Summary: Kassam-Adams N and Winston FK. "Predicting child PTSD: The relationship between acute stress disorder and PTSD in injured children," Journal of the American Academy of Child and Adolescent Psychiatry vol 43(4): 403-411. 2004.

Like posttraumatic stress disorder (PTSD), acute stress disorder (ASD) represents an extreme stress response in the aftermath of a traumatic event. Acute stress disorder, however, is diagnosed in the first month following the traumatizing event, while PTSD can be diagnosed only after at least a month has passed since the event. This study examines rates of ASD in a group of children and adolescents who were injured in accidents. The study also explores the links between ASD and PTSD in these children.

Each of the 177 children who completed the study was assessed twice. In the first assessment, researchers used a standard test to determine whether each child met all the criteria for ASD. They also looked at measures of "subsyndromal" ASD. A child had subsyndromal ASD if he or she had all the symptoms of ASD except dissociation. Dissociation means that the child felt detached from reality, either during the traumatic event or in the month afterward. Researchers were interested in finding out if having subsyndromal ASD might also predict who would later develop PTSD.

In the second assessment researchers used another tool to determine which children had PTSD or subsyndromal PTSD. Children were judged to have subsyndromal PTSD if they had at least one moderate to severe symptom of PTSD and were impaired because of it. The three symptoms of PTSD are reexperiencing, increased arousal, and avoidance. Reexperiencing refers to flashbacks or intrusive thoughts or dreams about the traumatic event. Increased arousal means the child is jumpy and irritable, and may have difficulty falling asleep or staying asleep. Avoidance includes withdrawal from other people and from activities the child once enjoyed as well as efforts to avoid thoughts, activities, and places that remind the child of the trauma.

Within the first month after their accident, 8 percent of the children had ASD and 14 percent had subsyndromal ASD-they met all the criteria for ASD except dissociation. At the second assessment, 6 percent of children had full PTSD while 11 percent had subsyndromal PTSD. There was a relationship between ASD and PTSD, however: 60 percent of the children who developed PTSD had not met the criteria for full or subsyndromal ASD in the first month.

While it appears that ASD is not a good predictor of later PTSD, mental health professionals do need to be alert to the possibility that injured children may develop ASD in the immediate aftermath of trauma. The search for good predictors of which children will develop PTSD after an injury or other trauma is an ongoing one.

While it appears that ASD is not a good predictor of later PTSD, mental health professionals do need to be alert to the possibility that injured children may develop ASD in the immediate aftermath of trauma. The search for good predictors of which children will develop PTSD after an injury or other trauma is an ongoing one.