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Challenges to Diagnosing PTSD in Young Children and Elderly

Find out the challenges to diagnosing PTSD in young children and elderly.
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© University of Glasgow
PTSD Diagnosis in Young Children

The highest rates of exposure to trauma have been found to occur during early childhood. Early childhood is a stage of life where children possess a unique set of both psychological and physical vulnerabilities which increase the risk of experiencing longer-term negative outcomes following a traumatic event. Establishing a correct diagnosis of PTSD in young children is therefore vital, as, without an accurate diagnosis, young children exposed to trauma may develop further mental and physical health issues as they grow.

The DSM-5 includes a sub-type of PTSD which is specific to children under the age of 6, known as PTSD<6. While symptoms of PTSD in young children are broadly similar to those found in older children and adolescents, the developmental differences that exist between these age groups can lead to distress being expressed differently by children under the age of 6. However, there are many challenges to correctly diagnosing PTSD in young children.

A banner showing a black-and-white photo of a young child. The caption reads "Challenge 1 – What does 'trauma' mean for children?" Source: Pexels.com

  • The types of events that can be described as ‘traumatic’ can be different for young children. For example, young children often find medical procedures following a severe injury to be more ‘scary’ than the injury itself (De Young & Landolt, 2018).
  • The way in which a child reacts to an event can also be influenced by their parents’ or caregivers’ reactions.

A banner showing a black-and-white photo of a young child. The caption reads "Challenge 2 – Difficulty in identifying PTSD symptoms". Source: Pexels.com

  • Certain PTSD symptoms are difficult to identify in young children, even when the PTSD<6 criteria are used. These include symptoms such as intrusive memories, loss of interest, and hypervigilance. This is especially true for children in the 0-3 age bracket, as their cognitive and language capacities are limited.
  • It is difficult to distinguish between ‘normal’ child behaviours and behaviours that may be symptomatic of PTSD.
  • There is a lack of evidence regarding signs of PTSD-linked functional impairment in children between 0-6 years old.

A banner showing a black-and-white photo of a young child. The caption reads "Challenge 3 – Use of Self-Report and Questionnaires". Source: Pixabay.com

  • People are generally unaware of how to recognise symptoms of PTSD. As a result, parents or health professionals may not identify potential symptoms of PTSD in children.
  • As children may find it difficult to express their thoughts and feelings, the diagnostic information they provide often needs to be supplemented by information given by their parents. However, research (Cohen & Scheeringa, 2009) has shown that child-parent agreement in relation to symptoms can be poor.
  • It is difficult to distinguish signs of avoidance from signs that a child is successfully coping following trauma. For example, if a clinician asks a child about a traumatic event and the child answers that they ‘never think about it’, is this a sign of avoidance or coping?

PTSD Diagnosis in the Elderly

There are also challenges associated with the diagnosis of PTSD in old age. A summary of these challenges is provided.

Research (Cook et al., 2017) suggests that older individuals are more likely to report somatic symptoms over-emotional or psychological symptoms, especially if the exposure to trauma occurred in the later stages of life. Memory issues associated with old age mean that it is possible that individuals who develop late-onset PTSD may not be able to articulate the traumatic event that led to the development of their disorder.
Living with chronic PTSD has been linked to a greater risk of developing dementia and other cognitive impairments. This means that older individuals who have lived with undiagnosed PTSD for long periods of time may find it more difficult to communicate and interpret their symptoms, increasing the difficulty of providing an accurate diagnosis. Older adults frequently experience PTSD-related symptoms but in numbers insufficient to meet the threshold for PTSD to be diagnosed (Durai et al., 2011). As there is a lack of guidance on how to treat and support individuals experiencing sub-threshold PTSD symptomatology, it is likely that these individuals will not receive the care they require.
Mental health-related stigma is more common in older-age cohorts. Elderly individuals with PTSD may therefore be more reluctant to access mental health services.

References

Chopra, M. (2018) PTSD in late life: Special issues. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/view/ptsd-late-life-special-issues<.sup>

Cohen, J. A., & Scheeringa, M. S. (2009). Post-traumatic stress disorder diagnosis in children: Challenges and promises. Dialogues in Clinical Neuroscience, 11(1), 91–99. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181905/

Cook, J. M., McCarthy, E., & Thorp, S. R. (2017). Older adults with PTSD: Brief state of research and evidence-based psychotherapy case illustration. The American Journal of Geriatric Psychiatry, 25(5), 522-530. https://doi.org/10.1016/j.jagp.2016.12.016

De Young, A. C., & Landolt, M. A. (2018). PTSD in children below the age of 6 Years. Current Psychiatry Reports, 20(11), 1-11. doi:10.1007/s11920-018-0966-z

Durai, U. N. B., Chopra, M. P., Coakley, E., Llorente, M. D., Kirchner, J. E., Cook, J. M., & Levkoff, S. E. (2011). Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: Comorbid conditions and self‐rated health status. Journal of the American Geriatrics Society, 59(6), 1087-1092. Doi:10.1111/j.1532-5415.2011.03407.x

Pless Kaiser, A., Cook, J. M., Glick, D. M., & Moye, J. (2019). Posttraumatic stress disorder in older adults: A conceptual review. Clinical Gerontologist, 42(4), 359-376. doi:10.1080/07317115.2018.1539801

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Post-Traumatic Stress Disorder (PTSD) in the Global Context

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