Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
Eur J Psychotraumatol. 2013 Aug 21;4. doi: 10.3402/ejpt.v4i0.20436. eCollection 2013.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)-Criteria A1 and A2 for posttraumatic stress disorder (PTSD) have been discussed extensively, with several studies in adults or adolescents supporting the removal of Criterion A2. However, solid research in children is missing.
This study evaluated the DSM-Criteria A1 and A2 in predicting posttraumatic stress in children.
A sample of 588 Dutch school children, aged 8-18 years, completed a self-report questionnaire to determine if they met Criteria A1 and/or A2. Their posttraumatic stress response was assessed using the Children's Revised Impact of Event Scale.
The contribution of Criterion A2 to the prediction of posttraumatic stress in children is of greater importance than the contribution of Criterion A1. Children who met Criterion A2 reported significantly higher levels of posttraumatic stress and were nine times more likely to develop probable PTSD than children who did not meet Criterion A2. When Criterion A1 was met, a child was only two times more likely to develop probable PTSD as compared with those where Criterion A1 was not met. Furthermore, the low sensitivity of Criterion A1 suggests that children may regularly develop severe posttraumatic stress in the absence of Criterion A1. The remarkably high negative predictive value of Criterion A2 indicates that if a child does not have a subjective reaction during an event that it is unlikely that he or she will develop PTSD.
In contrast to most adult studies, the findings of this study emphasize the significant contribution of Criterion A2 to the prediction of posttraumatic stress in children and raise fundamental questions about the value of the current Criterion A1.
创伤后应激障碍（PTSD）的《精神障碍诊断与统计手册》（DSM）标准 A1 和 A2 已经被广泛讨论过，多项针对成年人或青少年的研究支持删除标准 A2。然而，儿童方面的坚实研究仍然缺失。
本研究评估了 DSM 标准 A1 和 A2 在预测儿童创伤后应激反应中的作用。
一个由 588 名 8-18 岁荷兰在校儿童组成的样本完成了一份自我报告问卷，以确定他们是否符合标准 A1 和/或 A2。使用儿童修订版事件影响量表评估他们的创伤后应激反应。
标准 A2 对儿童创伤后应激反应的预测作用比标准 A1 更为重要。符合标准 A2 的儿童报告的创伤后应激水平显著更高，发展为可能 PTSD 的可能性是不符合标准 A2 的儿童的九倍。当符合标准 A1 时，儿童发展为可能 PTSD 的可能性与不符合标准 A1 的儿童相比仅增加两倍。此外，标准 A1 的低敏感性表明，即使没有标准 A1，儿童也可能经常出现严重的创伤后应激反应。标准 A2 的高阴性预测值表明，如果儿童在事件中没有主观反应，那么他或她不太可能发展为 PTSD。
与大多数成人研究结果不同，本研究的发现强调了标准 A2 在预测儿童创伤后应激反应中的重要贡献，并对当前标准 A1 的价值提出了根本性的质疑。
