Major Finding: Of 284 children aged 3-5 years who had been exposed to a traumatic event, 44% met full revised criteria for PTSD with discernable impairing symptoms.
Data Source: Results on the Preschool Age Psychiatric Assessment (PAPA), a validated instrument administered to caregivers, and the Preschool PTSD Criteria administered in studies at Tulane University in New Orleans.
Disclosures: Dr. Drury reported no relevant financial disclosures.
LOS ANGELES — Nearly half of preschool children meet age-adjusted criteria for posttraumatic stress disorder after experiencing a significant traumatic event, and some children are symptomatic even after relatively minor medical procedures, according to a researcher from Tulane University in New Orleans.
“Children under 6 years of age are particularly vulnerable to stressful experiences because of the rapid neural development they are undergoing,” Dr. Stacy S. Drury said at the International Conference on Pediatric Psychological Trauma.
In a study of 284 children aged 3-5 years who had been exposed to a traumatic event, 44% met full revised criteria for PTSD with discernable impairing symptoms, Dr. Drury, said at the meeting, which was sponsored by the University of Southern California, Los Angeles, and the University of California, Irvine.
No statistically significant differences were seen in rates of PTSD based on the type of trauma children experienced: a single-incident trauma (a motor vehicle accident, burn, or fall) (38%), observed domestic violence (42%), or Hurricane Katrina (48%).
Children were diagnosed using the structured Preschool Age Psychiatric Assessment (PAPA), a validated instrument administered to caregivers.
The study utilized the Preschool PTSD Criteria, which is less reliant on verbalization and abstract thought than DSM-IV PTSD criteria for adults (J. Am. Acad. Child Adolesc. Psychiatry 2003;42:561-70).
A second study assessed PTSD in 69 preschool children seen at a hospital-based primary care clinic more than 12 months after events that ranged from medical encounters that involved no procedures, procedures such as receiving stitches or getting a shot, nonmedical traumas such as motor vehicle accidents, and high-risk events such as abuse or neglect.
Dr. Drury showed that even “small things,” like stitches, had a lasting effect on some children. “Fifteen months after the event, these symptoms were recognizable to parents … and persistent,” she said.
Dr. Drury reviewed burgeoning neurobiological literature demonstrating that early stress results in changes within biocircuitry of the developing brain, altering the central nervous system, cortisol levels, and neurotransmitters.
“Altered neural circuits lead to lasting vulnerability,” she emphasized, adding that much more research needs to be done to pinpoint the timing of trauma and its ramifications on early brain development and behavior.
“Trauma at 1 year is very different than trauma at 3 or at 6 years old, in part because of what areas of the brain are developing most rapidly,” she said.
She and colleagues are developing cognitive behavioral therapies that can be delivered early to parents and children following symptoms of PTSD.
Dr. Drury reported no relevant financial disclosures.