title: What makes a life event traumatic for a child? The predictive values of DSM-Criteria A1 and A2.
abstract: BACKGROUND
  The Diagnostic and Statistical Manual of Mental Disorders (DSM)-Criteria A1 and A2 for posttraumatic stress disorder (PTSD) have been discussed extensively, with several studies in adults or adolescents supporting the removal of Criterion A2. However, solid research in children is missing.
  
  
  OBJECTIVE
  This study evaluated the DSM-Criteria A1 and A2 in predicting posttraumatic stress in children.
  
  
  METHODS
  A sample of 588 Dutch school children, aged 8-18 years, completed a self-report questionnaire to determine if they met Criteria A1 and/or A2. Their posttraumatic stress response was assessed using the Children's Revised Impact of Event Scale.
  
  
  RESULTS
  The contribution of Criterion A2 to the prediction of posttraumatic stress in children is of greater importance than the contribution of Criterion A1. Children who met Criterion A2 reported significantly higher levels of posttraumatic stress and were nine times more likely to develop probable PTSD than children who did not meet Criterion A2. When Criterion A1 was met, a child was only two times more likely to develop probable PTSD as compared with those where Criterion A1 was not met. Furthermore, the low sensitivity of Criterion A1 suggests that children may regularly develop severe posttraumatic stress in the absence of Criterion A1. The remarkably high negative predictive value of Criterion A2 indicates that if a child does not have a subjective reaction during an event that it is unlikely that he or she will develop PTSD.
  
  
  CONCLUSIONS
  In contrast to most adult studies, the findings of this study emphasize the significant contribution of Criterion A2 to the prediction of posttraumatic stress in children and raise fundamental questions about the value of the current Criterion A1.
authors: Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.
authors: Eva
authors: E
authors: Verlinden
authors: Mirjam
authors: M
authors: Schippers
authors: Els P M
authors: EP
authors: Van Meijel
authors: Renée
authors: R
authors: Beer
authors: Brent C
authors: BC
authors: Opmeer
authors: Miranda
authors: M
authors: Olff
authors: Frits
authors: F
authors: Boer
authors: Ramón J L
authors: RJ
authors: Lindauer
keywords: DSM-5; Diagnostic and Statistical Manual; assessment; classification; diagnosis; posttraumatic stress disorder (PTSD); stressor criterion; trauma
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