Journal of the American Academy of Child & Adolescent Psychiatry
ArticlesNew Findings on Alternative Criteria for PTSD in Preschool Children
Section snippets
Diagnostic Validity of the Alternative Criteria
This alternative set of criteria was compared with the DSM‐IV criteria on a sample of 12 cases younger than 48 months of age (Scheeringa et al., 1995). Four raters rated every symptom for all 12 cases from written case summaries created for the study. The median Cohen ê for interrater reliability for individual alternative symptoms was 0.67 compared with 0.50 for the DSM‐IV symptoms. The κ values ranged from 0.81 to 1.0 for the clusters in the alternative criteria compared with 0.17 to 0.39 for
Participants
Sixty‐two traumatized and 63 healthy control children who were 20 months through 6 years of age were recruited and assessed. The traumatized children were recruited over 16 months from an intensive care inpatient unit of a level 1 trauma center (n = 21), three battered women's shelters (n = 19), an outpatient mental health program that specializes in treating violence‐exposed children (n = 9), a pediatric cancer program (n = 6), and word of mouth (n = 7). Inclusion criteria were that the child
Cluster and Diagnosis Frequencies
The frequencies of each cluster and the rate of diagnosis for varying algorithm thresholds are listed in Table 2. Cluster B (reexperiencing) was common (68%). Cluster C (avoidance/numbing) based on the DSM‐IV threshold of three or more symptoms was extremely rare (2%) but became much more common when the threshold was lowered to one symptom (39%). Cluster D (arousal) was common when the DSM‐IV threshold of two symptoms (45%) was used, and it was more common when only one symptom was required
DISCUSSION
The results of this study make several contributions to understanding the diagnostic validity of PTSD in young children. First, validation was provided again for developmentally modifying the DSM‐IV criteria. The optimal (tentative) revision suggested by these findings is lowering the threshold for cluster C from three symptoms to one symptom. This results in a diagnosis rate of 26%, which contrasts to the DSM‐IV rate of 0%. The 26% rate is much more consistent with studies of traumatized older
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Supported by NIMH grant K08 MH01706 (Dr. Scheeringa) and the MacArthur Foundation Research Network on Early Experience and Brain Development (Dr. Zeanah). The authors thank the Medical Center of Louisiana Charity Hospital Trauma Center, the nursing staff of the Surgical Intermediate Care Area, Crescent House, Metropolitan Battered Women's Program, the Tulane Hospital for Children Pediatric Hematology/Oncology program, Children's Bureau of Greater New Orleans, and the Jefferson Parish Head Start program.