Skip to main content
SpringerLink
Log in

Are Trauma and Post-Traumatic Stress Disorder Connected to Psychiatric Comorbidity in Danish Pre-Schoolers?

  • ORIGINAL ARTICLE
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

This study examined the onset of seven psychiatric disorders and the amount of functional impairment in 80 preschool children (ages 1–6 years) following different kinds of traumatic events. Assessed via caregiver reports from an age-modified diagnostic interview, 46.3% of the children were identified as suffering from PTSD. Of those children, 78.3% had at least one comorbid disorder with oppositional defiant disorder, separation anxiety disorder, and major depression disorder being the most common. The prevalence of the disorders was significantly higher compared to the group of children without diagnosed PTSD. Furthermore, all the children displayed a wide range of symptomatology with profound functional impairment in different domains such as interpersonal relations with caregivers, siblings, and peers. These findings provide empirical support for assessing trauma related symptoms in very young children and indicate psychiatric comorbidity occurs in young traumatized children as evidenced in other age groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.

    Book  Google Scholar 

  • Breidenstine, A., Bailey, L., Zeanah, C., & Larrieu, J. (2011). Attachment and trauma in early childhood: a review. Journal of Child & Adolescent Trauma, 4(4), 274–290.

    Article  Google Scholar 

  • Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110(4), 585–599.

    Article  PubMed  Google Scholar 

  • Cloitre, M., Stolbach, B. C., Herman, J. L., Kolk, B. v. d., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399–408.

    Article  PubMed  Google Scholar 

  • Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L. (2011). Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. Journal of Traumatic Stress, 24(6), 615–627.

    Article  PubMed  Google Scholar 

  • Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584.

    Article  PubMed  Google Scholar 

  • D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012). Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200.

    Article  PubMed  Google Scholar 

  • De Young, A. C., Kenardy, J. A., & Cobham, V. E. (2011). Trauma in early childhood: a neglected population. Clinical Child and Family Psychology Review, 14(3), 231–250.

    Article  PubMed  Google Scholar 

  • Egger, H. L., Erkanli, A., Keeler, G., Potts, E., Walter, B. K., & Angold, A. (2006). Test-retest reliability of the preschool age psychiatric assessment (PAPA). Journal of the American Academy of Child and Adolescent Psychiatry, 45(5), 538–549.

    Article  PubMed  Google Scholar 

  • Elbert, T., Schauer, E., Schauer, M., Huschka, B., Hirth, M., & Neuner, F. (2009). Trauma-related impairment in children—A survey in sri lankan provinces affected by armed conflict. Child Abuse & Neglect, 33(4), 238–246.

    Article  Google Scholar 

  • Fairbank, J. A., Putnam, F. W., & Harris, W. W. (2007). The prevalence and impact of child traumatic stress. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD – Science and practice (pp. 229–251). New York: Guilford.

    Google Scholar 

  • Fan, F., Zhang, Y., Yang, Y., Mo, L., & Liu, X. (2011). Symptoms of posttraumatic stress disorder, depression, and anxiety among adolescents following the 2008 wenchuan earthquake in china. Journal of Traumatic Stress, 24(1), 44–53.

    Article  PubMed  Google Scholar 

  • Gigengack, M. R., van Meijel, E. P. M., Alisic, E., & Lindauer, R. J. L. (2015). Comparing three diagnostic algorithms of posttraumatic stress in young children exposed to accidental trauma: an exploratory study. Child and Adolescent Psychiatry and Mental Health, 9(14), 1–8.

    Google Scholar 

  • Gleason, M. M., Zeanah, C. H., & Dickstein, S. (2010). Recognizing young children in need of mental health assessment: development and preliminary validity of the early childhood screening assessment. Infant Mental Health Journal, 31(3), 335–357.

    Article  PubMed  Google Scholar 

  • Herman, J. L. (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391.

    Article  Google Scholar 

  • Hodges, M., Godbout, N., Briere, J., Lanktree, C., Gilbert, A., & Kletzka, N. T. (2013). Cumulative trauma and symptom complexity in children: a path analysis. Child Abuse & Neglect, 37(11), 891–898.

    Article  Google Scholar 

  • Kaplow, J. B., Saxe, G. N., Putnam, F. W., Pynoos, R. S., & Lieberman, A. F. (2006). The long-term consequences of early childhood trauma: a case study and discussion. Psychiatry, 69(4), 362–375.

    Article  PubMed  Google Scholar 

  • Kisiel, C., Fehrenbach, T., Liang, L., Stolbach, B., McClelland, G., Griffin, G., et al. (2014). Examining child sexual abuse in relation to complex patterns of trauma exposure: findings from the national child traumatic stress network. Psychological Trauma: Theory, Research, Practice, and Policy, 6(1), 29–39.

    Article  Google Scholar 

  • Luby, J. L., Heffelfinger, A. K., Mrakotsky, C., Hessler, M. J., Brown, K. M., & Hildebrandt, T. (2002). Preschool major depressive disorder: preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 928–937.

    Article  PubMed  Google Scholar 

  • MacDonald, H. Z., Beeghly, M., Grant-Knight, W., Augustyn, M., Woods, R. W., Cabral, H., et al. (2008). Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms. Development and Psychopathology, 20(2), 493–508.

    Article  PubMed  PubMed Central  Google Scholar 

  • McMillen, C., North, C., Mosley, M., & Smith, E. (2002). Untangling the psychiatric comorbidity of posttraumatic stress disorder in a sample of flood survivors. Comprehensive Psychiatry, 43(6), 478–485.

    Article  PubMed  Google Scholar 

  • Meiser-Stedman, R., Smith, P., Glucksman, E., Yule, W., & Dalgleish, T. (2008). The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents. The American Journal of Psychiatry, 165(10), 1326–1337.

    Article  PubMed  Google Scholar 

  • Nader, K. (2008). How children and adolescents are affected by trauma. In K. Nader (Ed.), Understanding and assessing trauma in children and adolescents: measures, methods, and youth in context (pp. 3–30). New York: Routledge.

    Google Scholar 

  • O’Donnell, M. L., Creamer, M., & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: understanding comorbidity. The American Journal of Psychiatry, 161(8), 1390–1396.

    Article  PubMed  Google Scholar 

  • Ogle, C. M., Rubin, D. C., & Siegler, I. C. (2014). The relation between insecure attachment and posttraumatic stress: early life versus adulthood traumas. Psychological Trauma: Theory, Research, Practice and Policy, 7(4), 324–332.

    Article  Google Scholar 

  • Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: how “states” become “traits”. Infant Mental Health Journal, 16(4), 271–291.

    Article  Google Scholar 

  • Rønholt, S. (2013). Diagnostic infant and preeschool assessment – et diagnostisk redskab til vurdering af psykopatologi hos førskolebørn. Odense: Videnscenter for psykotraumatologi.

    Google Scholar 

  • Scheeringa, M. S. (2006). Posttraumatic stress disorder: Clinical guidelines and research findings. In J. L. Luby (Ed.), Handbook of preschool mental health: Development, disorders, and treatment (pp. 165–185). New York: The Guilford Press.

  • Scheeringa, M. S. (2009). Posttraumatic stress disorder. In C. H. Zeanah (Ed.), Handbook of infant mental health (3rd ed., pp. 345–361). New York: Guilford.

    Google Scholar 

  • Scheeringa, M. S. (2015). Untangling psychiatric comorbidity in young children who experienced single, repeated, or hurricane Katrina traumatic events. Child & Youth Care Forum, 44(4), 475–492.

    Article  Google Scholar 

  • Scheeringa, M. S., & Haslett, N. (2010). The reliability and criterion validity of the diagnostic infant and preschool assessment: a new diagnostic instrument for young children. Child Psychiatry and Human Development, 41(3), 299–312.

    Article  PubMed  PubMed Central  Google Scholar 

  • Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm's way: onsets and comorbidity patterns of disorders in preschool children and their caregivers following hurricane Katrina. Journal of Clinical Child & Adolescent Psychology, 37(3), 508–518.

    Article  Google Scholar 

  • Scheeringa, M. S., Zeanah, C. H., & Myers, L. (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(5), 561–570.

    Article  PubMed  Google Scholar 

  • Scheeringa, M. S., Wright, M. J., Hunt, J. P., & Zeanah, C. H. (2006). Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. American Journal of Psychiatry, 163(4), 644–651.

    Article  PubMed  Google Scholar 

  • Schore, A. N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1–2), 201–269.

    Article  Google Scholar 

  • Stafford, B., Zeanah, C. H., & Scheeringa, M. (2003). Exploring psychopathology in early childhood: PTSD and attachment disorders in DC: 0-3 and DSM-IV. Infant Mental Health Journal, 24(4), 398–409.

    Article  Google Scholar 

  • Terr, L. C. (1991). Childhood traumas: an outline and overview. The American Journal of Psychiatry, 148(1), 10–20.

    Article  PubMed  Google Scholar 

  • Van der Kolk, B. A. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401–408.

    Article  Google Scholar 

  • Verlinden, E., Opmeer, B. C., Meijel, V., Els, P. M., Beer, R., De Roos, C., Bicanic, I. A. E., et al. (2015). Enhanced screening for posttraumatic stress disorder and comorbid diagnoses in children and adolescents. European Journal of Psychotraumatology, 6, 26661–26668.

    Article  PubMed  Google Scholar 

  • Wamser-Nanney, R., & Vandenberg, B. R. (2013). Empirical support for the definition of a complex trauma event in children and adolescents: complex trauma event in children. Journal of Traumatic Stress, 26(6), 671–678.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The study was supported by the Foundation for Ole Kirk (RJN/20-5675).

Author information

Authors and Affiliations

  1. Danish National Centre of Psychotraumatology, Department of Psychology, University of Southern Denmark, Campusvej 56, 5320, Odense M, DK, Denmark

    Sille Schandorph Løkkegaard, Sarah Agnethe Bonnemann Egebæk & Ask Elklit

Authors
  1. Sille Schandorph Løkkegaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Agnethe Bonnemann Egebæk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ask Elklit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ask Elklit.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation; The Regional Scientific Ethical Committees for Southern Denmark, and with the Helsinki Declaration of 1975, as revised in 2000.

Informed Consent

Was obtained from all patients for being included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Løkkegaard, S.S., Egebæk, S.A.B. & Elklit, A. Are Trauma and Post-Traumatic Stress Disorder Connected to Psychiatric Comorbidity in Danish Pre-Schoolers?. Journ Child Adol Trauma 10, 353–361 (2017). https://doi.org/10.1007/s40653-017-0146-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40653-017-0146-z

Keywords

Search

Navigation