Els van Meijel

97 Posttraumatic stress in young children | Chapter 6 Background The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013) includes a subtype for posttraumatic stress disorder (PTSD) in children 6 years and younger. Before the release of the DSM-5, several studies had shown that more developmentally sensitive PTSD criteria for young children were needed (De Young, Kenardy, & Cobham, 2011b; Postert, Averbeck-Holocher, Beyer, Muller, & Furniss, 2009; Scheeringa, Zeanah, Drell, & Larrieu, 1995). The PTSD criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; APA, 2000) were based on research among adults and older children (Postert et al., 2009; Scheeringa, Myers, Putnam, & Zeanah, 2012). Therefore, some of the symptoms were not suitable for young children, because they required skills that young children have not yet developed, such as verbal expression, memory or abstract thought (Postert et al., 2009; Scheeringa, Zeanah, Myers, & Putnam, 2003). As a consequence, not all young children with substantial levels of posttraumatic stress symptoms (PTSS) did fully meet the required DSM-IV criteria for PTSD, although these children can experience impairment and need trauma-focused treatment (Scheeringa, Zeanah, Myers, & Putnam, 2005). In order to improve the identification of PTSD in young children, Scheeringa and colleagues proposed alternative PTSD criteria for young children (Scheeringa et al., 1995). This alternative algorithm (PTSD-AA) focused on behavioral symptoms instead of thoughts and feelings, and included the following changes to the DSM-IV criteria. First, criterion A2 (response of fear, helplessness or horror) was removed because young children are less able to report their response to the traumatic event and witnesses are not always present. Second, the wording of some symptoms was adapted to make them more applicable for young children. Finally, the threshold to meet the avoidance/numbing criterion was lowered from 3 to 1 symptom (Scheeringa et al., 2012). These changes have been incorporated in the DSM-5 subtype for children 6 years and younger, in addition to the following (unrelated to the PTSD-AA proposal): First, criterion C avoidance/numbing has been split into “Persistent avoidance of stimuli” and “Negative alterations in cognitions”. Second, symptom C3 - “ Inability to recall an important aspect of the trauma” and symptom C7 - “Sense of a foreshortened future” have been removed. Third, symptom C3 - “Increased frequency of negative emotional states” has been added to criterion C (APA, 2013; Friedman, 2013). In accordance with