From the Guidelines
The diagnostic criteria for PTSD in children require exposure to a traumatic event, followed by symptoms of intrusion, avoidance, negative alterations in cognitions and mood, and increased arousal that persist for at least 1 month and result in significant impairment in social, academic, or other areas of functioning, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1. The symptoms of PTSD in children can be categorized into four main areas:
- Intrusion: repeated distressing memories and/or dreams (nightmares) about the traumatic event, loss of awareness of present surroundings (dissociation), and acting as if the traumatic event is reoccurring (flashbacks) 1.
- Avoidance: attempting to avoid distressing memories, thoughts, feelings, activities, and/or places that remind the child of the traumatic event 1.
- Negative alterations in cognitions and mood: problems remembering important aspects of the traumatic event, negative beliefs or expectations about oneself, others, or the world, and negative emotional states such as depression 1.
- Increased arousal and reactivity: irritable and angry outbursts, reckless or self-destructive behavior, hypervigilance, exaggerated startle response, problems with concentration, and sleep disturbance 1. These symptoms must occur for more than 1 month and cause significant distress or functional impairment, and not be attributable to substance use or another medical condition 1. It is essential to note that children's responses to traumatic events can be influenced by their age, developmental stage, and individual characteristics, and that proper diagnosis is crucial for developing an effective treatment plan 1.
From the Research
Diagnostic Criteria for PTSD
The diagnostic criteria for Post-Traumatic Stress Disorder (PTSD) are not explicitly stated in the provided studies. However, the studies discuss the treatment and management of PTSD, which implies that the diagnostic criteria are already established.
Treatment Options for PTSD
- The studies suggest that PTSD is responsive to pharmacotherapy and psychotherapy 2, 3, 4, 5, 6.
- Selective serotonin reuptake inhibitors (SSRIs) are the most studied medications for PTSD, with sertraline, paroxetine, and fluoxetine being the most extensively studied 2.
- The American Psychological Association (APA) recommends the use of cognitive-behavioral therapy, cognitive processing therapy, cognitive therapy, and prolonged exposure therapy for adults with PTSD 4.
- Medications such as fluoxetine, paroxetine, sertraline, and venlafaxine are conditionally recommended for the treatment of PTSD 4.
Predictors of Treatment Response
- The study by 6 found that gender, childhood sexual trauma, and sexual assault as index trauma moderated the population-level treatment response to SSRIs.
- The study also identified three latent classes of treatment response: fast responders, responders with low pretreatment symptom severity, and responders with high pretreatment symptom severity.
- Class membership was predicted based on time since index trauma, severity of depression, and severity of anxiety 6.
Comparison of Treatment Options
- The study by 5 found that there is insufficient evidence to determine whether SSRIs or trauma-focused psychotherapies are more effective for PTSD symptom reduction among adults with PTSD.
- The study by 2 suggests that SSRIs are effective in short-term trials, and continuation and maintenance treatment for 6-12 months decrease relapse rates.
- The study by 3 emphasizes the importance of evidence-based prescribing for PTSD, with fluoxetine, paroxetine, sertraline, and venlafaxine being the best-evidenced drugs.