Els van Meijel

102 Chapter 6 | Posttraumatic stress in young children a reliable and valid measure (Scheeringa & Haslett, 2010). The DIPA-questions were translated into Dutch by the first (MRG) and second author (EPMM) in consultation with a clinical psychologist/psychotherapist and a child and adolescent psychiatrist (the fourth author; RJLL). The ADIS-C/P questions were complemented with DIPA questions in order to measure all symptoms of the PTSD-AA algorithm and DSM-5 subtype for young children. No DIPA questions were added to the intrusion cluster of the ADIS-C/P. In the cluster avoidance/negative alterations in cognitions and mood a number of DIPA questions were added. First, the ADIS-C/P question regarding symptom C1 - ‘ Recurrent and intrusive distressing recollections ’ - was expanded with the following DIPA question ‘ Does s/he try to avoid conversations that might remind him/her of the trauma? ’ - ‘ Does s/he try to avoid private thoughts or feelings that might remind him/her of the trauma? ‘ (question 37). Furthermore, the following DIPA question was added: ‘ Since the trauma has s/he become more distant from family members and friends? I mean, s/he doesn’t want to show affection or maybe even be around people? ’ (question 44) . This question measures the adjusted symptom C5 - ‘Socially withdrawn behavior’ - of the PTSD-AA and DSM-5 subtype for young children. In order to measure symptom C6 - ‘Reduction in expression of positive emotions ’ - of the DSM-5 subtype for young children, the DIPA question ‘ Since the trauma, s/he doesn’t show as many happy emotions - like smiles or laughs - on his/her face, or doesn’t show them as strongly as s/he used to? ’ was added (question 41) . PTSD interviews were administered before the release of the DSM-5. The ADIS-C/P and the DIPA did not yet contain the new DSM-5 symptom C3 of the subtype for young children - ‘ Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion)’ . This symptom was measured with the following question derived from the DIPA ‘ Is your child more sad, angry or upset since the accident?’ (question 42). In the PTSD-AA algorithm and the DSM-5 subtype for children 6 years and younger the hyperarousal symptom ‘ Irritability, outbursts of anger ’ includes extreme temper tantrums. Therefore, the following part of DIPA question 47 was added to the hyperarousal cluster of the ADIS-C/P: ‘ Has s/he developed extreme temper tantrums since the trauma? ’ . PTS symptoms were scored present or absent based on the frequency. Symptoms were scored present if they occurred a couple of times a month. Intensity of the symptoms was based on the reported impairment. If parents reported no impairment, then