LOS ANGELES – Nearly half of preschool children meet age-adjusted criteria for posttraumatic stress disorder after experiencing a significant traumatic event, and some children are symptomatic even after relatively minor medical procedures, according to a researcher from Tulane University in New Orleans.
“Children under 6 years of age are particularly vulnerable to stressful experiences because of the rapid neural development they are undergoing,” said Dr. Stacy S. Drury at the International Conference on Pediatric Psychological Trauma sponsored by the University of Southern California, Los Angeles, and the University of California, Irvine.
In a study of 284 children aged 3-5 years who had been exposed to a traumatic event, 44% met full revised criteria for PTSD with discernable impairing symptoms, said Dr. Drury, who holds faculty positions in the departments of psychiatry, pediatrics, and neurology.
No statistically significant differences were seen in rates of PTSD based on the type of trauma children experienced: a single-incident trauma (a motor vehicle accident, burn, or fall) (38%), observed domestic violence (42%), or Hurricane Katrina (48%).
Children were diagnosed using the structured Preschool Age Psychiatric Assessment (PAPA), a validated instrument administered to caregivers.
The study used the Preschool PTSD Criteria, which is less reliant on verbalization and abstract thought than DSM-IV PTSD criteria for adults (J. Am. Acad. Child Adolesc. Psychiatry 2003;42:561–70). Specifically, the criteria developed at Tulane by Dr. Michael S. Scheeringa and associates eliminate developmentally inappropriate items (such as an individual's sense of a foreshortened future) and instead include such relevant indicators as the loss of previously acquired developmental skills such as language or toilet training.
A new diagnostic cluster appears in preschool criteria for PTSD, requiring at least one of the following behaviors frequently reported in traumatized children: new separation anxiety, new onset of aggression, or new fears without obvious links to the trauma, such as fear of the dark.
A second study assessed PTSD in 69 preschool children seen at a hospital-based primary care clinic more than 12 months after events that ranged from medical encounters that involved no procedures, procedures such as receiving stitches or getting a shot, nonmedical traumas such as motor vehicle accidents, and high-risk events such as abuse or neglect.
Although specific statistics were not released, Dr. Drury showed that even “small things,” like stitches, had a lasting effect on some children. “Fifteen months after the event, these symptoms were recognizable to parents–and persistent,” she said.
Dr. Drury reviewed burgeoning neurobiological literature demonstrating that early stress results in changes within biocircuitry of the developing brain, altering the central nervous system, cortisol levels, and neurotransmitters.
“Altered neural circuits lead to lasting vulnerability,” she emphasized, adding that much more research needs to be done to pinpoint the timing of trauma and its ramifications on early brain development and behavior.
“Trauma at 1 year is very different than trauma at 3 or at 6 years old, in part because of what areas of the brain are developing most rapidly,” she said.
She and her colleagues are developing cognitive behavioral therapies that can be delivered early to parents and children following symptoms of PTSD, or even as a preventive measure for children newly diagnosed with cancer or another serious illness.
Working to reduce “learned helplessness” on the part of the child begins by teaching parents how to reduce overcontrol in the parent-child relationship, leading children to a new sense of efficacy and mastery.
Meanwhile, children learn relaxation techniques, including controlled breathing and muscle contraction and release, an exercise one child enthusiastically dubbed, “old man wiggles.”
Traditional cognitive-behavioral therapy components such as systematic densensitization are adapted for preschoolers, and have been shown to be highly effective in reducing symptoms during 6-12 brief, manualized sessions, she said.
Dr. Drury reported no relevant financial disclosures.