Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood.

OBJECTIVE The reliability and validity of DSM-IV criteria and an alternative set of criteria for posttraumatic stress disorder (PTSD) are assessed in infants and young children (younger than 4 years of age). METHOD This study was conducted in three phases. Phase 1 applied DSM-IV criteria for PTSD to 20 case reports of severely traumatized infants from the literature. Phase 2 used an expanded checklist of symptoms that were developmentally sensitive and behaviorally anchored to create an alternative set of criteria for PTSD in infants. Phase 3 compared the DSM-IV criteria to the alternative criteria on 12 new cases of traumatized infants. RESULTS Infants and young children who have experienced severe traumas show many symptoms of impairment, similar to posttraumatic symptoms in older children and adults. The alternative criteria were more reliable and more valid for diagnosing PTSD in infancy than DSM-IV criteria. CONCLUSIONS Clinicians ought to be aware that infants and young children can develop posttraumatic disorders after traumatic events. Criteria for diagnosing these disorders in standard nosologies may need revision for use with children younger than 48 months of age.