Posttraumatic Stress Disorder in Children Under 6: A Comprehensive Review of the New Diagnosis
Research has shown that a significant number of young children will experience a traumatic event at some point during their lifetime. These experiences have also been shown to lead to negative reactions and adverse outcomes if not properly addressed and treated. Sometimes individuals who experience these traumatic events develop posttraumatic stress disorder (PTSD); however, concern about the under-diagnosis of PTSD in young children has only recently led to the creation of a subtype specifically for children ages six and under. This paper reviews and critically evaluates the Diagnostic and Statistical Manual of Mental Disorders’ (5th ed.; DSM-5; APA, 2013) novel PTSD subtype and empirical research supporting this new addition. Additionally, this paper summarizes empirical findings regarding the presentation of PTSD in young children and highlights areas for future research.
Keywords: childhood trauma, DSM-5, posttraumatic stress disorder
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd edition). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edition). Washington, DC: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Biederman, J., Mick, E., Faraone, S. V., Spencer, T., Wilens, T. E., & Wozniak, J. (2000). Pediatric mania: a developmental subtype of bipolar disorder? Biological Psychiatry, 48, 458–466. https://doi.org/10.1016/S0006-3223(00)00911-2
Blank, M. (2007). Posttraumatic stress disorder in infants, toddlers, and preschoolers. British Columbia Medical Journal, 49, 133–138.
Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence, and Abuse, 10, 198–210. https://doi.org/10.1177/1524838009334448
Breslau, N., & Kessler, R. C. (2001). The stressor criterion in DSM-IV-TR posttraumatic stress disorder: an empirical investigation. Biological Psychiatry, 50, 699–704.
Brewin, C. R., Lanius, R. A., Novac, A., Schnyder, U., & Galea, S. (2009). Reformulating PTSD for DSM-V: Life after Criterion A. Journal of Traumatic Stress, 22, 366–373. https://doi.org/10.1002/jts.20443
Cohen, J. A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with co-occurring trauma and behavior problems. Child Abuse & Neglect, 34, 215–224. https://doi.org/10.1016/j.chiabu.2009.12.003
Cohen, J. A., Kelleher, K. J., & Mannarino, A. P. (2008). Identifying, treating, and referring traumatized children: the role of pediatric providers. Archives of Pediatrics & Adolescent Medicine, 162, 447–452. https://doi.org/10.1001/archpedi.162.5.447
Courtois, C. A., & Ford, J. D. (2009). Treating Complex Traumatic Stress Disorders (Adults): Scientific Foundations and Therapeutic Models. Guilford Press.
Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310–321. https://doi.org/10.1177/1077559596001004003
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Steer, R. A. (2011). Trauma-focused cognitive behavioral therapy for children: Impact of the trauma narrative and treatment length. Depression & Anxiety (1091-4269), 28, 67–75. https://doi.org/10.1002/da.20744
Dehon, C., & Scheeringa, M. S. (2006). Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist. Journal of Pediatric Psychology, 31, 431–435. https://doi.org/10.1093/jpepsy/jsj006
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Fivush, R. (1998). Children’s recollections of traumatic and nontraumatic events. Development and Psychopathology, 10, 699–716.
Foy, D. W., 1944-, Madvig, B. T., & Pynoos, R. S., 1947-. (1996). Etiologic factors in the development of posttraumatic stress disorder in children and adolescents. Journal of School Psychology, 34, 133–145. https://doi.org/10.1016/0022-4405(96)00003-9
Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting here from there and where to go next. Journal of Traumatic Stress, 26, 548–556. https://doi.org/10.1002/jts.21840
Karatzias, T., Shevlin, M., Hyland, P., Brewin, C. R., Cloitre, M., Bradley, A., … Roberts, N. P. (2018). The role of negative cognitions, emotion regulation strategies, and attachment style in complex post-traumatic stress disorder: Implications for new and existing therapies. The British Journal of Clinical Psychology. https://doi.org/10.1111/bjc.12172
Kramer, D. N., Hertli, M. B., & Landolt, M. A. (2013). Evaluation of an early risk screener for PTSD in preschool children after accidental injury. Pediatrics, 132, 945–951. https://doi.org/10.1542/peds.2013-0713
Lieberman, A. F., Van Horn, P., & Ippen, C. G. (2005). Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1241–1248. https://doi.org/10.1097/01.chi.0000181047.59702.58
Mannarino, A. P., Cohen, J. A., Deblinger, E., Runyon, M. K., & Steer, R. A. (2012). Trauma-Focused Cognitive-Behavioral Therapy for children sustained impact of treatment 6 and 12 months later. Child Maltreatment, 17, 231–241. https://doi.org/10.1177/1077559512451787
Piaget, J., & Inhelder, B. (2008). The Psychology Of The Child. Basic Books.
Pine, D. S., & Cohen, J. A. (2002). Review: Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biological Psychiatry, 51, 519–531. https://doi.org/10.1016/S0006-3223(01)01352-X
Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A., & Fairbank, J. A. (2009). DSM-V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22, 391–398. https://doi.org/10.1002/jts.20450
Ramirez de Arellano, M. A., Lyman, D. R., Jobe-Shields, L., George, P., Dougherty, R. H., Daniels, A. S., … Delphin-Rittmon, M. E. (2014). Trauma-Focused Cognitive Behavioral Therapy: Assessing the evidence. Psychiatric Services (Washington, D.C.), 65, 591–602. https://doi.org/10.1176/appi.ps.201300255
Salloum, A., Scheeringa, M. S., Cohen, J. A., & Storch, E. A. (2014). Development of stepped care Trauma-Focused Cognitive-Behavioral Therapy for young children. Cognitive and Behavioral Practice, 21, 97–108. https://doi.org/10.1016/j.cbpra.2013.07.004
Saylor, C. F., Swenson, C. C., Reynolds, S. S., & Taylor, M. (1999). The Pediatric Emotional Distress Scale: A brief screening measure for young children exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 28, 70–81.
Scheeringa, M. S. (2010). Young Child PTSD Checklist. New Orleans, LA: Tulane University.
Scheeringa, M. S., Myers, L., Putnam, F. W., & Zeanah, C. H. (2012). Diagnosing PTSD in early childhood: An empirical assessment of four approaches. Journal of Traumatic Stress, 25, 359–367. https://doi.org/10.1002/jts.21723
Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011a). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three-through six year-old children: a randomized clinical trial. Journal of Child Psychology & Psychiatry, 52, 853–860. https://doi.org/10.1111/j.1469-7610.2010.02354.x
Scheeringa, M. S., Wright, M. J., Hunt, J. P., & Zeanah, C. H. (2006). Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. American Journal of Psychiatry, 163, 644–651. https://doi.org/10.1176/appi.ajp.163.4.644
Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011b). PTSD in children and adolescents: Toward an empirically based algorithm. Depression & Anxiety (1091-4269), 28, 770–782. https://doi.org/10.1002/da.20736
Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 191–200.
Scheeringa, M. S., Zeanah, C. H., Myers, L., & Putnam, F. W. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 561–570. https://doi.org/10.1097/01.CHI.0000046822.95464.14
Scheeringa, M. S., Zeanah, C. H., Peebles, C. D., & Cook, C. A. (2001). Toward establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 52–60.
Schierholz, A., Krüger, A., Barenbrügge, J., & Ehring, T. (2016). What mediates the link between childhood maltreatment and depression? The role of emotion dysregulation, attachment, and attributional style. European Journal of Psychotraumatology, 7. https://doi.org/10.3402/ejpt.v7.32652
Schneider, S. J., Grilli, S. F., & Schneider, J. R. (2013). Evidence-based treatments for traumatized children and adolescents. Current Psychiatry Reports, 15, 332. https://doi.org/10.1007/s11920-012-0332-5
Schore, A. (2002). Dysregulation of the right brain: A fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder. Australian & New Zealand Journal of Psychiatry, 36, 9–30.
Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6, 96–100.
Terr, L. C. (1991). Childhood traumas: An outline and overview (editorial). American Journal of Psychiatry, 10.
Vogt, D. S., King, D. W., & King, L. A. (2014). Risk pathways for PTSD: Making sense of the literature. In M. J. Friedman, T. M. Keane, P. A. Resick, M. J. (Ed) Friedman, T. M. (Ed) Keane, & P. A. (Ed) Resick (Eds.), Handbook of PTSD: Science and practice (2nd ed.). (pp. 146–165). New York, NY, US: Guilford Press.
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This work is licensed under a Creative Commons Attribution 4.0 International License.