Vol 11, N°1 Child and Adolescent Psychiatry
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ost individuals who experience life-threatening traumas show some symptoms of post-traumatic stress disorder (PTSD) immediately.1 Only approximately 30% have vulnerabilities to this disorder, and/or suffer the most chronic and terrifying events that maintain these symptoms as an enduring syndrome a month after the threats are gone.2 This is true for nearly all ages. Since the revision of PTSD in the Diagnostic and Statistical Manual of Mental Disorders,Third Edition-Revised (DSM-III-R) in 1987,3 the diagnostic criteria have included special developmental considerations for children and adoles- cents. This special language was revised with the subse- quent version of the DSM. Initially, skeptics doubted whether children could develop PTSD,4 but this is no longer debatable. More current concerns include whether the PTSD criteria adequately describe the psychopathol- ogy of children and adults who have experienced severe trauma.5 This paper will review the following important issues for assessing children who have experienced trau- matic events: (i) the specificity of the PTSD diagnosis; (ii) recognizing children who are symptomatic and function- ally impaired but do not have enough symptoms for the diagnosis; (iii) developmental considerations that impact on accurate diagnosis of PTSD; and (iv) a variety of assessment challenges that reflect the difficulty and com- plexity of interviewing children and caregivers about these symptoms. C l i n i c a l  r e s e a r c h M Copyright © 2009 LLS SAS.  All rights reserved www.dialogues-cns.org Post-traumatic stress disorder diagnosis in children: challenges and promises Judith A. Cohen, MD; Michael S. Scheeringa, MD, MPH    Keywords: child; adolescent; post-traumatic stress disorder; DSM-IV-TR; trauma; diagnostic criterion; internalizing disorder; treatment   Author   affiliations:    Professor   of   Psychiatry,   Drexel   University   College   of Medicine;   Medical   Director,   Center   for   Traumatic   Stress   in   Children   and Adolescents, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA (Judith A. Cohen); Associate Professor, Department of Psychiatry and Neurology, Tulane University   School   of   Medicine,   New   Orleans,   Louisiana,   USA   (Michael   S. Scheeringa) Address  for  correspondence: Judith  A.  Cohen  MD,  4  Allegheny  Center,  8th Floor, Pittsburgh, PA 15212, USA (e-mail: jcohen1@wpahs.org) Children and adolescents experience high rates of poten- tially traumatic experiences. Many children subsequently develop mental health problems, including post-trau- matic stress disorder (PTSD) symptoms. Accurately diag- nosing  PTSD  in  children  is  challenging.  This  paper reviews the following important issues: (i) the specificity of the PTSD diagnosis; (ii) children who are symptomatic and impaired but do not have enough symptoms for the diagnosis of PTSD; (iii) developmental considerations for preschool and school-age children; and (iv) a variety of assessment challenges that reflect the difficulty and com- plexity of interviewing children and caregivers about these symptoms. Despite these challenges, PTSD remains the best construct for clinical and research work with trauma survivors. Pediatric PTSD criteria are valuable for identifying children at risk and in need of treatment, and can be even more helpful when developmentally mod- ified in ways that are discussed. © 2009, LLS SAS Dialogues Clin Neurosci.  2009;11:91-99.