Diagnosing PTSD in early childhood: An empirical assessment of four approaches

Authors

  • Michael S. Scheeringa,

    Corresponding author
    1. Tulane Institute for Infant and Early Childhood Mental Health, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Lousiana, USA
    • 1440 Canal St., TB52, New Orleans, LA 70112.
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  • Leann Myers,

    1. Department of Biostatistics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Lousiana, USA
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  • Frank W. Putnam,

    1. Mayerson Center for Safe and Healthy Children, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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  • Charles H. Zeanah

    1. Tulane Institute for Infant and Early Childhood Mental Health, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Lousiana, USA
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  • This research was supported by National Institute of Mental Health grant (R01 MH065884) to Michael S. Scheeringa. The authors thank the Medical Center of Louisiana Charity Hospital Trauma Center, Crescent House, Metropolitan Battered Women's Program, St. Bernard Battered Women's Program, and Children's Bureau of Greater New Orleans.

Abstract

Prior studies have argued that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were insensitive for diagnosing posttraumatic stress disorder (PTSD) in young children. Four diagnostic criteria sets were examined in 284 3- to 6-year-old trauma-exposed children. The DSM-IV criteria resulted in significantly fewer cases (13%) compared to an alternative algorithm for young children (PTSD-AA, 45%), the proposed DSM-5 posttraumatic stress in preschool children (44%), and the DSM-5 criteria with 2 symptoms that are under consideration by the committee (DSM-5-UC, 49%). Using DSM-IV as the standard, the misclassification rate was 32% for PTSD-AA, 32% for DSM-5, and 37% for DSM-5-UC. The proposed criteria sets showed high agreement on the presence (100%), but low agreement on the absence (58–64%) of diagnoses. The misclassified cases were highly symptomatic, M = 7 or more symptoms, and functionally impaired, median = 2 domains impaired. The additional symptoms had little impact. Evidence for convergent validation for the proposed diagnoses was shown with elevations on comorbid disorders and Child Behavior Checklist Total scores compared to a control group (n = 46). When stratified by age (3–4 years and 5–6 years), diagnoses were still significantly elevated compared to controls. These findings lend support to a developmental subtype for PTSD.

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