New Thinking on Child Traumatic Stress

The recent toll of Hurricane Sandy has had all of us thinking about how the stress and dislocation caused by a natural disaster can affect families and kids.

But Sandy also presents an opportunity to address our evolving understanding of traumatic stress reactions in young people. It is helpful to know what is on the horizon in the upcoming revision to theDiagnostic and Statistical Manual (DSM-5) and how the approach to child traumatic stress is turning towards less restrictive criteria, a more nuanced consideration of developmental stages, and the provision of effective short-term treatment to more children at risk.

The fact is that the psychotherapeutic interventions we have developed for traumatic stress reactions pose no risks to the child and have proven very effective in nurturing a healthy recovery. We can’t hurt kids by intervening earlier and more often when a trauma impairs a child’s ability to function—but we can do a world of good.

This issue was raised at the recent International Society for Traumatic Stress Studies (ISTSS) conference. A summary of the thinking of two or three leading clinicians in this area can clarify how to use this knowledge and ensure that we help more children sooner rather than later.

Michael Scheeringa, who does work on PTSD in preschoolers at Tulane, was central to reformulating the DSM approach, most notably relaxing the criteria for diagnosis in young people and making certain developmental modifications. Currently for a PTSD diagnosis, intrusive thoughts must be experienced as “distressing.” However, young kids will often simply say something like, “Hey, did you know my dad hit my mom last night?” without any apparent distress—they don’t seem bothered by it. But that is developmentally typical. They don’t know how to label all their emotions. So that “distressing” criteria will change.

Another developmental difference that will be addressed concerns avoidance. Adults have to have multiple symptoms of avoidance or emotional numbing to be diagnosed, but that is a difficult concept to observe in children. In DSM-5 a child will only have to display one symptom.