Academic journal article Journal of Early Childhood and Infant Psychology

Posttraumatic Stress Disorder in Infants, Toddlers, and Young Children: Diagnostic Considerations

Academic journal article Journal of Early Childhood and Infant Psychology

Posttraumatic Stress Disorder in Infants, Toddlers, and Young Children: Diagnostic Considerations

Article excerpt

Prevalence of Trauma Exposure

Young children are frequently exposed to traumatic events in the United States and throughout the world. An appreciation of the prevalence of trauma exposure and the indicators of negative reactions to stress is critical for professionals working with young children. According to the National Center for Injury Prevention and Control (NCIPC, 2004), 903,000 children in the United States were at risk for or experienced abuse and or neglect in 2001. The Office of the Press Secretary of the United States reported that in 2002 approximately 900,000 children were victims of abuse or neglect. Physical abuse was evident among 19% of victims and 10% were sexually abused. Similarly, the NCIPC (2001) reports that approximately 30% of rapes occur before the age of 12.

With respect to accident related traumas a host of events (e.g., motor vehicle accidents, dog bites, bicycle accidents, fires) have been investigated and suggest high degrees of traumatic exposure in the early years of life. For example, the 2003 motor vehicle accident injury rate for children less than 5 years was 300 per 100,000 and increased to 372 per 100,000 between the ages of 5-9 years (National Highway Traffic Safety Administration, 2004). Nearly 31,000 children between the ages of 5-14 years accounted for pedestrian-related injuries in 2002 (NCIPC, 2004). With regard to non-motor vehicle accidents the 2003 injury rates were 15 per 100,000 and 59 per 100,000 for less than 5 years of age and 5 to 9 years of age, respectively. Bicycling accidents account for approximately 140,000 children under the age of 15 who are treated for traumatic brain injuries. Furthermore, the risk for dog bites is greater among children, with 2.5% of children per year being bitten by a dog (NCIPC, 2001). In addition, 45% of fireworks-related injuries involved children below the age of 14 years with children 5 to 9 years old being at greatest risk. Similarly, children under 4 are at greater risk for fire-related injuries (NCIPC, 2004). Given the degree of exposure to traumatic events, it is important to understand the reactions infants, toddlers, and children may have to such traumatic events.

History of Stress Reactions in Children

The effects of traumatic experiences on young children have long been of interest to clinicians and researchers. As early as 1937, Bender and Blau examined sixteen children at the Children's Ward of the Psychiatric Division of Bellevue Hospital who had had sexual relations with adults. The authors made specific reference to feelings of fear, avoidance, irritability, nightmares, trauma reenactments, and hypervigilance. In some cases, academic impairment was also indicated. Whereas a great majority of literature during World War II recorded the symptoms of adults exposed to war-related stressors (Saigh, 1992), several researchers (e.g., Bodman, 1941; Mercer & Despert, 1943) examined the psychiatric morbidity of children who were exposed to comparable stressors.

In 1941, Frank Bodman, the Deputy Director of the Bristol Child Guidance Clinic, reported on the findings of a survey examining the incidence of "strain" following the British air-raids on 8,000 British school children ranging in age from five to fourteen years. It was observed that 4% presented with psychological (e.g., nightmares, war-related fears, psycho-physiological reactivity, avoidance, aggressive behaviors) or psychosomatic (e.g., headaches, enuresis, encopresis, indigestion) symptoms. Given that this survey was conducted during a time when raids were still occurring, Bodman conducted a follow-up study with 54 children (age range 2 months to 12 years) who had been evacuated from the Children's Hospital in Bristol. According to Bodman (1941), "soldiers were crunching through a litter of broken glass, fallen plaster, and blown-in black- out material, picking children out of cots and beds and, tucking them under their arms, running down the steps and dumping them pell-mell into the lorry" (p. …

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