Diagnosis of Post Traumatic Stress

Diagnosis of Post Traumatic Stress Disorder in Children

In a recent article, "The child behavior checklist PTSD scale: screening for PTSD in young children with high exposure to trauma," published in the Journal of Traumatic Stress, Loeb et. al. examined the validity of new methods designed to identify Post-Traumatic Stress Disorder (PTSD) in children. The team examined the validity of the Child Behavior Checklist PTSD subscale to screen for PTSD in children attending an inner-city early childhood mental health center. Using various measures, the team assessed 51 preschool-age children with high exposure to trauma receiving outpatient child -- parent psychotherapy for PTSD.

The team compared 15 items on the CBCL, a proposed subscale indicative of PTSD, to the UCLA-PTSD Index and to clinical diagnosis based on the American Psychiatric Association's DSM-IV classifications as well as the Diagnostic Classi-cation of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC). Using the DC criteria, 24% of the children were diagnosed with PTSD, but only 4% using the DSM-IV. The team concluded that the new CBCL-PTSD subscale did not reach signi-can't sensitivity or speci-city to be a valuable screening tool for PTSD in this population.

Rationale

I selected the article because the effects of PTSD among children, which often goes undiagnosed, can lead to a number of other behavioral health and juvenile delinquency issues for the afflicted child. The prevalence of PTSD among children is just starting to be recognized among the general public, with the scientific community barely a decade ahead of the general public.

It is important to settle on an effective diagnostic tool for PTSD in children and adolescents. Because children and adults respond to stressful situations quite differently, it is not useful to apply the same standard PTSD diagnostic tools to children, as children may not exhibit the behaviours that counsellors and psychiatrists are used to looking for in diagnosing PTSD.

Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

Common causes of PTSD are natural disasters, Assault, Domestic Abuse, Imprisonment, Rape, Terrorism, or War, but can include any event which triggers strong feelings of fear in the subject.

Symptoms of PTSD fall into three main categories which correspond to the Fight-Flight-Submission model of human responses: Reliving, Avoidance, and Arousal. The subject may unintentionally "relive" the event in her mind through flashback episodes, memories, or nightmares of the event. The subject may also cope through avoidance of the experience, accomplished through the numbing of emotions and/or withdrawal from people, places, or activities that remind them of the event. The trauma of the event might also cause unprovoked arousal, where the subject has difficulty concentrating and sleeping and constantly feels nervous or on edge, which causes him to startle or get angry easily.

Although PTSD can occur at any age, the symptoms which indicate PTSD may vary depending on the age of the subject. For teenagers, avoidance and arousal are much more likely than reliving. Teens are more likely than younger children or adults to show impulsive and aggressive behaviors. One distinguishing feature for teenagers is that they are more likely than younger children or adults to show impulsive and aggressive behaviors which grow out of the more general arousal responses.

The symptoms which indicate PTSD may also vary depending on the nature of the traumatic event which causes the symptoms. Although PTSD is often caused by events which harm the subject directly, it can also occur when an event harms a loved one. The shock one feels when a loved one passes away often triggers avoidance responses such as withdrawal or depressed moods. Certain symptoms of reliving are also common, but involve reliving of events, often fond memories, involving the person instead of the event which caused the death. Such fond memories may cause feelings of longing and deprivation. Arousal is much less common because the event did not harm the individual to trigger flight responses such as nervousness and hyper-vigilance.

Counseling Techniques

The treatment of PTSD implicates the counseling profession because counseling is the primary means through which PTSD is treated. In contrast, adults, who are under more pressure to start functioning normally in society, are often treated for PTSD through anti-anxiety medications which are prescribed for their quick results. Because children and adolescents are still undergoing mental development, it is still possible to retrain their minds to reduce the influence of traumatic events on their everyday functioning.