The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital‐attending children and a randomized controlled proof‐of‐concept trial of trauma‐focused cognitive therapy, for 3‐ to 8‐year‐olds

Background: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ≤6‐year‐old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD‐YC), including the adult‐led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive‐focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD‐YC. Method: Study 1 (N = 105) assessed ASD and PTSD‐YC diagnosis in 3‐ to 8‐year‐old children within one month and at around three months following attendance at an emergency room. Study 2 (N = 37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early‐phase trial comparing CBT‐3M, a cognitive‐focused intervention, to treatment‐as‐usual (TAU) delivered within the UK NHS to 3‐ to 8‐year‐olds diagnosed with PTSD‐YC. Results: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD‐YC (minus the duration requirement) was 8.6% in the first month post‐trauma and 10.1% at 3 months. Length of hospital stay, but no other demographic or trauma‐related characteristics, predicted development of later PTSD‐YC. Early (within one month) diagnosis of acute PTSD‐YC had a positive predictive value of 50% for later PTSD‐YC. In Study 2, most children lost their PTSD‐YC diagnosis following completion of CBT‐3M (84.6%) relative to TAU (6.7%) and CBT‐3M was acceptable to recipient families. Effect sizes were also in favor of CBT‐3M for secondary outcome measures. Conclusions: The ASD diagnosis is not fit for purpose in this age‐group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive‐focused treatment for PTSD, and a larger trial of CBT‐3M is now warranted