title: Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: Prevalence, course, prognosis, diagnostic suitability, and risk markers.
abstract: Early recovery from trauma exposure in youth is poorly understood. This prospective longitudinal study examined the early course of traumatic stress responses in recently trauma-exposed youth, evaluated the revised DSM-5 acute stress disorder (ASD) and PTSD diagnoses and alternative diagnoses, and identified risk factors for persistent traumatic stress.
  
  
  
  Participants were 8- to 17-year-old emergency departments attendees exposed to single incident traumas. Structured clinical interviews were undertaken at 2 (n = 226) and 9 weeks (n = 208) posttrauma.
  
  
  
  Using the revised criteria in DSM-5, 14.2% met criteria for ASD at week 2 and 9.6% met criteria for PTSD at week 9. These prevalences were similar to the corresponding DSM-IV diagnoses (18.6% ASD at week 2; 8.7% PTSD at week 9). Using the same diagnostic criteria (DSM-IV or DSM-5) across assessments (i.e., "2-week PTSD") suggested that caseness declined in prevalence by approximately half. Overlap between DSM-IV and DSM-5 ASD and DSM-5 preschool child PTSD diagnoses was considerable. Two diagnoses were strongly predictive of corresponding week 9 diagnoses. Youth with ASD who subsequently had PTSD reported more negative alterations in cognition and mood at 2 weeks than those youth who did not develop PTSD.
  
  
  
  Youth exposed to single-event traumas experience considerable natural recovery in the first months posttrauma. Using DSM-5 criteria, ASD may not capture all clinically significant traumatic stress in the acute phase and is only moderately sensitive for later PTSD. Future research needs to address the role and etiology of negative alterations in cognition and mood symptoms.
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge.|Department of Clinical Psychology, University of East Anglia, Norwich, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Meiser-Stedman
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge.
authors.forename: Anna
authors.initials: A
authors.lastname: McKinnon
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge.
authors.forename: Clare
authors.initials: C
authors.lastname: Dixon
authors.affiliation: Cambridge University Hospitals NHS Foundation Trust.
authors.forename: Adrian
authors.initials: A
authors.lastname: Boyle
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
authors.forename: Patrick
authors.initials: P
authors.lastname: Smith
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge.|Cambridgeshire and Peterborough NHS Foundation Trust.
authors.forename: Tim
authors.initials: T
authors.lastname: Dalgleish
mesh_terms: D000293:Adolescent; D002648:Child; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D040701:Stress Disorders, Traumatic, Acute / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology
keywords: PTSD/posttraumatic stress disorder; anxiety/anxiety disorders; child/adolescent; life events/stress; trauma