Now, the Archives of General Psychiatry has published an article that addresses this. It is subscription-only, but there is a good summary of it on MedPage Today, so nonspecialists don't really need access to the full article.
Traumatic Events and Posttraumatic Stress in Childhood
William E. Copeland, PhD; Gordon Keeler, MA; Adrian Angold, MRCPsych; E. Jane Costello, PhD
Arch Gen Psychiatry. 2007;64:577-584.
Context Traumatic events are common and are related to psychiatric impairment in childhood. Little is known about the risk for posttraumatic stress disorder (PTSD) across different types of trauma exposure in children.
Objective To examine the developmental epidemiology of potential trauma and posttraumatic stress (PTS) in a longitudinal community sample of children.
Methods A representative population sample of 1420 children aged 9, 11, and 13 years at intake were followed up annually through 16 years of age.
Main Outcome Measure Traumatic events and PTS were assessed from child and parent reports annually to 16 years of age. Risk factors and DSM-IV disorders were also assessed.
Results More than two thirds of children reported at least 1 traumatic event by 16 years of age, with 13.4% of those children developing some PTS symptoms. Few PTS symptoms or psychiatric disorders were observed for individuals experiencing their first event, and any effects were short-lived. Less than 0.5% of children met the criteria for full-blown DSM-IV PTSD. Violent or sexual trauma were associated with the highest rates of symptoms. The PTS symptoms were predicted by previous exposure to multiple traumas, anxiety disorders, and family adversity. Lifetime co-occurrence of other psychiatric disorders with traumatic events and PTS symptoms was high, with the highest rates for anxiety and depressive disorders.
Conclusions In the general population of children, potentially traumatic events are fairly common and do not often result in PTS symptoms, except after multiple traumas or a history of anxiety. The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders.
The main finding is that, in the study, they found only 0.5% of children had PTSD. There is some concern about the validity of that statistic, however. The diagnostic criteria were developed using studies on adults. It may not be valid to apply those same criteria to children. Also, 68% of children reported a traumatic event by age 16. That is not really a surprise, but it is a pretty high number.
One thing to note about this study, is they found that children tend to be highly resilient to trauma. This is not surprising; Anna Freud noted the same thing in World War II. Her work found that children were less traumatized if they had supportive parents, and were not separated from their parents for very long. It also helped if they were able to form close relationships with peers after having been exposed to trauma. The design of Copeland's study did not assess for these factors (You can't separate children from their parents just to see how traumatized they will be).
Aside from the study itself, there are a couple of things I want to mention. First, Arch Gen Psychiatry needs to make more article open tot he public; second, the MedPage Today summary offers 0.25 CME credits for free, which is a nice bonus; third, on MedPage Today, I noticed this little button (not active here):
Comments
Do YOU think it's possible that babies born extremely premature, who endure months of the NICU, years of medical intervention, could be labled with PTSD? There are so many VLBW preemies who are DX with and/or medicated for anxiety and depression, just wondering where the damage could have occurred.
BTW, I just found your site through PGR on Ami's blog and I look forward to reading more of your posts.
Stacy
Posted by: Stacy | May 21, 2007 11:09 AM
There are a few related questions here. Can preemies develop PTSD, can they be labeled with PTSD, if they can get PTSD is it fundamentally the same as it is in adults, and if it is different should we call it something else????
I am curious about this topic and plan to look into it some more.
Posted by: Joseph j7uy5 | May 21, 2007 10:16 PM