Evaluating Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Posttraumatic Stress Disorder Diagnostic Criteria in Older Children and Adolescents

Abstract

Objectives: Few studies have assessed how the diagnostic criteria for posttraumatic stress disorder (PTSD) apply to older children and adolescents. With the introduction of a new, developmentally sensitive set of criteria for very young children (age 6 years and younger) in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), this raises new questions about the validity of the criteria for older children and adolescents. The current study investigated how diagnostic changes in DSM-5 impact diagnosis rates in 7-18-year olds.

Methods: PTSD, impairment, and comorbid psychopathology were assessed in 135 trauma-exposed, treatment-seeking participants. Children (ages 7-12) were examined separately from adolescents (ages 13-18) to assess for potential developmental differences.

Results: A significantly higher proportion of 7-12-year-old children met criteria for DSM-5 diagnosis (53%) compared to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (37%). However, among 13-18-year-old adolescents, the proportions diagnosed with DSM-5 (73%) and DSM-IV (74%) did not differ. Participants who met criteria for DSM-5 only (17%) did not differ from those diagnosed with DSM-IV in terms impairment or comorbidity. Using the newly accepted age 6 years and younger criteria resulted in a significantly higher proportion of 7-12-year-old (but not 13-18-year olds) children meeting criteria compared to DSM-IV or DSM-5. However, these children showed less impairment and comorbidity than those diagnosed with DSM-IV.

Conclusion: These findings suggest that DSM-5 criteria may be more developmentally sensitive than DSM-IV criteria, and may lead to higher prevalence rates of PTSD for 7-12-year-old children, but not for adolescents. Using the very young children criteria for 7-12-year-old children may further increase prevalence, but capture children with less severe psychopathology.

Keywords: DSM-5; adolescents; children; diagnostic criteria; posttraumatic stress disorder.

FIG. 1.

Overlap among posttraumatic stress disorder criteria sets. The left diagram represents all 7–12-year-old children and the right diagram represents all 13–18-year-old adolescents who were diagnosed using one or more criteria sets (n = 53 and n = 45, respectively). For 7–12-year-old children, 50.9% met criteria for PTSD by all three diagnostic algorithms, 1.9% met criteria by DSM-IV and very young children criteria but not DSM-5, 24.5% met criteria by DSM-5 and very young children criteria but not DSM-IV, and 22.6% met criteria only by very young children criteria. In contrast, for 13–18-year-old adolescents, 91.1% met criteria for PTSD by all three diagnostic algorithms. Venn diagrams were created using BioVenn (Hulsen et al. 2008). DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition; PTSD, posttraumatic stress disorder.