PTSD and Trauma-Related Disorders 6–17 years • Posttraumatic Stress Disorder (lasting over one month) • Acute Stress Disorder (lasting up to one month) • Adjustment Disorders (occurring within three months of stressor, not meeting criteria for above) CLINICAL PEARLS • Exposure to trauma is common; by the end of adolescence more than half of young people will have been exposed to a traumatic event. Screening for trauma/stressors when behavioral/ emotional problems emerge is imperative to accurate diagnosis. • First line-treatment is a trauma-focused therapy (e.g. trauma-focused cognitive behavioral therapy, eye-movement desensitization and reprocessing therapy)10 • Screening for abuse and trauma should occur in a developmentally appropriate environment, which includes interviewing the child or adolescent alone • If abuse is suspected the DHS hotline should be called 800-522-3511 • Co-morbidity with ADHD, anxiety, substance use, depression and others is common. If comorbid diagnosis is not improving with treatment, a trauma-focused treatment should be implemented.14 RATING SCALES • Child and Adolescent Trauma Screen (CATS) http://oklahomatfcbt.org/audiences/tf-cbt-therapists/assessment-resources/ TREATMENT APPROACH Stage 1: Trauma-focused therapy including parent/guardian (trauma-focused cognitive behavioral therapy, seeking safety, cognitive-behavioral interventions for trauma in schools, eye-movement desensitization and reprocessing therapy). 1A: Monitor for treatment response with rating scale. If improving, continue therapy, if not improving, follow up with therapist. Stage 2: With co-morbid symptoms not responsive to therapy medication may be indicated. 2A: With Co-Morbid Anxiety or Depression: If symptoms persist or co-morbid anxiety/depression consider starting SSRI10 (e.g. citalopram11) four to six weeks for treatment response in combination with trauma-focused therapy.
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