Improving posttraumatic stress disorder assessment in young children: comparing measures and identifying clinically-relevant symptoms in children ages six and under.

Young children exposed to trauma are vulnerable to developing posttraumatic stress disorder (PTSD). Although experts agree on the importance of tailoring PTSD assessments to be developmentally-appropriate for young children, there is little research on which assessment methods best identify clinically significant symptomatology in this difficult-to-assess population. Two competing models for assessing PTSD have been proposed by the DSM-5 and ICD-11. This study compared a DSM-5 measure to an ICD-11 measure in young children (ages 1-6) exposed to a natural disaster. The measures identified similar rates of PTSD in children; however, diagnostic agreement between the measures was low (31-36%). Both PTSD measures were associated with actual and perceived life threat, functional impairment, and comorbid psychopathology. PTSD symptom and cluster endorsement rates were also binned by age and compared to functional impairment to identify commonly-reported and highly impairing symptoms in trauma-exposed young children, as potential candidates for inclusion in future revisions of diagnostic criteria. Across age ranges, increased clinginess post-trauma was the most commonly reported symptom and was associated with functional impairment. Arousal symptoms (startle, hypervigilance) and Re-experiencing symptoms (nightmares) also emerged as relevant for young children. Findings may contribute to efforts to improve assessment for PTSD in young children.

Perceived life threat in children during the COVID-19 pandemic: associations with posttraumatic stress, anxiety, and depressive symptoms.

Defining children's "trauma exposure" in the context of the COVID-19 pandemic has been a source of debate. Children were exposed to threatening messaging about COVID-19 but might interpret this information differently than adults. Perceived life threat (PLT), the belief that one's life is in danger, has been identified as a robust predictor of posttraumatic stress symptoms (PTSS), and may be a better predictor of PTSS than actual life threat (ALT). This study investigated parent reports of children's self-PLT (belief that they might die from COVID-19) and family-PLT (belief that a family member might die from COVID-19). The aims were to compare PLT to ALT, evaluate their associations with children's psychological functioning, and identify risk factors associated with PLT. We hypothesized an association between PLT and children's psychological functioning in the context of the COVID-19 pandemic. Parents (N = 140) reported on their child's (M age = 9.81 years, 47% female) pandemic experiences, psychological functioning, and both self-PLT and family-PLT. Results revealed self-PLT for 10% of the children and family-PLT for 43% of the children, yet only 6% experienced ALT (i.e., they or their parent tested positive for COVID-19). Children with reported self- or family-PLT had higher PTSS, depressive symptoms, anxiety symptoms, and functional impairment compared to children without these reported beliefs. PLT, but not ALT, was associated with psychological outcomes. Children with only PLT had greater PTSS and impairment than children with ALT. There were differences in parental functioning and pandemic-related information/media exposure between children with and without PLT. Children's perceptions, rather than objective experiences, may be more central to their psychological functioning. This has implications for screening for pandemic-related symptomatology in children as traditional trauma exposure measures may not adequately identify distressed children.