Posttraumatic stress disorder in young children 3 years posttrauma: Prevalence and longitudinal predictors

Objective: Age-appropriate criteria for posttraumatic stress disorder (PTSD) in young children have been established. The present study investigated the long-term course of such PTSD and its predictors in young children. Methods: Young children (aged 2–10 years) and parents/caregivers who had attended emergency departments after motor vehicle collisions (MVCs) between May 2004 and November 2005 were assessed at 2 to 4 weeks and 6 months post-MVC; 71 families were re-interviewed 3 years post-MVC. Participants were assessed according to standard DSM-IV criteria for PTSD and a well-validated alternative algorithm for diagnosing PTSD in young children (PTSD-AA). Demographic, trauma-related, and parental mental health variables and intellectual ability were also assessed at baseline. Results: Using an “optimal-report” procedure (a positive diagnosis according to parent or child for older children, or just parent for younger children), 7.0% met criteria for DSM-IV PTSD and 16.9% for PTSD-AA at 3 years. Using parent report alone, these rates were 1.4% and 2.8%, respectively. Parent-child agreement for PTSD and PTSD-AA was no better than chance (Cohen κ = –0.03 and –0.04, respectively). Baseline parent posttraumatic stress relating to the child’s trauma, and not trauma severity, was correlated with optimal-report child PTSD-AA at each assessment (r values = 0.29–0.31) and accounted for unique variance in logistic regression models of this outcome at each assessment. Conclusions: PTSD-AA in young children can persist for years but is underrecognized by parents despite its being shaped to a large extent by parents’ own acute traumatic stress in response to the child’s trauma.