PTSD involves flashbacks, nightmares and various other symptoms following an exceptionally stressful or traumatic event. It is not always easy for the clinical raters to decide what constitutes an exceptional stressful or traumatic event. That is why it is important, where possible, for you to record enough open-ended informtion about the traumatic event to allow the clinical raters to decide. It is obviously not appropriate to probe for details of the trauma if this is clearly too distressing for the respondent. However, if at all possible, it will be a great help to the clinical rater if you can record enough details of the trauma to allow the rater to judge whether the relevant trauma was so unusual or extreme that it would be subsequently become deeply engraved on a child's memory and liable to cause flashbacks and vivid nightmares. Being chased by muggers or having to escape from a burning house are clear but unusual examples. Many other events could be relevant provided that they are of the sort of event that would tend to become engraved in the memory. Being abused is one possibility.
It is important to stress that this section does not cover all the events and occurrences that might have upset a child. For example, a child may well be extremely upset by a grandparent's death or by his or her parents separating, but we will pick this up elsewhere in the interview, e.g. when asking about symptoms such as depression. The same applies to the death of a pet or to breaking up with a close friend. This is relevant to you because some parents or children will mention these 'ordinary stresses' when asked about other traumas. It is vey helpful to the clinical rater if you to provide a detailed enough description of this for the rater to judge whether or not it is an exceptionally stressful or traumatic event that might justify a diagosis of PTSD. Even if it is not, the description may still help the clinical rater in deciding about other possible diagnoses.
However, even an 'ordinary' stress that wouldn't normally qualify a child for PTSD may be relevant when the stress occurs in a particularly vivid or intense way. For example, although losing a pet would not normally qualify a child for a PTSD, imagine that a boy was walking his dog in the park, and that the dog was mauled and killed in a bloody attack by a Rottweiler. It's not hard to imagine that he would develop vivid flashbacks or nightmares of the dog bleeding to death, marked fear in the presence of dogs, and avoidance of parks and anything else that reminds him of the attack.
Here's another example, this time of something even worse. The death of a father is obviously going to be a stressful event for any child. But if the death is peaceful or happens when the child is not there, it is not going to trigger PTSD. But in some circumstances, a father's death can trigger PTSD. Imagine, for example, that a father and daughter are alone at home when the father develops a severe asthma attack. His daughter calls the ambulance and goes with her father in the ambulance because she can't stay alone at home with no one to look after her. In the ambulance, the father's asthma deteriorates and he dies in front of his daughter despite the efforts of the ambulance crew try to resuscitate him. This would certainly be the sort of trauma that could trigger off a PTSD.
What you can see is that the key factor is not the category of stressful event (death of pet, death of parent) but the circumstances in which it occurs. If the respondent says there has been a stressful event, you need to find out enough about it for the clinical rater to judge whether it might have been capable of triggering off a PTSD. As long as you describe the trauma clearly, the clinical rater will be able to decide whether it 'counts' or not.
It is unusual for children to have experienced even one trauma of the sort needed to trigger off PTSD. Consequently, it is unlikely that the same child will have experienced several different traumas - but this does happen at times. When a child has had several severe traumas, treat them together when asking the remaining questions about symptoms and their impact. For example, you would ask about flashbacks or numbing related to any or all of the traumas they have experienced.
Last modified : 05/09/09