How Do New PTSD Diagnostic Criteria Impact Children and Adolescents?

What you need to know

• The new ICD-11 criteria for PTSD are more stringent and may result in fewer children and adolescents receiving a diagnosis compared to previous diagnostic systems
• Young trauma survivors often show different symptoms than adults, making developmentally-sensitive assessment crucial
• Both self-reports from children/adolescents and caregiver observations are important for accurate diagnosis

Understanding Trauma in Young People

Experiencing trauma in childhood or adolescence is surprisingly common, with studies showing that 30-56% of young people encounter at least one traumatic event. While not everyone develops post-traumatic stress disorder (PTSD), those who do can face significant challenges in their daily lives and development. The way children and teens respond to trauma can look quite different from adults - for instance, young children might reenact the trauma through play rather than having flashbacks like adults do.

Changes in Diagnostic Criteria

The International Classification of Diseases (ICD-11) has introduced important changes in how PTSD is diagnosed. The criteria are now more focused on core symptoms like re-experiencing the trauma, avoidance, and heightened arousal. Additionally, a new diagnosis called complex PTSD (CPTSD) has been added for cases with additional difficulties in emotional regulation, self-image, and relationships.

Impact on Diagnosis Rates

The study found that using these new ICD-11 criteria resulted in fewer children and adolescents receiving a PTSD diagnosis compared to previous diagnostic systems. For example, some young people who showed significant trauma-related distress didn’t meet the stricter criteria for diagnosis, even though they might benefit from treatment. This raises important questions about whether the new criteria might be too restrictive for younger populations.

Key Findings About Symptoms

The researchers discovered that children and teens were most likely to miss getting a diagnosis because they didn’t show enough symptoms in two key areas:

• Re-experiencing the trauma (like having flashbacks or nightmares)
• Heightened arousal (like being easily startled or having trouble sleeping)

This could be because these symptoms often show up differently in young people compared to adults. For instance, a child might express their trauma through behavioral changes rather than being able to describe flashbacks.

What This Means for You

If you’re a parent, caregiver, or professional working with trauma-exposed young people:

• Be aware that children and teens may show trauma symptoms differently than adults
• Look for age-specific signs like changes in play behavior, regression in development, or new fears
• Consider both the child’s own report of symptoms and observations from caregivers
• Remember that a child might need help even if they don’t meet full diagnostic criteria
• Seek professional assessment if you notice concerning changes after a traumatic event

Conclusions

• Trauma assessment in young people needs to take development into account - what’s normal for a 6-year-old looks very different from a teenager
• The stricter ICD-11 criteria might mean some children who need help don’t receive a diagnosis
• Using multiple sources of information (child, parent, and professional observations) leads to better assessment