title: Posttraumatic stress without trauma in children.
abstract: OBJECTIVE
  It remains unclear to what degree children show signs of posttraumatic stress disorder (PTSD) after experiencing low-magnitude stressors, or stressors milder than those required for the DSM-IV extreme stressor criterion.
  
  
  METHODS
  A representative community sample of 1,420 children, ages 9, 11, and 13 at intake, was followed annually through age 16. Low-magnitude and extreme stressors as well as subsequent posttraumatic stress symptoms were assessed with the Child and Adolescent Psychiatric Assessment. Two measures of posttraumatic stress symptoms were used: having painful recall, hyperarousal, and avoidance symptoms (subclinical PTSD) and having painful recall only.
  
  
  RESULTS
  During any 3-month period, low-magnitude stressors occurred four times as often as extreme stressors (24.0% compared with 5.9%). Extreme stressors elicited painful recall in 8.7% of participants and subclinical PTSD in 3.1%, compared with 4.2% and 0.7%, respectively, for low-magnitude stressors. Because of their higher prevalence, however, low-magnitude stressors accounted for two-thirds of cases of painful recall and half of cases of subclinical PTSD. Moreover, exposure to low-magnitude stressors predicted symptoms even among youths with no prior lifetime exposure to an extreme stressor.
  
  
  CONCLUSIONS
  Relative to low-magnitude stressors, extreme stressors place children at greater risk for posttraumatic stress symptoms. Nevertheless, a sizable proportion of children manifesting posttraumatic stress symptoms experienced only a low-magnitude stressor.
authors.affiliation: Center for Developmental Epidemiology, Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, Box 3454, Durham, NC 27710, USA. william.copeland@duke.edu
authors.forename: William E
authors.initials: WE
authors.lastname: Copeland
authors.forename: Gordon
authors.initials: G
authors.lastname: Keeler
authors.forename: Adrian
authors.initials: A
authors.lastname: Angold
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Costello
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology