Skip to main content

Advertisement

Log in

Posttraumatic Stress Disorder in Young Children Exposed to Terrorism: Validation of the Alternative Diagnostic Criteria

  • Effect of Trauma on Children, Adolescent, and/or Their Caregiver
  • Published:
Journal of Child & Adolescent Trauma Aims and scope Submit manuscript

Abstract

The need to adapt the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association, 1994) criteria for diagnosing posttraumatic stress disorder (PTSD) in young children is widely recognized, yet attempts to validate alternative criteria have been limited. We examined profiles of PTSD symptoms in 29 Israeli children directly exposed to terrorism and a comparison group of 25 unexposed children. Whereas only 7% of the exposed children met PTSD criteria according to the DSM, an additional 24% were identified using the alternative criteria adopted in the revised diagnostic classification of 0 to 3. None of the children in the comparison group met criteria for diagnosis. Significant associations between exposure variables and PTSD supported the validity of the alternative criteria.

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

Access this article

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

  • Achenbach, T. M. (1991). Integrative guide to the 1991 CBCL, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington: University of Vermont Department of Psychiatry.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Berman, H. (2001). Children and war: Current understandings and future directions. Public Health Nursing, 18, 243–252.

    Article  PubMed  Google Scholar 

  • Bryant, R. A. (2000). Cognitive-behavioral therapy of violence-related posttraumatic stress disorder. Aggression and Violent Behavior, 5, 79–97.

    Article  Google Scholar 

  • Cohen, E. (2006). Play and adaptation in traumatized young children and their caregivers in Israel. In L. Barbanel & R. J. Sternberg (Eds.), Psychological interventions in times of crisis (pp. 151–180). New York: Springer.

    Google Scholar 

  • Cohen, E. (2009). Parenting in the throes of traumatic events: Relational risks and protection processes. In J. Ford, R. Pat-Horenczyk, & D. Brom (Eds.), Treating traumatized children: Risk, resilience, and recovery (pp. 72–84). Florence, KY: Routledge.

    Google Scholar 

  • Cohen, E., Chazan S. E., Lerner, M., & Maimon, E. (in press). Posttraumatic play in young children exposed to terrorism: An empirical study. Infant Mental Health Journal.

  • Cohen, J., & West, S. G. (2003). Applied multiple regression/correlation analysis for behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Dehon, C., & Scheeringa, M. S. (2006). Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist. Journal of Pediatric Psychology, 31, 431–435.

    Article  PubMed  Google Scholar 

  • Fletcher, K. E. (1996). Childhood posttraumatic stress disorder. In E. J. Mash & R. Barkley (Eds.), Child psychopathology (pp. 242–276). New York: Guilford.

    Google Scholar 

  • Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. (1993). Reliability and validity of a brief instrument for assessing posttraumatic stress disorder. Journal of Traumatic Stress, 6, 459–473.

    Article  Google Scholar 

  • Fremont, W. P. (2004). Childhood reactions to terrorism-induced trauma: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 381–392.

    Article  PubMed  Google Scholar 

  • Gil, S. (2005). Evaluation of premorbid personality factors and pre-event posttraumatic stress symptoms in the development of posttraumatic stress symptoms associated with bus explosion in Israel. Journal of Traumatic Stress, 18, 563–567.

    Article  PubMed  Google Scholar 

  • Joshi, P. T., & O’Donnell, D. A. (2003). Consequences of child exposure to war and terrorism. Clinical Child and Family Psychology Review, 6, 275–292.

    Article  PubMed  Google Scholar 

  • Marsee, M. (2008). Reactive aggression and posttraumatic stress in adolescents affected by Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37, 519–529.

    Article  PubMed  Google Scholar 

  • Ohmi, H., Kojima, S., Awai, Y., Kamata, S., Sasaki, K., Tanaka, Y., et al. (2002). Posttraumatic stress disorder in pre-school aged children after a gas explosion. European Journal of Pediatrics, 161, 643–648.

    Google Scholar 

  • Osofsky, J. D. (1995). The effects of exposure to violence on young children. American Psychologist, 50, 782–788.

    Article  PubMed  Google Scholar 

  • Pfefferbaum, B., Pfefferbaum, R. L., Gurwitch, R. H., Nagumalli, S., Brandt, E. N., Robertson, M. J., et al. (2003). Children’s response to terrorism: A critical review of the literature. Current Psychiatry Reports, 5, 95–100.

    Article  PubMed  Google Scholar 

  • Pine, D. S., Costello, J., & Masten, A. (2005). Trauma, proximity and developmental psychopathology: The effects of war and terrorism on children. Neuropsychopharmacology, 30, 1781–1792.

    Article  PubMed  Google Scholar 

  • Salmon, K., & Bryant, R. A. (2002). Posttraumatic stress disorder in children: The influence of developmental factors. Clinical Psychology Review, 22, 163–188.

    Article  PubMed  Google Scholar 

  • Scheeringa, M. S., Peebles, C. D., Cook, C. A., & Zeanah, C. H. (2001). Towards establishing procedural, criterion, and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 52–60.

    Article  PubMed  Google Scholar 

  • Scheeringa, M. S., Salloum, A., Arnberger, R. A., Weems, C. F., Amaya-Jackson, L., & Cohen, J. A. (2007). Feasibility and effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder in preschool children: Two case reports. Journal of Traumatic Stress, 20, 631–636.

    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, 644–651.

    Article  PubMed  Google Scholar 

  • Scheeringa, M. S., & Zeanah, C. H. (1995). Symptom expression and trauma variables in children under 48 months of age. Infant Mental Health Journal, 16, 259–270.

    Article  Google Scholar 

  • Scheeringa, M. S., & Zeanah, C. H. (2002). Coding manual for PTSD semi-structured interview and observational record for infants and young children (0-48 months). Unpublished manuscript, Tulane University.

    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, 508–518.

    Article  Google Scholar 

  • Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 191–200.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Shalev, A. Y., Tuval, R., Frenkiel-Fishman, S., Hadar, H., & Eth, S. (2006). Psychological responses to continuous terror: A study of two communities in Israel. American Journal of Psychiatry, 163, 667–673.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  • Stover, C. S., & Berkowitz, S. (2005). Assessing violence exposure and trauma symptoms in young children: A critical review of measures. Journal of Traumatic Stress, 18, 707–717.

    Article  PubMed  Google Scholar 

  • Task Force on Research Diagnostic Criteria: Infancy and Preschool. (2003). Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1504–1512.

    Article  Google Scholar 

  • Thabet, A. A., Karim, K., & Vostanis, P. (2006). Trauma exposure in pre-school children in a war zone. British Journal of Psychiatry, 188, 154–158.

    Article  PubMed  Google Scholar 

  • Ulman, S. E. (1995). Adult trauma survivors and posttraumatic stress sequelae: An analysis of reexperiencing, avoidance, and arousal criteria. Journal of Traumatic Stress, 8, 179–188.

    Article  Google Scholar 

  • Yule, W. (2001). Posttraumatic stress disorder in children and adolescents. International Review of Psychiatry, 13, 194–200.

    Article  Google Scholar 

  • Zero to Three (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood: Revised edition (DC: 0-3R). Washington, DC: Zero to Three Press.

    Google Scholar 

  • Zilber, N., Aurebach, A., & Lerner, Y. (1994). Israeli norms for the Achenbach Child Behavior Checklist: Comparison of clinically referred and non referred children. Israel Journal of Psychiatry and Related Sciences, 31, 5–12.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sther Cohen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohen, S., Gadassi, R. Posttraumatic Stress Disorder in Young Children Exposed to Terrorism: Validation of the Alternative Diagnostic Criteria. Journ Child Adol Trauma 2, 229–241 (2009). https://doi.org/10.1080/19361520903317295

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1080/19361520903317295

Keywords

Navigation