The Diagnosis of Posttraumatic Stress Disorder in School-Aged Children and Adolescents Following Pediatric Intensive Care Unit Admission

Abstract

Objectives: This study explored the diagnosis of posttraumatic stress disorder (PTSD) in children and adolescents following pediatric intensive care unit (PICU) admission. Specifically, the study aimed to describe the presentation and prevalence of PTSD symptoms 6 months postdischarge, explore the validity of the DSM-IV PTSD algorithm and alternative PTSD algorithm (PTSD-AA) in school-aged children and adolescents, and examine the diagnostic utility of Criterion C3 (inability to recall aspects of a trauma) in this cohort. Methods: Participants were 59 children aged 6-16, admitted to PICU for at least 8 hours. PTSD was assessed via diagnostic interview (Children's PTSD Inventory) 6 months following PICU discharge. Results: The PTSD-AA was found to provide the most valid measure of PTSD at 6 months. Removing Criterion C3 improved the validity of Criterion C. Conclusions: This study supports the use of the PTSD-AA excluding Criterion C3 for identifying highly traumatized children and adolescents following PICU admission.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

“…Most recently, Dow et al[14] explored the prevalence and presentation of posttraumatic stress in 59 school-aged children and adolescents six months after PICU admission lasting at least eight hours. Post-traumatic stress disorder (PTSD) was evaluated using the Children’s PTSD Inventory during a clinician administered interview.…”

“…Although the evidence is limited, psychological morbidity has perhaps been the aspect of PICS that has received the most attention after PICU discharge[8,10-12,14,19,22-24]. All studies included in our review evaluated school-aged patients for post-traumatic stress symptoms, which may be related to “post traumatic stress” being included as a specific term in the search strategy encompassing psychiatric morbidity after PICU admission.…”

Aggravating factors and assessment tools for Posttraumatic Stress Disorder in children after hospitalization

“…One more assessment tool that approved valid was the PTSD-AA excluding Criterion C3 which was used to identify children and adolescents following PICU admission who are in great danger of developing PTSD. 32 For one more time DSM-IV PTSD lagged in relation to other tools, as PTSD-AA found to be superior to DSM-IV PTSD in young children, was more diagnostically valid in older children and was more sensitive identifying children with functional impairment.…”

The manifestation of post-traumatic stress in children and young persons aged 7-14 years and implications for PTSD diagnosis

“…Despite mixed findings on the predictive validity of peri-traumatic emotions in the diagnosis of PTSD (Dow et al, 2013;Kaplan et al, 2013;Wei et al, 2013), this research demonstrated the early presence of a wide range of negative emotional states in children exposed to trauma. However, these symptoms may only be transitory reactions to acute stress and we cannot assume that early negative emotions will evolve into enduring PTSD symptoms.…”

“…The symptom, inability to recall an important aspect of the trauma, has been the focus of several recent studies leading many researchers to recommend the exclusion of this symptom from the diagnosis of children (Boelen & Spuij, 2013;Dow, Kenardy, Le Brocque, & Long, 2013;Iselin et al, 2010;Kassam-Adams et al, 2010). Both Dow et al (2013) and Iselin et al (2010) found that this symptom, when used as part of an alternative algorithm for PTSD in children (PTSD-AA), over-identified PTSD in children exposed to medical trauma.…”