We are aware of no empirical examination to date of the factor structure of PTSD symptoms in young children. To receive a diagnosis, a child must present with at least four symptoms from the three clusters, alongside functional impairment. The avoidance and negative alterations in cognitions cluster is further subdivided conceptually into two avoidance symptoms (DSM-5 PTSD-6Y C1-C2) and four negative alterations in cognitions symptoms (DSM-5 PTSD-6Y C3–C7), but these are not separate clusters in the diagnostic algorithm. Accordingly, symptoms of PTSD-6Y are arranged into re-experiencing, arousal, and avoidance and negative mood and cognition clusters (Table 1: Model 1). However, PTSD-6Y retains the distinctive symptom clustering of the adult diagnosis reflecting an as yet untested assumption that the latent structure of preschool PTSD symptoms mirrors that in adults. Consequently, the key differences between PTSD with DSM-IV and PTSD-6Y within DSM-5 are the adaptation of symptoms for young children, the addition of a mood item (DSM-5 PTSD-6Y C3), and the requirement of only four symptoms instead of five for diagnosis. 2003a, b).īased on these findings, PTSD-6Y was established as a distinct diagnostic subtype in the DSM-5, mirroring the structure of PTSD-AA. Prior to DSM-5, several studies showed that this alternative algorithm (PTSD-AA) was superior to the DSM-IV algorithm in its alignment with the presence of PTSD-related clinical impairment (De Young et al.

A proposal for more developmentally sensitive criteria modified the diagnostic algorithm to four symptoms only, removed the requirement for peri-event emotions, and suggested important developmental adaptations.

2001, 2005) with consequent effects for funding, and care provision.

This algorithm was problematic as several symptoms from the DSM-IV avoidance cluster (e.g., a sense of hopelessness) were rarely detectable in young children, leading to under-diagnosis of the disorder (Scheeringa et al. Under DSM-IV, to receive a PTSD diagnosis, a young child must have experienced a Criterion A trauma eliciting high levels of affect, presented with at least one re-experiencing symptom, three avoidance symptoms, two arousal symptoms, and shown impaired functioning. Studies leading up to the DSM-5 revealed that PTSD was underdiagnosed in young children (Scheeringa et al. The introduction of posttraumatic stress disorder for children 6 years and younger (PTSD-6Y) in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5 2013) is an important acknowledgement that stress responses of young children show developmental differences compared to adults. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These two models also only showed small levels of convergence with CBCL dimensions. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. Criterion related validity was established by comparing each model to a categorical rating of impairment. Convergent validity was established against the Child Behavior Checklist (CBCL). The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5).

Ptsd criteria dsm 5 pearson