Els van Meijel

106 Chapter 6 | Posttraumatic stress in young children Discussion This is one of the first studies comparing the three most prominent diagnostic algorithms for PTSD simultaneously in a substantial sample of young children exposed to accidental trauma. We found that 9.2% of the young children developed substantial PTSS following an accident. This finding is in line with a previous study on the PTSD- AA algorithm following a motor vehicle accident (10%) (Meiser-Stedman et al., 2008). Our findings indicate that both the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm appear to be more sensitive for young children than the DSM-IV algorithm. Using these two algorithms most of the children with substantial PTSS were identified (7 out of 9). In contrast, a minority of the children with substantial PTSS met the criteria of the DSM-IV algorithm (2 out of 9). The improved sensitivity of the PTSD criteria for young children seems a step forward, now that more young children suffering from substantial PTSS can be identified and thereby offered treatment. We believe it is important to maximize the sensitivity and to identify as many young children with substantial symptoms and impairment as possible, instead of not identifying young children who do have substantial PTSS and might need treatment. Intrusion and hyperarousal symptoms were common, however, in accordance with other studies (De Young et al., 2011a; Scheeringa, Wright, Hunt, & Zeanah, 2006), most of the children (7 out of 9) did not meet the DSM-IV threshold of the avoidance cluster (3 symptoms). With the lower threshold from the PTSD-AA and DSM-5 subtype for children 6 years and younger (1 avoidance symptom required instead of 3) all children met the criterion. Besides the lower threshold, the following adaptation of avoidance symptoms in the DSM-5 subtype for young children might have made this cluster better suited for young children: the wording of some symptoms has beenmade more appropriate for young children, 2 symptoms which were not applicable for young children have been removed, and 1 symptom better suited for young children has been added (APA, 2013; Friedman, 2013). Our findings indicate that the DSM-5 subtype for children 6 years and younger and the PTSD-AA algorithm identify the same children with substantial PTSS. On the one hand, this seems evident because the algorithms aremainly similar and incorporated roughly