Most of the criteria used to diagnose posttraumatic stress disorder (PTSD) have been created with adults rather than children in mind. The authors of this article developed an instrument called the Child and Adolescent Psychiatric Assessment to measure exposure to traumatic events and the presence of PTSD in children and adolescents. This measure uses structured interviews of both children and their parents to ask about a wide range of stressful and potentially stressful events in the child's life, from moving and breaking up with a boy- or girlfriend to surviving a fire, being raped, or having been kidnapped.
When children or their parents report that the child has lived through traumatic events, interviewers then screen for three core symptoms of PTSD-reexperiencing the event, increased arousal, and avoidance. Reexperiencing refers to intrusive thoughts or dreams about the event after the event is over, including flashbacks. Difficulty falling or staying asleep, irritability, and an increased startle response are some symptoms of increased arousal. Avoidance behavior includes efforts to avoid thoughts, activities, and places that remind the child of the trauma and withdrawal from other people and from activities the child once enjoyed. When these problems are present, the interviewer continues the assessment by asking more targeted questions to establish whether the child does indeed have PTSD.
The Child and Adolescent Psychiatric Assessment-a "test"-is designed to be used both within and outside of mental health or medical offices. In doctors' and counselors' offices it serves as a diagnostic tool for children who have been brought in because of psychological problems they are suffering. Outside the clinic, the Child and Adolescent Psychiatric Assessment can be used to assess how widespread PTSD and trauma are among children in a given community.