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PTSD in children and adolescents: toward an empirically based algorithma
Michael S Scheeringa1, Charles H Zeanah, Judith A Cohen
1Institute of Infant and Early Childhood Mental Health, Tulane University School of Medicine, New Orleans, Louisiana, USA. mscheer@tulane.edu
Depression and Anxiety
|August 25, 2010
Summary
Revising the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) requires considering developmental influences on posttraumatic stress disorder (PTSD) symptoms in children. Recommendations include modifying PTSD criteria for preschoolers and school-aged children to improve diagnosis.
Area of Science:
- Child and Adolescent Psychiatry
- Psychological Diagnostics
- Developmental Psychology
Background:
- Diagnostic criteria for posttraumatic stress disorder (PTSD) require revision to better account for developmental influences.
- Current DSM-IV criteria for PTSD have been evaluated for their applicability to children and adolescents.
- Understanding developmental variations in symptom expression is crucial for accurate diagnosis.
Purpose of the Study:
- To review research on posttraumatic stress disorder (PTSD) symptom expression in children and adolescents.
- To provide recommendations for revising the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for PTSD.
- To assess the utility of existing DSM-IV PTSD criteria in pediatric populations.
Main Methods:
- Systematic review of research published in the last 15 years on PTSD in preschool children, school-aged children, and adolescents.
- Analysis of studies examining the DSM-IV criteria for PTSD in these age groups.
- Evaluation of evidence supporting modifications to PTSD diagnostic criteria.
Main Results:
- Evidence supports modifying criteria A-D for PTSD to include developmental manifestations in preschool children.
- A distinct preschool PTSD subtype is suggested, lowering the symptom threshold for Cluster C from three to one.
- Limited evidence suggests modifications, including fewer Cluster C symptoms, may improve PTSD diagnosis accuracy in school-aged children and adolescents.
Conclusions:
- Developmental considerations are essential for revising PTSD diagnostic criteria in the DSM-V.
- Specific modifications are recommended for preschool children, including a new subtype.
- Further research is needed to refine PTSD diagnostic criteria for school-aged children and adolescents.
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