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PTSD (Children < 6 years) (Diagnostic Criteria (D. Alterations in…
PTSD (Children < 6 years)
Risk and Prognostic Factors
Peritraumatic
Environmental - severity (dose) of trauma. The greater the magnitude of trauma, the greater the likelihood of PTSD. Perceived life threat, personal injury, interpersonal violence (particularly trauma perpetrated by a caregiver or involving a witnessed threat to a caregiver in children)
Posttraumatic
Temperamental - negative appraisals and coping strategies
Environmental - exposure to repeated upsetting reminders, ALEs and support (inc. family stability for children).
Pretraumatic
Temperamental - childhood emotional problems by age 6 years (e.g., prior traumatic exposure, externalizing or anxiety problems)
Environmental - low SES, education, cultural characteristics (e.g., fatalistic or self-blaming coping strategies)
Diagnostic Criteria
D.
Alterations in arousal and reactivity:
Irritable behaviours, angry outbursts (temper tantrum)
Hyper-vigilance
Exaggerated startle response
Problems with concentration
Sleep disturbance
G.
Not attributable to a medical or substance
C.
1+ Sx present, beginning or worsened after the event - persistent avoidance or negative cognitions and mood associated with:
Avoidance of places, reminders --> recollection
Avoidance of interpersonal, reminders --> recollection
Increase in negative emotions
Diminished interest in activities; play
Socially withdrawn
Persistent decrease in positive affect
ADULTS: Avoidance and negative cognitions are separated to include more on negative affect like - blame themselves, feelings of detachment
E.
Duration 1+ month
B.
Presence of 1+ of following intrusive Sx associated w/event, after it occurred:
Recurrent, involuntary intrusive thoughts
Recurrent distressing dreams in which the content and/or emotions are related to the event (nightmare)
F.
Clinically Siginifcat distress and/or impairment
A.
Exposure to actual or threatened death, serious injury or sexual violence in 1+ of following:
Direct exposure
Witnessing (in person) event happening to others
Learning that the event happened to a primary caregiver
(ADULTS) 4. Repeated exposure to aversive stimuli
Prevalence
in children is unknown (more common in adults who 3.5% in a 12-m prev).
Development and Course
Following exposure to a traumatic event. Sometimes the Sx will come on immediately - 3m after vent, others are 'with delayed expression'. In children < 6 years, they are most likely to reexperience the trauma through play and storytelling.
Sx's can persist for a long time, depends on individual and level of help they have.
Children may become preoccupied with the negative thoughts around the event. Because of young children's limitations in expressing thoughts or labeling emotions, negative alterations in mood or cognition tend to involve primarily mood changes
Avoidant behavior may be associated with restricted play or exploratory behavior in young children; reduced par ticipation in new activities in school-age children; or reluctance to pursue developmental op portunities in adolescents (e.g., dating, driving).
Irritable or aggressive behavior in children and adoles cents can interfere with peer relationships and school behavior. Reckless behavior may lead to accidental injury to self or others, thrill-seeking, or high-risk behaviors.
Older children and adolescents may judge themselves as cowardly. Adolescents may harbor beliefs of being changed in ways that make them socially undesirable and estrange them from peers.
Specify whether:
With dissociative Sx
Depersonalisation - feelings that you are not real
Derealisation - unreality of surroundings
With delayed expression - do not show full Sx until 6+ months after the event