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Toward an Empirical Definition of Pediatric PTSD: The Phenomenology of PTSD Symptoms in Youth

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ABSTRACT

Objective

To examine the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms and their relation to clinical impairment, to examine the requirement of meeting all DSM-IV symptom cluster criteria (i.e., criteria B, C, D), and to examine the aggregation of PTSD symptom clusters across developmental stages.

Method

Fifty-nine children between the ages of 7 and 14 years with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents.

Results

Data support the utility of distinguishing between the frequency and the intensity of symptoms in the investigation of the phenomenology of pediatric PTSD. Children fulfilling requirements for two symptom clusters did not differ significantly from children meeting all three cluster criteria with regard to impairment and distress. Reexperience (cluster B) showed increased aggregation with avoidance and numbing (cluster C) and hyperarousal (cluster D) in the later stages of puberty.

Conclusions

Frequency and intensity of symptoms may both contribute to the phenomenology of pediatric PTSD. Children with subthreshold criteria for PTSD demonstrate substantial functional impairment and distress.

Section snippets

Participants

The sample was recruited from local social service departments and mental health clinics. All of the children in this sample were referred to the project because of exposure to interpersonal trauma. Therapists and caseworkers were the referring sources. We recruited only children who (1) had at least one episode of exposure to trauma, as defined by DSM-IV criterion A1 (American Psychiatric Association, 1994); (2) had undergone the trauma episode or episodes for which the individual was referred

RESULTS

Fourteen of the 59 children (24%) met full diagnostic criteria for PTSD on the CAPS-CA (criteria A through F). Children within the sample demonstrated a variety of comorbid psychiatric conditions as assessed by the K-SADS. The top six individual comorbid DSM-IV conditions were depressive disorder not otherwise specified (NOS) (12%), major depressive disorder (11%), attention-deficit/hyperactivity disorder (ADHD) (11%), specific phobia (9%), separation anxiety disorder (7%), and social phobia

DISCUSSION

This study contributes to the literature on the phenomenology of pediatric PTSD in three areas. First, data supported the utility of distinguishing between the frequency and the intensity of symptoms. Second, findings supported the hypothesis that children with subthreshold criteria did not differ significantly from children meeting all three cluster criteria with regard to impairment and distress. Third, there was more symptom cluster aggregation in the later stages of puberty. In terms of the

REFERENCES (34)

  • MS Scheeringa et al.

    Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood

    J Am Acad Child Adolesc Psychiatry

    (1995)
  • J Aaron et al.

    Posttraumatic stress in children following acute physical injury

    J Pediatr Psychol

    (1999)
  • TM Achenbach

    Manual for the Child Behavior Checklist and Revised Child Behavior Profile

    (1991)
  • American Academy of Child and Adolescent Psychiatry

    Practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder

    J Am Acad Child Adolesc Psychiatry

    (1998)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)

    (1994)
  • SL Berman et al.

    The impact of exposure to crime and violence in urban youth

    Am J Orthopsychiatry

    (1996)
  • DD Blake et al.

    The development of a clinician-administered PTSD scale

    J Trauma Stress

    (1995)

    • Cited by (0)

    This research was supported by an NIMH Minority Research Supplement Award to Dr. Victor G. Carrion and Dr. Allan L. Reiss (RO1 MH50047). The authors thank Elana Newman, Ph.D., Natalie Pageler, Jessica Letchemanan, and the California San Mateo and San Francisco counties for their participation in this project.

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    Copyright © 2002 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.