ABSTRACT
Pediatric posttraumatic stress disorder (PTSD) is unique among disorders of childhood and adolescence in its requirement of an etiopathogenic agent with enduring sequelae.(1) As in adults it is characterized by a cluster of symptoms that develop in the aftermath of traumatic events that involve actual or threatened death or injury or threat to the physical integrity of one’s self or others. Traumatic events include physical or sexual abuse or maltreatment, road traffic injuries, violence, war-related trauma, severe burns, and natural disasters, among others.(1) These events are considered trauma-tic because they overwhelm a child or adolescent’s perceived ability to cope. During the traumatic event, there is recruitment of adaptive, stressmediating neural systems (e.g., hypothalamic-pituitary-adrenal axis and sympathetic nervous system) that, in turn, produces adaptive physiological, behavioral, emotional, and cognitive responses necessary for survival.(2) By definition and according to the DSM-IV-TR, traumatic events should evoke acute subjective reactions of intense fear, horror, or helplessness.(1, 3)
However, the DSM-IV-TR includes a qualifier for children and adolescents who may instead show responses of disorganized or agitated behavior.(3) The DSM-IV-TR requirement of a subjective response acknowledges that individual traumatic reactions play a crucial role in determining the development of PTSD.
