The importance of the DSM-5 posttraumatic stress disorder symptoms of cognitions and mood in traumatized children and adolescents: two network approaches.

BACKGROUND: The aim of this study is to provide a better understanding of the central symptoms of DSM-5 posttraumatic stress disorder (PTSD) in children and adolescents from the perspective of the child and its caregiver. Identifying core symptoms of PTSD can help clinicians to understand what may be relevant targets for treatment. PTSD may present itself differently in children and adolescents compared to adults, and no study so far has investigated the DSM-5 PTSD conceptualization using network analysis.

METHODS: The network structure of DSM-5 PTSD was investigated in a clinical sample of n = 475 self-reports of children and adolescents and n = 424 caregiver-reports using (a) regularized partial correlation models and (b) a Bayesian approach computing directed acyclic graphs (DAGs).

RESULTS: (a) The 20 DSM-5 PTSD symptoms were positively connected within the self-report and the caregiver-report sample. The most central symptoms were negative trauma-related cognitions and persistent negative emotional state for the self-report and negative trauma-related cognitions, intrusive thoughts or memories and exaggerated startle response for the caregiver-report. (b) Similarly, symptoms in the negative alterations in cognitions and mood cluster (NACM) have emerged as key drivers of other symptoms in traumatized children and adolescents.

CONCLUSIONS: As the symptoms in the DSM-5 NACM cluster were central in our regularized partial correlation networks and also appeared to be the driving forces in the DAGs, these might represent important symptoms within PTSD symptomatology and may offer key targets in PTSD treatment for children and adolescents.