Toward Assessing Traumatic Events and Stress Symptoms in Preschool Children From Low-Income Families
Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1043, USA. American Journal of Orthopsychiatry
(Impact Factor: 1.36).
05/2008; 78(2):220-8. DOI: 10.1037/a0013977
Traumatic events can seriously disrupt the development of preschool children. Yet few studies capture developmentally specific examples of traumas and the expression of distress for this age group. Mothers and teachers of 138 preschoolers from low-income families were interviewed about traumatic events and completed a new measure assessing their child's traumatic stress symptoms. They reported traumatic events as the death of a person, death of a pet, family violence, high conflict divorce, sudden family loss, accident or injury, and viewing the World Trade Center attack. Factor analysis of 17 trauma symptoms revealed three internally consistent and valid scales: Intrusions, Emotional Reactivity, and Fears, plus a Total omnibus score. Traumatic stress symptoms varied by the type of event. Scores were higher for traumatic events involving close family members than for distal events.
Available from: Melissa Jeanne Hagan
- "This finding suggests that providers may wish to pay particular attention to a preponderance of mood versus anxiety-related post-traumatic stress symptoms depending on whether traumatic experiences were lossrelated or violence-related. Although specificity between trauma type and mental health problems has been examined in middle childhood and adolescence, it remains relatively understudied in early childhood (Graham-Bermann et al. 2008; Margolin et al. 2010). Person-Centered Approaches to the Study of Traumatic Events Developmental psychopathology and dynamic systems frameworks imply that individual development involves multiple factors that can be described as patterns or profiles (Bogat 2009) and highlight the need to utilize methods sensitive to individual differences in environmental exposure and behavior (Cicchetti 2013). "
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ABSTRACT: Studies of the association between traumatic experiences and psychopathology in early childhood have primarily focused on specific types of events (e.g., sexual abuse) or aggregated different types of events without differentiating among them. We extend this body of work by investigating patterns of traumatic event exposure in a high-risk, ethnically diverse sample of children ages 3-6 (N = 211; 51 % female) and relating these different patterns to parents' reports of child externalizing, internalizing, and post-traumatic stress symptomatology. Using latent class analysis, which divides a heterogeneous population into homogenous subpopulations, we identified three patterns of traumatic events based on parents' responses to an interview-based assessment of trauma exposure in young children: (1) severe exposure, characterized by a combination of family violence and victimization; (2) witnessing family violence without victimization; and (3) moderate exposure, characterized by an absence of family violence but a moderate probability of other events. The severe exposure class exhibited elevated internalizing and post-traumatic stress symptoms relative to the witness to violence and moderate exposure classes, controlling for average number of traumatic events. Results highlight the need for differentiation between profiles of traumatic life event exposure and the potential for person-centered methods to complement the cumulative risk perspective.
Available from: Lea R. Dougherty
- "Bipolar disorder, conduct disorder, eating disorders, posttraumatic stress disorder, and obsessive-compulsive disorder were not assessed because they are very rare at age 3  , although some of these conditions may be more common in older preschool-aged children (eg, Refs.  and ). Dimensional symptom scales were created by summing items in each diagnostic category. "
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Recent studies indicate that many preschoolers meet diagnostic criteria for psychiatric disorders. However, data on the continuity of these diagnoses are limited, particularly from studies examining a broad range of disorders in community samples. Such studies are necessary to elucidate the validity and clinical significance of psychiatric diagnoses in young children. The authors examined the continuity of specific psychiatric disorders in a large community sample of preschoolers from the preschool period (age 3) to the beginning of the school-age period (age 6).
Eligible families with a 3-year child were recruited from the community through commercial mailing lists. For 462 children, the child's primary caretaker was interviewed at baseline and again when the child was age 6, using the parent-report Preschool Age Psychiatric Assessment, a comprehensive diagnostic interview. The authors examined the continuity of DSM-IV diagnoses from ages 3 to 6.
Three-month rates of disorders were relatively stable from age 3 to age 6. Children who met criteria for any diagnosis at age 3 were nearly five times as likely as the others to meet criteria for a diagnosis at age 6. There was significant homotypic continuity from age 3 to age 6 for anxiety, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder, and heterotypic continuity between depression and anxiety, between anxiety and oppositional defiant disorder, and between ADHD and oppositional defiant disorder.
These results indicate that preschool psychiatric disorders are moderately stable, with rates of disorders and patterns of homotypic and heterotypic continuity similar to those observed in samples of older children.
Available from: Alexandra C De Young
- "The most common symptoms that are reported across studies, including either interview or questionnaire data, are talking about the event, distress upon reminders, nightmares, new separation anxiety or clinginess, new fears, crying, sleep disturbance, increased motor activity and increased irritability or tantrums (Graham-Bermann et al. 2008; Klein et al. 2009; Levendosky et al. 2002; Saylor et al. 1992; Scheeringa et al. 2001, 2003; Zerk et al. 2009). "
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ABSTRACT: Infants, toddlers and preschoolers are a high risk group for exposure to trauma. Young children are also vulnerable to experiencing adverse outcomes as they are undergoing a rapid developmental period, have limited coping skills and are strongly dependent on their primary caregiver to protect them physically and emotionally. However, although millions of young children experience trauma each year, this population has been largely neglected. Fortunately, over the last 2 decades there has been a growing appreciation of the magnitude of the problem with a small but expanding number of dedicated researchers and clinicians working with this population. This review examines the empirical literature on trauma in young children with regards to the following factors: (1) how trauma reactions typically manifest in young children; (2) history and diagnostic validity of posttraumatic stress disorder (PTSD) in preschoolers; (3) prevalence, comorbidity and course of trauma reactions; (4) developmental considerations; (5) risk and protective factors; and (6) treatment. The review highlights that there are unique developmental differences in the rate and manifestation of trauma symptomatology, the current Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV-TR) PTSD criteria is not developmentally sensitive and the impact of trauma must be considered within the context of the parent-child relationship. Recommendations for future research with this population are also discussed.
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