Tuesday, October 21, 2008

Fewer Criteria Needed to Detect PTSD in Children

I found this article very interesting as PTSD is supposedly a issue not many want to tackle as some of you might know first hand.
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New research suggests an alternative approach to diagnosing post traumatic stress disorder (PTSD) that requires fewer avoidance and numbing criteria is more sensitive than standard Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria in detecting this condition in preschool children.
However, the DSM-IV criteria are still preferable for children older than 7 years as are symptom reports from both the parent and child.
The study, which is one of the largest to examine the prevalence of PTSD in youngsters, found that up to 15% of children can experience PTSD and that their condition does not appear to resolve spontaneously.
"This suggests that the mental health needs of young children exposed to traffic accidents and other traumatic events; for example, witnessing violence and other forms of accidents or disasters, need to be considered," study investigator Richard Meiser-Stedman, PhD, from the Institute of Psychiatry, King's College in London, United Kingdom, told Medscape Psychiatry.
The researchers investigated 114 children ranging in age from 2 to 10 years who were involved in a motor vehicle crash and taken to 1 of 3 London emergency departments. Most of the children were pedestrians or passengers in a car, and all sustained relatively minor injuries.
The study is published in the October issue of the American Journal of Psychiatry.
Parents and older children (aged ≥ 7 years) completed structured interviews 2 to 4 weeks after the motor vehicle crash, and 109 families also completed interviews 6 months later. The children were assessed on both the DSM-IV criteria and the alternative approach that requires only 1 of a possible 7 criteria for avoidance or numbing symptoms instead of the standard 3.
Some Symptoms Difficult to Diagnose in Children
The rationale for using the alternative approach is that some standard criteria do not apply to young children, said Dr. Meiser-Stedman. "Some symptoms, for example, not wanting to think about what happened, and feeling emotionally numb, are quite difficult to diagnose in young children, and some symptoms, for example, a sense of a foreshortened future, are just not appropriate to their level of development," he said.
The study found that among younger children aged 2 to 6 years, the rate of PTSD with use of the alternative criteria was 10.0% vs 1.7% with the DSM-IV criteria. As well, the mean number of DSM-IV symptoms in children diagnosed with the alternative criteria was 10.0, indicating that these children were severely symptomatic even when relatively few criteria for the diagnosis were used.
"Our findings suggest that the alternative diagnosis, when applied to preschool children, is a more reliable way to assess for PTSD," said Dr. Meiser-Stedma. "It identifies more children who have clinically significant difficulties stemming from the event they have experienced. The DSM-IV diagnosis is too insensitive; it does not pick up children who are experiencing significant post traumatic stress symptoms and this means it is also of no use in predicting which preschool children will go on to have chronic difficulties."
For the older children, the researchers uncovered a rate of diagnosis of 18.8% by the alternative criteria vs 2.1% with DSM-IV criteria.
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Source and More but you must sign up to the site to see the entire article but this has given you the general idea. It is worth your time signing up to this site.
http://www.medscape.com/viewarticle/582124

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