The Dimensionality of Proposed DSM-5 PTSD Symptoms in Trauma-Exposed Young Children.


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Authors
McKinnon, Anna 
Scheeringa, Michael S 
Meiser-Stedman, Richard  ORCID logo  https://orcid.org/0000-0002-0262-623X
De Young, Alexandra 
Abstract

A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. Data for N = 284 (3-6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. The model was compared to DSM-IV, a 4-factor 'dysphoria' model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Convergent validity was established against the Child Behavior Checklist (CBCL). Criterion related validity was established by comparing each model to a categorical rating of impairment. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. These two models also only showed small levels of convergence with CBCL dimensions. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group.

Description
Keywords
DSM-5, Factor analysis, Posttraumatic stress disorder, Young children, Affective Symptoms, Child, Child, Preschool, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Male, Models, Statistical, Psychological Trauma, Reproducibility of Results, Sensitivity and Specificity, Stress Disorders, Post-Traumatic
Journal Title
J Abnorm Child Psychol
Conference Name
Journal ISSN
0091-0627
1573-2835
Volume Title
47
Publisher
Springer Science and Business Media LLC
Sponsorship
MRC (unknown)
Medical Research Council (MC_UU_00005/14)
Medical Research Council (MC_UU_00005/4)