimal algorithm (one cluster B symptom, one cluster C symptom, and two cluster D symptoms) diagnosed PTSD at a rate of 26%. Measures of comorbid symptoms concurrently provided convergent validation to support this revised algorithm.

CONCLUSION: Revisions to the DSM-IV PTSD criteria continue to be supported so that highly symptomatic young children can be diagnosed.

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