Academic journal article European Journal of Psychotraumatology

Posttraumatic Stress Disorder in Early Childhood: Classification and Diagnostic Issues

Academic journal article European Journal of Psychotraumatology

Posttraumatic Stress Disorder in Early Childhood: Classification and Diagnostic Issues

Article excerpt

INVITED PAPERS 13TH EUROPEAN CONFERENCE ON TRAUMATIC STRESS

Posttraumatic stress disorder in early childhood: classification and diagnostic issues

Alessandra Simonelli*

Department of Developmental and Social Psychology, Padova University, Padua, Italy

Abstract

The 0-3 diagnostic classification of infant mental health, on the basis of DSM-IV-R, describes posttraumatic stress disorder (PTSD) as a pattern of symptoms that may be shown by children who have experienced a single traumatic event, a series of connected traumatic events, or chronic, enduring stress situations. This definition, related to young children, needs the consideration of several factors to understand the child's symptoms, organize the diagnostic process, and realize clinical interventions. In this sense, the clinician must appreciate the classification criteria of PTSD in early childhood in the context of the child's age, temperament, and developmental level. This report presents a review of the research in the domain of the PTSD in early childhood with particular attention to the developmental considerations to define critical diagnostic criteria, specifically organized on the child characteristics, competences, and needs. Along this line, it will describe two proposed modifications of the diagnostic classification in childhood: the Post Traumatic Stress Disorder Alternative Algorithm (PTSD-AA) and the definition of developmental trauma disorder (DTD).

Keywords: posttraumatic stress disorder; early childhood; 0-3 diagnostic classification; PTSD alternative algorithm; developmental trauma disorder

*Correspondence to: Alessandra Simonelli, Department of Developmental and Social Psychology, University of Padova, Via Belzoni, 80, 35131 Padova, Italy, Tel: +39 049 8278456, Email: alessandra.simonelli@unipd.it

For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Received: 9 May 2013; Revised: 9 September 2013; Accepted: 14 September 2013; Published: 20 December 2013

European Journal of Psychotraumatology 2013. © 2013 Alessandra Simonelli. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Citation: European Journal of Psychotraumatology 2013, 4 : 21357 - http://dx.doi.org/10.3402/ejpt.v4i0.21357

According to the review studies by Scheeringa, Zeanah, and Cohen (2011) and Koenen, Roberts, Stone, and Dunn (2010) on community samples of either adults or children (both in infancy and in early childhood), 40-68% of the subjects had experienced at least one potentially traumatic event and 37% had been exposed to more than one. It has been well established from studies on adult populations that while most individuals are resilient to trauma exposure, roughly 30% of traumatized adults will develop posttraumatic stress disorder (PTSD) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) and of these subjects, approximately 50%, will have an unremitting and impaired course of consequences (Davidson & Fairbank, 1993).

Similar to adults, data on children clearly show that post-traumatic symptoms commonly occur following exposure to a traumatic event and don't quickly remit in the course of development.

The studies reveal that 75% of children with PTSD also had at least one comorbid disorder and over 50% of these first occurred after their traumatic experiences (Scheeringa & Zeanah, 2008). The most commonly associated conditions are: oppositional defiant disorder (ODD, 75-61%), separation anxiety disorder (SAD, 68-21%), attention-deficit/hyperactivity disorder (ADHD, 38-33%), and major depressive disorder (MDD, 43-6%) (Scheeringa & Zeanah, 2008; Scheeringa, Zeanah, Myers, & Putnam, 2003). …

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