Discuss diagnosing childhood PTSD and doing a differential diagnosis (include acute stress disorder, reactive attachment disorder, disinhibited social engagement disorder, depression, OCD, oppositional defiant disorder, adjustment disorder and bipolar disorder). List the central features of each and how to differentiate it from PTSD. How does acute verses chronic trauma play a role and what is a "dose-response effect"? What are the best methods for diagnosing appropriately? 

 

Children can develop PTSD after experiencing a life-threatening situation or sexual violence. The symptoms of PTSD in children are age-specific and is diagnosed if the symptoms have occurred and persisted one (1) month after the traumatic event. The increased likelihood of children developing PTSD include how severe the traumatic event is, how their parents reacted to the event, and their "physical proximity to the traumatic event."

• Acute stress disorder (ASD)- ASD has the same symptoms as PTSD but is diagnosed when the symptoms persist for three (3) days up to a month only after the exposure to the stressor.
• Reactive attachment disorder (RAD) - Children with RAD show limited emotional responses and do not form an emotional attachment with their caregivers or do not want comfort from them.
• Disinhibited social engagement disorder (DSED) - Children with DSED are the opposite of those with RAD. Children are often wary of strangers, but children with DSED are unusually open to interacting with strangers and are overly friendly and comfortable with unfamiliar people.
• Major depressive disorder (MDD) - MDD may either be preceded or not by a traumatic experience and "should be diagnosed if other PTSD symptoms are absent." MDD does not include other PTSD criteria (Criteria B to E).
• Obsessive-compulsive disorder (OCD) - OCD is diagnosed when the recurrent thoughts meet the criteria of an obsession and are not related to a traumatic event. Furthermore, compulsions can be present, and with the absence of other PTSD or acute stress disorder symptoms.
• Oppositional defiant disorder (ODD) - Children with ODD are prone to persistent outbursts of anger, hostility, and have a pattern of disobedience and defiance against authority.
• Adjustment disorder - Adjustment disorder is diagnosed when: (1) the stressor includes actual or threatened death, serious injury, or sexual violence but does not meet the other criteria, or (2) the stressor does not include actual or threatened death, serious injury, or sexual violence.
• Bipolar disorder - Like MDD, bipolar disorder may or not be preceded by a traumatic event, and its main difference to MDD is the extreme mood swings (depression and mania).

Acute trauma is often associated with short-term posttraumatic stress disorder, according to the National Institute of Mental Health.

Symptoms of chronic trauma sometimes do not resurface immediately and may manifest after an extended period, sometimes years after the traumatic event, as in the case of people who experienced acute trauma, according to the American Psychological Association.

The dose-response effect is the relationship between the quantity of the treatment, e.g., its length, frequency, and the likelihood of patient improvement. 

How to diagnose appropriately:

• Gather sufficient information (observation, conduct a clinical interview, and administer comprehensive assessment if necessary)
• Use a standard classification system (DSM-5)
• Form a diagnostic impression