PTSD in Children and Adolescents Review of Psychiatry Series John M. Oldham, M.D. Michelle B. Riba, M.D., M.S. Series Editors No. 1 Washington, DC London, England PTSD in Children and Adolescents EDITED BY Spencer Eth, M.D. Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2001 American Psychiatric Publishing, Inc. 04 03 02 01 4 3 2 1 ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper First Edition American Psychiatric Publishing, Inc. 1400 K Street, NW Washington, DC 20005 www.appi.org The correct citation for this book is Eth S (editor): PTSD in Children and Adolescents (Review of Psychiatry Series, Volume 20, Number 1; Oldham JM and Riba MB, series editors). Washington, DC, American Psychiatric Publishing, 2001 Library of Congress Cataloging-in-Publication Data PTSD in children and adolescents / edited by Spencer Eth. p. ; cm — (Review of Psychiatry ; v. 20, no. 1) Includes bibliographical references and index. ISBN 1-58562-026-2 (alk. paper) 1. Post-traumatic stress disorder in children. 2. Teenagers—Mental health. [DNLM: 1. Stress Disorders, Post-Traumatic—diagnosis—Adolescence. 2. Stress Disorders, Post-Traumatic—diagnosis—Child. 3. Stress Disorders, Post-Traumatic—therapy—Adolescence. 4. Stress Disorders, Post-Traumatic—therapy—Child. 5. Forensic Psychiatry—methods. 6. Psychotherapy—methods—Adolescence. 7. Psychotherapy—methods— Child. WM 170 P975 2001] I. Title: Post-traumatic stress disorder in children and adolescents. II. Eth, Spencer, 1950- III. Review of psychiatry series ; v. 20, 1 RJ506.P55 .P875 2001 616.85′21—dc21 00-067404 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Cover photograph: Copyright © 2001 David Oliver/Stone. To my wife, Cheryl, a woman of kindness and valor. Contents Contributors xi Introduction to the Review of Psychiatry Series xiii John M. Oldham, M.D., and Michelle B. Riba, M.D., M.S., Series Editors Introduction: Childhood Trauma in Perspective xvii Spencer Eth, M.D. Chapter 1 Evaluation and Assessment of PTSD in Children and Adolescents 1 Evan B. Drake, Ph.D. Sherry F. Bush, Ph.D. Wilfred G. van Gorp, Ph.D. Introduction 1 Issues in the Assessment of Children and Adolescents 1 Clinical Guidelines for Assessment 4 Recent Developments in Clinical Assessment 5 Multidimensional Approach to Assessment 15 Conclusions 26 References 27 Chapter 2 Forensic Aspects of PTSD in Children and Adolescents 33 James E. Rosenberg, M.D. Introduction 33 Diagnosis 34 Epidemiology 38 Genetics 39 Risk Factors in Various Settings 39 Psychophysiology 44 Assessment 45 PTSD and Memory 47 Treatment 50 Conclusions and Recommendations 51 References 54 Chapter 3 PTSD in Children and Adolescents in the Juvenile Justice System 59 William Arroyo, M.D. Introduction 59 Demographics 60 Mental Disorders 61 Posttraumatic Stress Disorder 62 Incarcerated Youth 63 Female Population 65 Predisposing Factors 65 Interventions 70 Special National Challenge 77 Summary 78 References 79 Chapter 4 Biological Treatment of PTSD in Children and Adolescents 87 Soraya Seedat, M.B. Dan J. Stein, M.B. Diagnosis and Phenomenology 88 Neurobiologic Systems in PTSD 90 Biologic Treatments in Children and Adolescents 94 Assessing Outcome in Children and Adolescents 104 Quality of Life 105 Conclusions 105 References 107 Chapter 5 Relationship Between Childhood Traumatic Experiences and PTSD in Adults 117 Rachel Yehuda, Ph.D. Ilyse L. Spertus, Ph.D. Julia A. Golier, M.D. Introduction 117 Long-Term Consequences of Childhood Maltreatment—Sexual Abuse, Physical Abuse, Emotional Abuse, and/or Neglect 118 Challenges in Formulating a Model of the Effects of Early Child Maltreatment on the Adult 124 Long-Term Consequences of Single-Episode Traumatic Events: Preliminary Evidence 125 Prevalence of PTSD in Children and Adults Following Childhood Trauma 127 Impact of Early Maltreatment on Reaction to Subsequent Trauma and Risk of Revictimization 129 Biological Models of the Effects of Stress: The Centrality of Sensitization as a Mechanism of Permanent Stress Responses 132 Developmental Influences of Early Stress in Animals 133 Biological Consequences in Adults Who Experienced Trauma in Childhood 135 PTSD and Other Psychological Symptoms in Adults Who Survived the Holocaust as Children 141 Methodologic Considerations in the Study of the Long-Term Impact of Childhood Trauma 143 Summary and Conclusions 146 References 146 Index 159 [...]... available to clinicians, then the CAPA -PTSD may well prove to be a useful tool in the clinical assessment of PTSD Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV (CAPS-CA) The Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV (CAPS-CA; Nader et al 1998) is a detailed, structured clinical interview developed by the National Center for PTSD and the University... Children and Traumatic Stress New York, John Wiley and Sons, 2000 xxvi PTSD IN CHILDREN AND ADOLESCENTS Chapter 1 Evaluation and Assessment of PTSD in Children and Adolescents Evan B Drake, Ph.D Sherry F Bush, Ph.D Wilfred G van Gorp, Ph.D Introduction Posttraumatic stress disorder (PTSD) as a psychiatric diagnosis was formally introduced in DSM-III in 1980 by the American Psychiatric Association In. .. competence, and familial support can further influence diagnosis and the manifestation of the disorder 2 PTSD IN CHILDREN AND ADOLESCENTS The research literature on childhood PTSD is diverse in terms of precipitating events studied (e.g., war, floods, school violence, bombings, physical abuse, sexual abuse) In contrast, the literature focusing on the clinical assessment of PTSD in children and adolescents. .. allowed us to noninvasively see into the living human body The new imaging methods, fortunately, do not involve the risk of radiation exposure, and the capacity of the newest imaging machines to reveal brain structure and function in great detail is remarkable Yet in many ways these techniques still elude clinical application, since they are expensive and increasingly complex to administer and interpret John... C, and D symptom clusters, respectively Although reliability and validity data remain sparse, the CAPS-CA provides a detailed, easily administered structured interview that will guide the clinician through all aspects of assessing PTSD and assist in the diagnosis of the disorder Children s PTSD Inventory (CPTSDI) The Children s PTSD Inventory (CPTSDI; Saigh et al 2000) is a rapidly administered interview... has been increased awareness of the prevalence and clinical manifestations of the disorder in children and adolescents The aim of this chapter is to provide the reader with a greater understanding of the clinical issues in, and an approach to, the evaluation of a child or adolescent at risk for PTSD To this end, we review recently developed assessment methods of PTSD in children and adolescents and present... Greening (2000) reported on symptoms of posttraumatic stress in parentally bereaved children and adolescents Frederick (1985) was a pioneer in the use of a standardized instrument (the reaction index) to measure the severity of traumatic symptoms in children Rating scales have since proven invaluable in both their research applications and their clinical applications In Chapter 1, Drake, Bush, and van... England, Blackwell Scientific, 1985, pp 152–176 xxiv PTSD IN CHILDREN AND ADOLESCENTS Goodwin, J: Post-traumatic symptoms in incest victims, in Post-Traumatic Stress Disorder in Children Edited by Eth S, Pynoos RS Washington, DC, American Psychiatric Press, 1985, pp 155–168 Green AH: Children traumatized by physical abuse, in Post-Traumatic Stress Disorder in Children Edited by Eth S, Pynoos RS Washington,... developments in Advances in Brain Imaging, and the shift toward xiv PTSD IN CHILDREN AND ADOLESCENTS greater clinical utility is clear in their descriptions of these methods Perhaps most intriguing is the promise that through these methods we can identify, before the onset of symptoms, those most at risk of developing psychiatric disorders, as discussed by Daniel Pine regarding childhood disorders and by... concepts, including frequency (calendars marked with Xs), Evaluation and Assessment of PTSD in Children and Adolescents 7 intensity-problems (cartoon figures with facial and somatic expressions), and intensity-feelings (facial expressions) The CAPSCA also assesses the frequency and intensity of PTSD- associated symptoms that are not part of the DSM-IV diagnostic criteria Before administering the full . PTSD in Children and Adolescents Review of Psychiatry Series John M. Oldham, M.D. Michelle B. Riba, M.D., M.S. Series Editors No. 1 Washington, DC London, England PTSD in Children and Adolescents EDITED. Adolescents 87 Soraya Seedat, M.B. Dan J. Stein, M.B. Diagnosis and Phenomenology 88 Neurobiologic Systems in PTSD 90 Biologic Treatments in Children and Adolescents 94 Assessing Outcome in Children. authors have delighted in find- ing literary descriptions characteristic of PTSD in various fiction and nonfiction works dating back to Homer (Daly 1983). xviii PTSD IN CHILDREN AND ADOLESCENTS The