Famularo R, Fenton T, Kinscherff R, Augustyn M
Boston Juvenile Court, Massachusetts Department of Mental Health, USA.
Child Abuse Negl. 1996 Oct;20(10):953-61. doi: 10.1016/0145-2134(96)00084-1.
The purpose of this study was to examine the psychiatric comorbidity between children presenting with Post Traumatic Stress Disorder (PTSD) and traumatized children not developing this disorder.
One-hundred and seventeen severely maltreated children were examined for evidence of PTSD. Analyses probed for diagnostic relationship, between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised Version (DICA-CR).
All children presented before a juvenile/family court due to severe child maltreatment and psychological trauma. These children had been ordered removed from parental custody due to the trauma suffered by the child. For the purposes of analyses, this entire group of maltreated and traumatized children were dichotomized into a PTSD group and a non-PTSD group. Thirty-five percent (41 of 117) of the children met strict DICA criteria for PTSD.
The children were examined by means of a structured clinical interview. The Diagnostic Interview for Children and Adolescents, revised version (DICA-Child-R), along with a more general psychiatric interview. The DICA-Child-R responses provided the only determination of whether the children met formal PTSD criteria. Data gathering on the sample also included a comprehensive review of risk factors for the development of PTSD, including demographics, and type(s) of trauma suffered.
Findings revealed that the PTSD diagnosis was significantly correlated with: 1. Attention Deficit Hyperactivity Disorder (ADHD) 2. Other anxiety disorders 3. Brief Psychotic Disorder or Psychotic Disorder NOS 4. The presence of suicidal ideation 5. A trend toward mood disorders. There were no differences between the two samples on measures of age, race, and family income.
Pediatric PTSD is a severe psychiatric disorder. In this study, PTSD was statistically related to other formal psychiatric diagnoses. The investigators attended to the issues relating to true comorbidity versus inaccurate diagnosis secondary to symptom overlap between different conditions. Applying strict criteria, the results suggest that the presence of PTSD in children confers a substantial likelihood of other formal diagnosis. Moreover, the symptom of suicidal ideation was overrepresented among PTSD subjects. Given these additional conditions, more extensive evaluation and specialized, multi-modal treatment should be considered in children presenting with PTSD.
本研究旨在调查患有创伤后应激障碍（PTSD）的儿童与未患该障碍的受创伤儿童之间的精神疾病共病情况。
对117名受严重虐待的儿童进行PTSD证据检查。分析探究了PTSD与《儿童及青少年诊断访谈修订版》（DICA - CR）中其他正式诊断之间的诊断关系。
所有儿童因严重的儿童虐待和心理创伤而在少年/家庭法庭出庭。由于儿童遭受的创伤，这些儿童已被下令脱离父母监护。为了进行分析，将这一整个受虐待和受创伤儿童群体分为PTSD组和非PTSD组。35%（117名中的41名）儿童符合PTSD的严格DICA标准。
通过结构化临床访谈对儿童进行检查。采用《儿童及青少年诊断访谈修订版》（DICA - Child - R）以及更全面的精神科访谈。DICA - Child - R的回答是确定儿童是否符合正式PTSD标准的唯一依据。对样本的数据收集还包括对PTSD发展风险因素的全面审查，包括人口统计学特征以及所遭受创伤的类型。
研究结果显示，PTSD诊断与以下因素显著相关：1. 注意力缺陷多动障碍（ADHD）；2. 其他焦虑症；3. 短暂精神病性障碍或未特定的精神病性障碍；4. 自杀意念的存在；5. 有患情绪障碍的趋势。两组样本在年龄、种族和家庭收入测量方面没有差异。
儿童PTSD是一种严重的精神疾病。在本研究中，PTSD与其他正式精神科诊断在统计学上相关。研究人员关注了与真正共病以及不同病症之间症状重叠导致的不准确诊断相关的问题。应用严格标准后，结果表明儿童中PTSD的存在意味着有很大可能性存在其他正式诊断。此外，自杀意念症状在PTSD受试者中更为常见。鉴于这些额外情况，对于患有PTSD的儿童应考虑进行更广泛的评估和专门的多模式治疗。
