Post-traumatic stress disorder in children: Clinical aspects and comorbidity

Introduction - Like adults, children and teenagers are increasingly confronted with threatening and traumatizing events. Clinical practice shows that serious psychological disorders may occur during these events, which frequently engenders disturbance of the adaptation of these young people. Nevertheless, research on this disorder has overlooked the young population, despite being subject to the same traumatic experiences as adults. Aim of the study - This clinical study therefore focused on young subjects aged from 4 to 17 and who were victims of road accidents in May 2004. Methods - The size of the sample was of 15 children and teenagers: 10 boys and 5 girls. Their disorders were evaluated by a clinical interview that made use of a semi-structured questionnaire K-SADS-PL two months after the trauma, then another after six months. Clinical aspects - The diagnosis of PTSD was found among 14 out of the 15 patients during the first evaluation and among the entire sample after six months. Among these children, four (26.7%) were injured during the accident (fracture, brain damage, superficial injuries). About half of the sample (46.6%) lost a member of their families (6 lost their mother, 1 lost his brother) and 40% lost a relative (grand-mother, aunt, or cousin). Results - Using the clinical analysis with the K-SADS has shown validity of DSM IV criteria. The symptoms of dissociation, observed after two months, disappeared significantly six months later. This fact may be due to the emotional collapse which accompanies the most violent types of stress. An important comorbidity of depressive and anxious disorders - especially separation anxiety - was found constant during both evaluations. It represents a supplementary handicap and risk for important psychological after-effects, even after some years. Some disorders such as separation anxiety, regressive symptoms and psychosomatic manifestations are frequently associated with the PTSD. Conclusion - We hypothesise that these disorders should be considered as diagnostic criteria and not as comorbid disorders.