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Posttraumatic Stress Disorder in Very Young Children: Diagnostic Agreement Between ICD-11 and DSM-5
Mira Vasileva1, Ann-Christin Haag2, Markus A Landolt2,3
1Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany.
Insights
The International Classification of Diseases (11th rev.; ICD-11) criteria for posttraumatic stress disorder (PTSD) appear less sensitive in very young children compared to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5). This study compared diagnostic agreement in children aged 1-6 years.
Area of Science:
- Child and Adolescent Psychiatry
- Psychological Assessment
- Trauma Studies
Background:
- Diagnostic criteria for posttraumatic stress disorder (PTSD) vary in prevalence among very young children.
- Previous research on the International Classification of Diseases (11th rev.; ICD-11) for PTSD has primarily focused on children over 6 years old.
- Understanding diagnostic agreement is crucial for accurate assessment and intervention in pediatric populations.
Purpose of the Study:
- To evaluate the diagnostic agreement between the ICD-11 and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for PTSD in children aged 6 years and younger.
- To compare the prevalence rates of PTSD using both ICD-11 and DSM-5 criteria in young children.
- To explore potential modifications to the ICD-11 criteria to improve diagnostic agreement.
Main Methods:
- Caregivers of children (N=147, aged 3-6 years) in foster care in Germany and parents of children (N=149, aged 1-4 years) treated for burns in Switzerland completed PTSD questionnaires.
- PTSD rates were calculated using ICD-11 (with two conceptualizations of intrusive memories) and DSM-5 criteria.
- Statistical analyses included McNemar's tests and Cohen's kappa to compare diagnostic agreement.
Main Results:
- The ICD-11 criteria identified 0.6-25.8% fewer PTSD cases compared to DSM-5 criteria in young children.
- Moderate diagnostic agreement was found between ICD-11 algorithms and DSM-5 criteria (κ = 0.52-0.66).
- The DSM-5 criteria demonstrated higher predictive power for functional impairment than the ICD-11 algorithms.
Conclusions:
- The ICD-11 criteria appear less sensitive in diagnosing PTSD in very young children, potentially due to a more stringent avoidance cluster.
- Adaptations to the ICD-11 avoidance cluster symptom combinations could enhance diagnostic agreement with DSM-5.
- Further research is needed to refine PTSD diagnostic criteria for optimal application in pediatric populations.
Abstract:
The prevalence of posttraumatic stress disorder (PTSD) in very young children depends on the diagnostic criteria. Thus far, studies have investigated the International Classification of Diseases (11th rev.; ICD-11) criteria for PTSD only in samples of children older than 6 years of age. The aim of this study was to test the diagnostic agreement between the ICD-11 and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for children who are 6 years old and younger. Caregivers of children aged 3-6 years in foster care in Germany (N = 147) and parents of children aged 1-4 years who had attended a hospital in Switzerland following burn injuries (N = 149) completed a questionnaire about children's PTSD. Rates of PTSD were calculated according to ICD-11 (considering a specific and a more general conceptualization of intrusive memories) and DSM-5 criteria and were compared using McNemar's tests and Cohen's kappa. The proportion of children who met the ICD-11 criteria was 0.6-25.8% lower than the proportion of PTSD cases according to the DSM-5 criteria. The diagnostic agreement between each ICD-11 algorithm and DSM-5 was moderate, κ = 0.52-0.66. A systematic investigation of adaptions of the ICD-11 avoidance cluster identified alternative symptom combinations leading to higher agreement with the DSM-5 requirements. Furthermore, DSM-5 had higher predictive power for functional impairment than the ICD-11 algorithms. In conclusion, the findings suggest that the ICD-11 criteria show less sensitivity in very young children, which can be explained by the more stringent avoidance cluster.
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