Post Traumatic Stress Disorder: Cognitive Therapy with Children and Young People

By Patrick Smith; Sean Perrin et al. | Go to book overview

10
Future issues

Recent years have seen considerable advances in our understanding and treatment of traumatic stress reactions in young people. However, much remains to be discovered. A selection of issues that are likely to become a focus of clinical and research attention in the near future are highlighted below.


Delineating children’s traumatic stress reactions

Building on the early clinical descriptions of children’s reactions to extreme stress, recent studies have employed multi-informant, multi-mode methodologies to assess high-risk samples using prospective longitudinal designs (Bryant et al. 2007; Meiser-Stedman et al. 2007). This work has helped to define more precisely the natural history of children’s reactions to trauma, not only in terms of PTSD but also including other reactions such as anxiety, depression and grief. However, progress in our understanding of children’s reactions has also raised a number of important questions. Most obviously, the DSM-IV criteria for PTSD, which were developed for adults, may not capture fully the reactions of young people. When working clinically, the DSM-IV requirement for at least three symptoms of avoidance/ numbing results in many young people being formally categorised as below diagnostic threshold, despite presenting with cardinal PTSD symptoms and clear impairment in functioning. This is most apparent in work with very young (pre-school) children, where the utility of the current diagnostic criteria is doubtful (Scheeringa et al. 2006; Meiser-Stedman et al. 2008). Ongoing and future research will benefit from a focus on refinement to the criteria for making diagnoses in children across the age range, especially younger children. For example, further detailed prospective studies with high-risk young children, assessing both symptoms and functioning over

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