Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed.Keywords adolescent, trauma, posttraumatic stress, abuse, development, risk factors, suicidality, substance use Key Points of the Research Review Trauma in AdolescenceFour of five adolescents meet DSM criteria for exposure to a serious traumatic event. Of these, 3-57% meet diagnostic criteria for Posttraumatic Stress Disorder (PTSD). Child maltreatment is a common type of trauma for those under 18. There were over 2 million reported cases in the United States in 2008, which likely represents a fraction of the actual incidents of abuse and neglect. PTSD in AdolescenceThe average rate of adolescent PTSD was nearly 14% among studies conducted in the last decade. Rates of PTSD in adolescence are related to type of trauma. Trauma that is associated with more shame and deviance is associated with higher rates of PTSD (e.g., for sexual abuse 57% have PTSD vs. 10% for natural disasters). Risk Factors for PSTDRates of traumatic exposure peak in adolescence compared to adulthood, which is associated with correspondingly higher rates of PTSD (adult PTSD 7% vs. adolescent PTSD 13%). Adolescent females are twice as likely to develop PTSD following a significant trauma than males. Repeated trauma, regardless of type, heightens the probability of PTSD symptoms and diagnosis. Adolescents with less social support are more likely to experience trauma and develop PTSD.Serious physical health problems increase risk of PTSD in adolescence. Correlates of PTSDAdolescents with PTSD are significantly more likely to have failed a grade or to have been suspended than those without PTSD. Over 80% of individuals with PTSD have a comorbid substance-use disorder, typically beginning in adolescence. Approximately 6% of adolescents with PTSD have made a suicide attempt versus less than 2% for adolescents with no history of trauma or PTSD. Brain imaging studies relate PTSD and trauma to differences in emotion regulation, dopamine, and norepinephrine activation.
While both Ritalin LA and Concerta were shown to be effective, the different release profiles of each formulation can result in distinct differences between the effects on measures of attention and deportment.
The term source monitoring refers to a variety of cognitive processes individuals use to determine whether an experience originated within the self or came from an external source. A belief that auditory hallucinations are real entities independent of the self may be considered an error in source monitoring. The Source Monitoring Framework (SMF) is the most developed and empirically validated model of how ordinary individuals judge whether an event was self-generated or occurred in the outside world. This study of 41 acute inpatients is a first attempt to apply the SMF to autobiographical reports of auditory hallucinations in a clinical setting. Consistent with the SMF, results suggest that similarities between "voices" and real speakers may offer a partial explanation of why patients believe the voices are real. While the SMF provides a useful conceptual background for examining the phenomenology of these voices, the types of source monitoring errors typically encountered in normal individuals do not fully account for this belief as it occurs in psychotic individuals.
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