This algorithm was problematic as several symptoms from the DSM-IV avoidance cluster (e.g., a sense of hopelessness) were rarely detectable in young children, leading to under-diagnosis of the disorder (Scheeringa et al. Under DSM-IV, to receive a PTSD diagnosis, a young child must have experienced a Criterion A trauma eliciting high levels of affect, presented with at least one re-experiencing symptom, three avoidance symptoms, two arousal symptoms, and shown impaired functioning. Studies leading up to the DSM-5 revealed that PTSD was underdiagnosed in young children (Scheeringa et al. The introduction of posttraumatic stress disorder for children 6 years and younger (PTSD-6Y) in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5 2013) is an important acknowledgement that stress responses of young children show developmental differences compared to adults. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These two models also only showed small levels of convergence with CBCL dimensions. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. Criterion related validity was established by comparing each model to a categorical rating of impairment. Convergent validity was established against the Child Behavior Checklist (CBCL). The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. doi:10.A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Pharmacologic treatment approaches for children and adolescents with posttraumatic stress disorder. Responding to Students with Posttraumatic Stress Disorder in Schools. Kataoka S, Langley AK, Wong M, Baweja S, Stein BD. Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period. Marsac ML, Kassam-Adams N, Delahanty DL, Widaman KF, Barakat LP. Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets. Identification of trauma exposure and PTSD in adolescent psychiatric inpatients: An exploratory study. Havens JF, Gudiño OG, Biggs EA, Diamond UN, Weis JR, Cloitre M. How Common is PTSD in Children and Teens?. Department of Veterans Affairs National Center for PTSD. Post-traumatic Stress Disorder in Children. Journal of Clinical Child & Adolescent Psychology. Aggressive behavior and its associations with posttraumatic stress and academic achievement following a natural disaster. Post-traumatic stress disorder diagnosis in children: challenges and promises. Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. Research Review: Changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma - a meta-analytic study. Hiller RM, Meiser-Stedman R, Fearon P, et al. Substance Abuse and Mental Health Services Administration (SAMHSA).
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