A multi-method and multi-informant approach to assessing post-traumatic stress disorder (PTSD) in children

Abstract

Trauma exposure is highly prevalent among children globally, and is associated with elevated rates of PTSD. The goal of this study was to systematically evaluate the effects of multiple informants and multiple screening measures on the identification of specific PTSD symptoms and rates of PTSD diagnoses. Participants in this study included 350 maltreated children from two cohorts, one recruited from Connecticut (n = 130), and the other from Vermont (n = 220). Both cohorts completed the Screen for Child Anxiety-Related Emotional Disorders (SCARED) before a PTSD self-report measure. The KSADS psychiatric interview was also completed with the Connecticut cohort, with best-estimate ratings generated using parent and child interview, child self-report, and teacher questionnaire data. In addition to the SCARED and PTSD self-report scale, parents of the Vermont cohort completed the Child Behavioural Checklist. Significant differences emerged between parent and child report of sleep, nightmares, concentration, and irritability problems, suggesting the need for multiple informants in PTSD screening. Children also under-reported nightmares when asked in the context of a trauma-specific screening tool. As child trauma is associated with a broad range of psychiatric sequelae, comprehensive assessment using both general symptomatology and trauma-specific measures is recommended, since children often shut down when completing trauma measures.

Keywords:

• PTSD
• multi-method
• multi-informant assessments
• ICD
• DSM
• RDoC

Acknowledgements

The authors thank the children and families who participated in this research, and the administration of the Connecticut and Vermont Department of Children and Families for their collaboration on this effort.

Disclosure statement

Dr Althoff has received grant funding from the National Institutes of Health (NIH) and the Klingenstein Third Generation Foundation, receives an honoraria as the Associate Editor of the Journal of the American Academy of Child and Adolescent Psychiatry and from the Massachusetts General Hospital Psychiatry Academy, and is a partner in WISER Systems LLC which, through a licence with the University of Vermont, distributes the suicide risk assessment, SERAS, from which he may receive royalties. Dr Hudziak has also received grants from the NIH, Apple, and Conrad Hilton. Dr Kaufman has received funding from the NIH, has recently served as a consultant for Pfizer and Otskuka Pharmaceuticals, and may in the future receive royalties from KSADS-COMP, LLC.

Dr Grant, Dr Holbrook, Dr Grasso, Dr Perepletchikova, Ms O’Loughlin, and Ms Kearney report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work was funded by NIH R01MH098073 (JK, JH), NIH RO1 MH077087 (JK), and the Zanvyl and Isabelle Krieger Fund (JK).