CHICAGO -- Preliminary findings suggest that the pediatric symptom checklist can identify high rates of posttraumatic stress disorder among children, but that results vary depending on whether a child or parent completes the checklist.
Based upon parental responses to the Pediatric Symptom Checklist (PSC), 25% of 72 children evaluated in a New York City practice had positive screens for general psychosocial dysfunction. But when the children completed the youth-PSC, 33% had positive screens.
This suggests that parents and children have very different perceptions of a child's level of distress, Deborah Steinbaum, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
The sensitivity for detecting children with likely posttraumatic stress disorder (PTSD) was 58% for the youth-PSC and 33% for the parent-PSC. When the cutoff for a positive youth-PSC screen was lowered from 30 to 28--as has been done in some studies--the sensitivity rose to 83%, she said. Specificity was about 70%.
'The parent-PSC didn't do so well because it identified fewer of the likely PTSD children than would have been identified by a coin toss,' said Dr. Steinbaum of Mount Sinai Medical Center, New York. 'A lot of the research [on] the PSC has been based on the parent report, so to me this is an important thing to keep in our minds.'
Data from the ongoing study were from 72 children, aged 8-10 years, seen at the Pediatric Associates Practice at Mount Sinai. The mean age was 9.1 years, 57% were female, and 52% had ongoing medical problems such as asthma (30%) or allergies (11%).
One-fourth of caregivers said their child had an ongoing emotional or behavioral problem, and 28% said their child had seen a mental health professional--defined broadly as a counselor, social worker, psychologist, or psychiatrist--in the previous year. Most of the caregivers (60%) defined themselves as Latino or Hispanic.
Screens were considered positive if they had scores of at least 30 on the youth-PSC and at least 28 on the parent-PSC.
A score of at least 38 on the 45-item University of California, Los Angeles, Posttraumatic Stress Reaction Index (PTSRI) indicates likely PTSD. The PTSRI identified 16% of children in the study group as positive, which means they probably had PTSD, Dr. Steinbaum said. The rate of PTSD in the general pediatric population is unknown. However, the results are from an inner-city population and can't be generalized to the community at large.
Overall, Dr. Steinbaum said the study population had very high rates of psychosocial dysfunction, possibly higher than others studied, and exhibited high rates of trauma exposure and subsequent distress.
Almost all of the children in the study reported experiencing one or more major traumatic events, such as bullying, domestic violence, sexual abuse, or witnessing a shooting. Despite these experiences, the children did not commonly identify very violent or frightening events as their primary trauma on the PTSRI, but instead listed events such as a grandmother's death. However, bullying did affect a significant number of children with higher PTSRI scores.
PATRICE WENDLING
Chicago Bureau
