Trauma in Early Childhood: A Neglected Population
Infants, toddlers and preschoolers are a high risk group for exposure to trauma. Young children are also vulnerable to experiencing adverse outcomes as they are undergoing a rapid developmental period, have limited coping skills and are strongly dependent on their primary caregiver to protect them physically and emotionally. However, although millions of young children experience trauma each year, this population has been largely neglected. Fortunately, over the last 2 decades there has been a growing appreciation of the magnitude of the problem with a small but expanding number of dedicated researchers and clinicians working with this population. This review examines the empirical literature on trauma in young children with regards to the following factors: (1) how trauma reactions typically manifest in young children; (2) history and diagnostic validity of posttraumatic stress disorder (PTSD) in preschoolers; (3) prevalence, comorbidity and course of trauma reactions; (4) developmental considerations; (5) risk and protective factors; and (6) treatment. The review highlights that there are unique developmental differences in the rate and manifestation of trauma symptomatology, the current Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV-TR) PTSD criteria is not developmentally sensitive and the impact of trauma must be considered within the context of the parent–child relationship. Recommendations for future research with this population are also discussed.
KeywordsTrauma Infant, toddler and preschooler Posttraumatic stress Parent–child relationship Treatment
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed., DSM-IV). Washington, DC: Author.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
- American Psychiatric Association. (2010). Proposed draft revisions to DSM disorders and criteria. Retrieved from http://www.dsm5.org/Pages/Default.aspx.
- Australian Institute of Health and Welfare. (2009). A picture of Australia’s children 2009. Cat. no. PHE 112. Canberra: AIHW.Google Scholar
- Australian Institute of Health and Welfare. (2010). Child protection Australia 2008–2009. Cat. no. CWS 35. Canberra: AIHW.Google Scholar
- Cohen, J. A., Bukstein, O., Walter, H., Benson, R. S., Chrisman, A., & Farchione, T. R. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4), 414–430.Google Scholar
- Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press.Google Scholar
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., & Edwards, V. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.PubMedCrossRefGoogle Scholar
- Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., & Zaslavsky, A. M. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113–123.PubMedCrossRefGoogle Scholar
- Howe, M. L. (2010). Children’s memory development and trauma: Advances in early memory research. Paper presented at the 1st international conference: Pediatric psychological trauma in infants and young children from illness, injury and medical intervention. Los Angeles, CA.Google Scholar
- Howe, M. L., Toth, S. L., & Cicchetti, D. (2006). Memory and developmental psychopathology. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology, Vol. 2: Developmental neuroscience (2nd ed., pp. 629–655). Hoboken, NJ: Wiley.Google Scholar
- Kidsafe QLD. (2006). Kidsafe fact sheets. Retrieved from http://www.kidsafe.qld.com.au.
- Kilpatrick, D., Resnick, H., Freedy, J., Pelcovitz, D., Resick, P., & Roth, S. (1998). Posttraumatic stress disorder field trial: Evaluation of the PTSD construct—Criteria A through E. In T. Widiger, A. Frances, H. Pincus, R. Ross, M. First, W. Davis, & M. Kline (Eds.), DSM-IV sourcebook (pp. 803–844). Washington, DC: American Psychiatric Association.Google Scholar
- Lewis, M. (1993). The emergence of human emotions. In M. Lewis & J. M. Haviland (Eds.), Handbook of emotions (pp. 223–235). New York, NY: Guilford Press.Google Scholar
- Lieberman, A. F., & Knorr, K. (2007). The impact of trauma: A development framework for infancy and early childhood. Psychiatric Annals, 37(6), 416–422.Google Scholar
- Nugent, N. R., Ostrowski, S., Christopher, N. C., & Delahanty, D. L. (2007). Parental posttraumatic stress symptoms as a moderator of child’s acute biological response and subsequent posttraumatic stress symptoms in pediatric injury patients. Journal of Pediatric Psychology, 32(3), 309–318.PubMedCrossRefGoogle Scholar
- Postert, C., Averbeck-Holocher, M., Beyer, T., Muller, J., & Furniss, T. (2009). Five systems of psychiatric classification for preschool children: Do differences in validity, usefulness and reliability make for competitive or complimentary constellations? Child Psychiatry and Human Development, 40(1), 25–41.PubMedCrossRefGoogle Scholar
- Rosenblum, K. L., Dayton, C. J., & Muzik, M. (2009). Infant social and emotional development: Emerging competence in a relational context. In C. H. Zeanah Jr. (Ed.), Handbook of infant mental health (3rd ed., pp. 80–103). New York, NY: Guilford Press.Google Scholar
- Scheeringa, M. S. (2006). Posttraumatic stress disorder: Clinical guidelines and research findings. In J. L. Luby (Ed.), Handbook of preschool mental health: Development, disorders, and treatment (pp. 165–185). New York, NY: Guilford Press.Google Scholar
- Scheeringa, M. S. (2009). Posttraumatic stress disorder. In C. H. Zeanah Jr (Ed.), Handbook of infant mental health (3rd ed., pp. 345–361). New York, NY: Guilford Press.Google Scholar
- Scheeringa, M. S., & Gaensbauer, T. J. (2000). Posttraumatic stress disorder. In C. H. Zeanah Jr (Ed.), Handbook of infant mental health (2nd ed., pp. 369–381). New York, NY: Guilford Press.Google Scholar
- Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2010). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry (advance online publication). doi: 10.1111/j.1469-7610.2010.02354.x.
- Scheeringa, M. S., & Zeanah, C. H. (1994). PTSD semi-structured interview and observational record for infants and young children. New Orleans: Department of Psychiatry and Neurology, Tulane University Health Sciences Center.Google Scholar
- Sheridan, M., & Nelson, C. A. (2009). Neurobiology of fetal and infant development: Implications for infant mental health. In C. H. Zeanah Jr. (Ed.), Handbook of infant mental health (3rd ed., pp. 40–58). New York, NY: Guilford Press.Google Scholar
- Thomas, J. M. (1995). Traumatic stress disorder presents as hyperactivity and disruptive behavior: Case presentation, diagnoses, and treatment. Infant Mental Health Journal. Special Issue: Posttraumatic stress disorder (PTSD) in Infants and Young Children, 16(4), 306–317.Google Scholar
- U.S. Department of Health and Services. (2009). Child maltreatment 2007. Retrieved from http://www.acf.hhs.gov/programs/cb/pubs/cm07/chapter3.htm.
- van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401–408.Google Scholar
- Zeanah, C. H., & Zeanah, P. D. (2009). The scope of infant mental health. In C. H. Zeanah Jr. (Ed.), Handbook of infant mental health (3rd ed., pp. 5–21). New York, NY: Guilford Press.Google Scholar
- Zero to Three. (1994). Diagnostic classification of mental health and developmental disorders of infancy and early childhood (DC:0-3). Arlington, VA.Google Scholar
- Zero to Three. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood (DC: 0-3R) (revised edition). Washington, DC.Google Scholar