Childhood PTSD

face="Helvetica, Arial, sans-serif">Domestic violence and
other forms of childhood trauma are all too common.  The
effects of trauma on children have been studied in a variety of ways,
but much of this research has not employed strict diagnostic criteria.
 

Now, the Archives of General Psychiatry
has published an article that addresses this.  It is
subscription-only, but there is a href="http://www.medpagetoday.com/Psychiatry/Depression/tb/5602">good
summary of it on MedPage Today,
so nonspecialists don't really need access to the full article.
 

face="Helvetica, Arial, sans-serif"> href="http://archpsyc.ama-assn.org/cgi/content/short/64/5/577">Traumatic
Events and Posttraumatic Stress in Childhood
face="Helvetica, Arial, sans-serif">William E. Copeland,
PhD; Gordon Keeler, MA; Adrian Angold, MRCPsych; E. Jane Costello, PhD
face="Helvetica, Arial, sans-serif">Arch Gen Psychiatry.
2007;64:577-584.

face="Helvetica, Arial, sans-serif">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.

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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; href="https://www.aei.org/publications/filter.all,pubID.19916/pub_detail.asp">Anna
Freud noted the same thing in World War II.   href="http://en.wikipedia.org/wiki/Anna_Freud#1938_and_later:_Anna_in_London">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):

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This
is pretty cool.  If you are signed in to Google, and you click
that button, Google will be sure to add results from MedPage Today to
your results, and presumably rank them higher.  Clever.