Els van Meijel

107 Posttraumatic stress in young children | Chapter 6 similar changes to the DSM-IV criteria. For example, in both algorithms the wording of some symptoms was adapted to make them more applicable for young children and the threshold to meet the avoidance criterion was lowered from 3 to 1 symptom (Scheeringa et al., 2012). On the other hand, the algorithms are not completely similar, because the DSM-5 subtype for children 6 years and younger was slightly more adapted by removing 2 avoidance symptoms and adding 1 new symptom to the avoidance cluster (APA, 2013; Friedman, 2013). Scheeringa and colleagues found that these adaptations had a limited effect on the prevalence of the avoidance criterion (Scheeringa et al., 2012). The prevalence of the PTSD-AA avoidance criterion and the prevalence of this criterion according to the DSM-5 subtype for young children was almost equal (Scheeringa et al., 2012). This might explain why both algorithms identify the same children, despite a number of dissimilar avoidance symptoms. The prevalence rate of PTSD more than tripled when the PTSD-AA algorithm or the DSM-5 subtype for children 6 years and younger algorithm (7.0%) was used instead of the DSM-IV algorithm (2.0%), although still 2 of the 9 children who experienced substantial PTSS and impairment did not fully meet the criteria of one of the three algorithms (2.0%). Scheeringa and colleagues measured PTSD in young traumatized children at three time points and also found that, in particular at the last time point, more children were impaired but not diagnosed with PTSD (Scheeringa et al., 2005). Angold and colleagues suggest to classify impaired but undiagnosed children into a not otherwise specified category of a disorder, in order to improve the identification of these children (Angold, Costello, Farmer, Burns, & Erkanli, 1999). We suggest to pay attention to this group of children. Clinicians should be aware that children with substantial PTSS who do not fully meet the criteria of any of the PTSD algorithms, can be very impaired and might need treatment. Limitations and strengths This is an exploratory and retrospective study with a number of limitations. We interviewed parents 4 months to 5 years after the accident of their child. Parents’ recollections of the accident and their child’s posttraumatic stress symptoms may have become biased over time. For example, parents and children with physical or psychological symptoms and a long rehabilitation period, may have had more