The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents.) Font: AMERICAN JOURNAL OF PSYCHIATRY. 2008 OCT;165(10):1326-1337.
Richard Meiser-Stedman; Patrick Smith; Edward Glucksman; William Yule;Tim Dalgleish.
Resum:
Més informació:
"De modo creciente, los niños están siendo diagnosticados con trastornos psiquiátricos, incluyendo los niños en edad preescolar. "
"Estos diagnósticos plantean preguntas referente a :
1) cómo deberían modificarse los algoritmos de diagnóstico de los trastornos individuales para los grupos de niños de corta edad,
2) cómo la psicopatología se detecta mejor en una etapa temprana, y
3) cómo hacer uso de informadores múltiples.
Los autores examinaron estos aspectos en una valoración longitudinal prospectiva de niños en edad preescolar y educación primaria, expuestos a un evento traumático.
Los participantes fueron 114 niños (2-10 años) que habían experimentado un accidente de tráfico.
Los padres y los niños mayores (7-10 años) completaron entrevistas estructuradas de 2-4 semanas (valoración inicial) y 6 meses (periodo seguimiento de seis meses) después del evento traumático.
Se utilizó un algoritmo de síntoma alternativo recientemente propuesto para diagnosticar el trastorno de estrés postraumático (PTSD) y se comparó con algoritmos DSM-IV estándares para diagnosticar el PTSD y trastornos de estrés agudos.
En la valoración de 2-4 semanas, 11.5% de los niños cumplieron las condiciones para un diagnóstico de PTSD basado en los criterios del algoritmo alternativos a través de los informes de los padres, y el 13.9% cumplieron con los criterios para este diagnóstico en el seguimiento de seis meses.
Estos porcentajes fueron mucho mayores que aquellos para los diagnósticos DSM-IV del trastorno de estrés agudo y PTSD. Entre los sujetos de 7-10 años, el uso combinado de los síntomas de los padres y de los niños para derivar un diagnóstico, dio como resultado un número creciente de niños en esta categoría de edad que se identificaron con una enfermedad psiquiátrica en relación con los informes de los padres únicamente.
El acuerdo entre el los síntomas del padre y el niño para 1) un diagnóstico de PTSD basado en los criterios de algoritmo alternativos y 2) diagnóstico del trastorno de estrés agudo DSM-IV y PTSD en esta categoría de edad fue pobre.
Entre los sujetos de 2-6 años, el diagnóstico PTSD a través del informe de los padres fue un predictor más sensible del inicio posterior de una psicopatología en relación con un diagnóstico de trastorno de estrés agudo DSM-IV o PTSD a través del informe de los padres.
Sin embargo, en sujetos de 7-10 años, un informe de síntomas combinado (padres y niño) fue óptimo para predecir la psicopatología postraumática.
Estos resultados soportan el uso del algoritmo alternativo propuesto para valorar el PTSD en niños jóvenes y sugiere que el diagnóstico de PTSD basado en los criterios del algoritmo alternativo es estable desde la fase aguda en adelante.
Cuando se utilizan los síntomas manifestados por los padres y niños para la valoración del PTSD en niños de 7-10 años, el algoritmo alternativo y los criterios DSM-IV tienen una amplia validez comparable.
Sin embargo, en ausencia de síntomas manifestados por el niño, los criterios del algoritmo alternativo a través de los informes de los padres parecen ser una medida diagnóstica óptima de PTSD en niños en esta categoría de edad, en relación al algoritmo DSM-IV estándar para diagnosticar el trastorno. "
"Para acceder al texto completo consulte las características de suscripción de la fuente original": ajp.psychiatryonline.org/index.dtl
Abstract
Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and elementary school-age children who were exposed to a traumatic event. Participants were 114 children (age range: 2–10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7–10 years) completed structured interviews 2–4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder.
Increasingly, children are being diagnosed with psychiatric disorders, including preschool-age children. These diagnoses in young children raise questions pertaining to 1) how diagnostic algorithms for individual disorders should be modified for young age groups, 2) how psychopathology is best detected at an early stage, and 3) how to make use of multiple informants. The authors examined these issues in a prospective longitudinal assessment of preschool- and elementary school-age children who were exposed to a traumatic event. Participants were 114 children (age range: 2–10 years) who had experienced a motor vehicle accident. Parents and older children (age range: 7–10 years) completed structured interviews 2–4 weeks (initial assessment) and 6 months (6-month follow-up) after the traumatic event. A recently proposed alternative symptom algorithm for diagnosing posttraumatic stress disorder (PTSD) was utilized and compared with the standard DSM-IV algorithms for diagnosing PTSD and acute stress disorder. At the 2- to 4-week assessment, 11.5% of the children met conditions for a diagnosis of PTSD based on the alternative algorithm criteria per parent report, and 13.9% met criteria for this diagnosis at the 6-month follow-up. These percentages were much higher than those for DSM-IV diagnoses of acute stress disorder and PTSD. Among 7- to 10-year-old subjects, the use of combined parent- and child-reported symptoms to derive a diagnosis resulted in an increased number of children in this age group who were identified with psychiatric illness relative to the use of parent report alone. Agreement between parent and child on symptoms for 1) a diagnosis of PTSD based on the alternative algorithm criteria and 2) diagnoses of DSM-IV acute stress disorder and PTSD in this age group was poor. Among 2- to 6-year-old subjects, the alternative algorithm PTSD diagnosis per parent report was a more sensitive predictor of later onset psychopathology relative to a diagnosis of DSM-IV acute stress disorder or PTSD per parent report. However, among 7- to 10-year-old subjects, a combined symptom report (from both parent and child) was optimal in predicting posttraumatic psychopathology. These findings support the use of the proposed alternative algorithm for assessing PTSD in young children and suggest that the diagnosis of PTSD based on the alternative algorithm criteria is stable from the acute phase onward. When both parent- and child-reported symptoms are utilized for the assessment of PTSD among 7- to 10-year-old children, the alternative algorithm and DSM-IV criteria have broad comparable validity. However, in the absence of child-reported symptoms, the alternative algorithm criteria per parent report appears to be an optimal diagnostic measure of PTSD among children in this age group, relative to the standard DSM-IV algorithm for diagnosing the disorder.
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