LEXINGTON, Ky. (April 30, 2013) - The following column appeared in Lexington Herald-Leader on Sunday, April 28.

By Ginny Sprang

The American Psychiatric Association will recognize traumatic stress in preschoolers younger than age six as a unique form of Post-Traumatic Stress Disorder (PTSD) when it releases its newest version of the Diagnostic and Statistical Manual (DSM) at its annual conference in May. The DSM is the manual that is used by clinicians and researchers to diagnose and classify mental disorders.

Although PTSD — a traumatic stress response to exposure to actual or threatened death, serious injury or sexual violation — has been reported in preschool and school age children for many years, the current criteria used to diagnose the condition was developed and field tested for adults and adolescents (15 and older). Data from published studies provided evidence that the current standards for diagnosing PTSD in young children may be insufficient.

Many clinicians found the criteria difficult to apply to young children and not representative of the types of responses found following exposure to a traumatic event in early childhood. Consequently, the prevalence of the disorder in this age group was lower than expected, leading clinicians and researchers to question the way PTSD was being diagnosed in young children. As a result, new diagnostic standards have been revised.

For example, previous criteria required assessing for the presence of a "feeling of detachment or estrangement from others" in infants and toddlers. In the new DSM, this has been modified to "markedly diminished interest or participation in significant activities, including constriction of play."

By defining this response as an observable behavior, which can be noted by caregivers, the ability to assess the presence of this type of social withdrawal is increased.

Additionally, items such as "an inability to recall an important aspect of the trauma" and "sense of foreshortened future" will be excluded.

PTSD in preschool children is not considered a separate type of traumatic stress disorder, but rather a subtype of PTSD. Following direct exposure to an event, witnessing the traumatic situation as it occurred to others (especially caregivers), or learning that an event occurred to a parent or caregiver, four clusters of symptoms associated with the traumatic stressor are assessed. These include:

• Intrusive symptoms such as nightmares, re-enacting the event in play or persistent avoidance of activities or people who remind the child of the event
• Negative changes in cognitions or mood
• Changes such as increased irritability, sleep disturbance or tantrums
• To be considered PTSD, Preschool Subtype, the symptoms must be present for at least one month.

Fortunately, there are effective treatments for young children who experience PTSD. Trauma-Focused Cognitive Behavioral Therapy is appropriate for children as young as three years of age, and Child-Parent Psychotherapy targets children and caregivers under age five.

Relief from trauma symptoms is usually accomplished within the context of the parent-child relationship for young children, so parent or caregiver participation in these treatments is crucial.

The UK Center on Trauma and Children provides training on Trauma-Focused Cognitive Behavioral Therapy to behavioral health professionals. For more information, contact Dr. Ginny Sprang at sprang@uky.edu or visit the center's website at UKY.Edu/ctac

Ginny Sprang is executive director of the Center on Trauma and Children at the University of Kentucky.

LEXINGTON, Ky. (April 26, 2013) - The Center on Trauma and Children (CTAC) has moved to the College of Medicine to facilitate and enhance the translational research activities of the center.

CTAC is dedicated to the enhancement of the health and well-being of children and their families through research, service and dissemination of information about child abuse and trauma.

"We are excited about the opportunities at the College of Medicine to work in an interdisciplinary setting and pursue our goal of improving the lives of children and families affected by trauma," said Ginny Sprang, executive director of CTAC.

More than three million children in the United States are impacted by traumatic events each year. Research shows that multiple factors increase the likelihood of trauma exposure including poverty, stress, depression, natural disasters and substance abuse. Each child - whether they experience neglect, injury or violence - is profoundly altered as a result.

At CTAC, pediatricians, child psychiatrists, social workers and psychologists work together to make a difference through research and clinical programming, resulting in demonstrably effective outcomes. CTAC uses an interdisciplinary approach to create a dialogue between researchers and clinicians.

The Center’s primary mission is to develop, assimilate and disseminate knowledge and best practices that will contribute to reducing and ending violence against children and the effects of violence and trauma exposure across the life cycle.  The Center’s dissemination of evidence-based knowledge extends to health and behavioral health organizations, systems of protection and care, as well as individual provider level interventions. 

Other CTAC activities include:

• Clinical research on children who have experienced and witnessed violence and trauma
• Epidemiological research on the incidence and prevalence of violence against children and its consequences to health, mental health and social functioning across the life cycle
• Development of evidence-based behavioral health practices with children, families and adults whose lives have been affected by violence
• Clinical practice including assessment and treatment of children and family members who have been affected by violence
• Conducting behavioral health services outcome research among children, families and adults whose lives have been affected by child maltreatment and its consequences to health, mental health and social functioning

CTAC is also charged with informing federal, state and regional policies with regard to child maltreatment and trauma effects across the life cycle. 

For more information about CTAC, visit their web site at www.uky.edu/CTAC or call 859-543-0078. Questions about CTAC can also be emailed to Sprang at sprang@uky.edu or Adrienne Whitt-Woosley at alwhit4@uky.edu.