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The KID CATCH Foundation
kidcatch.org
New Orleans, LA
2012
Assessment and Treatment of Very Young
Children Victims of Trauma:
Resources for Clinicians
Michael Scheeringa, MD, MPH and colleagues have pioneered assessment and treatment techniques
with hundreds of preschool children since 1993 at Tulane University. In addition to providing treatment,
part of their mission is education about the impact of trauma exposure and increase the identification
and treatment of these children. Based on their work with victims of Hurricane Katrina, accidental
injuries, violence exposure, maltreatment, and many other types of trauma, below are some common
answers to questions about assessment and treatment for very young children.
Assessment Tips
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Posttraumatic stress disorder (PTSD) is the core psychological injury. Comorbidity of
other syndromes with PTSD is very common, but it is not nearly as confusing as some
studies suggest. Studies by McMillen et al (2002) with adults and Scheeringa et al.
(2008) with young children and their caregivers have shown that non-PTSD disorders
rarely arise in the absence of PTSD symptoms following traumas. While other symptoms
are important, they are not the core psychological disturbance. The most efficient,
evidence-based method to identify children who need help following trauma is to
screen for PTSD.
PTSD is well-validated in very young children (De Young, Kenardy, and Cobham, 2011;
Scheeringa, Zeanah, and Cohen, 2011). The DSM-5 will include a modified diagnosis for
PTSD for young children as the first developmental subtype of a disorder in the history
of the DSM taxonomy.
PTSD is one of the most difficult syndromes to assess and is often misunderstood and
missed. For more on challenges and recommendations for assessment see Cohen and
Scheeringa (2009) and Scheeringa (2011).
For more information on assessment and trauma reactions in children, visit the National
Child Traumatic Stress Network at www.nctsn.org.
Assessment Tools
All of the following tools are public domain, can be reproduced as needed, and are free to
download at the Tulane Institute of Infant and Early Childhood Mental Health website,
www.infantinstitute.org.
 Screen. The Young Child PTSD Screen (YCPS) is a 6-item screen. Items were chosen
empirically on studies from over 500 preschool children.
Prepared by Michael Scheeringa, MD, MPH and Stacy Drury, MD, PhD
Traumatic Stress Clinic, Child Counseling Associates, LLC
(504) 842-3200 ccanola.com
1315 Jefferson Highway, New Orleans, LA 70124
The KID CATCH Foundation
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kidcatch.org
New Orleans, LA
2012
Checklist. The Young Child PTSD Checklist (YCPC) is a 24-item questionnaire. Nineteen
items cover all of the DSM-IV PTSD symptoms and five items cover symptoms that
empirically have been found to be common in this age group. In addition, there are 6
functional impairment items.
Interview. The Diagnostic Infant and Preschool Assessment (DIPA) is a diagnostic
interview of caregivers of preschool children (Scheeringa and Haslett, 2010). The DIPA
covers 14 disorders. The PTSD module was based on and replaced the PTSD SemiStructured Interview and Observational Record for Infants and Young Children.
The YCPS, YCPC, and DIPA PTSD module each include an inventory of traumatic events.
This measures 12 types of traumatic events plus frequencies and dates of onsets.
Others have developed measures that cover a broader range of syndromes and
problems than PTSD but these can be longer or yield scores that can be more
challenging to interpret.
Treatment for Very Young Children
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If emotional or behavioral problems persist after the first month, it is time to seek help.
PTSD symptoms can be chronic (Scheeringa et al., 2005). If they persist after the first
month, they are likely to remain for years.
Posttraumatic symptoms are very treatable in young children. Some children improve
in a few sessions, and others need 10-15 sessions of evidence-based therapies such as
cognitive behavioral therapy (CBT) (Deblinger et al,. 2001; Cohen and Mannarino, 1996;
Scheeringa et al., 2007, 2011).
Scheeringa et al. (2011) showed that CBT techniques are feasible and effective in 3-6
years old children for a variety of types of traumas. Their 12-session CBT manual is
public domain and free to download at www.infantinstitute.org. Training in this model
is available upon request to Dr. Scheeringa at [email protected].
Other structured treatments could also be effective, such as the trauma-focused CBT
model (Cohen et al., 2004) or eye movement desensitization and reprocessing (EMDR).
Play therapy has been shown to be effective in some case studies (Gaensbauer and
Siegel, 1995), but the therapy must involve an emotional engagement with the trauma
memories (Zoellner et al., 2001).
Effective treatment of PTSD symptoms also results in decreases in symptoms of other
disorders including oppositional behavior and other anxiety symptoms (Scheeringa et
al., 2011).
If loved ones died in the trauma, grief may be another important issue that needs
special treatment.
Approximately 30-40% of children exposed to traumatic events develop significant
symptoms of PTSD, and approximately 20% of preschool children in non-high risk
environments are exposed to at least one traumatic event. Screening and assessment
in communities where violence exposure and traumatic events are common is critical.
Prepared by Michael Scheeringa, MD, MPH and Stacy Drury, MD, PhD
Traumatic Stress Clinic, Child Counseling Associates, LLC
(504) 842-3200 ccanola.com
1315 Jefferson Highway, New Orleans, LA 70124
The KID CATCH Foundation
kidcatch.org
New Orleans, LA
2012
Literature Cited
Cohen JA, Deblinger E, Mannarino AP, Steer RA (2004). A multisite, randomized controlled trial for
children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child &
Adolescent Psychiatry, 43, 393-402.
Cohen JA, Mannarino AP (1996). A treatment outcome study for sexually abused preschool children:
Initial findings. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 42-50.
Cohen JA, Scheeringa MS (2009). Post-traumatic stress disorder diagnosis in children: Challenges and
promises. Dialogues in Clinical Neuroscience, 11(1), 91-99.
Deblinger E, Stauffer LB, Steer, RA (2001). Comparative efficacies of supportive and cognitive behavioral
group therapies for young children who have been sexually abused and their nonoffending
mothers. Child Maltreatment, 6, 332-343.
De Young AC, Kenardy JA, Cobham VE (2011). Trauma in early childhood: A neglected population.
Clinical Child and Family Psychology Review, 14, 231-250.
Gaensbauer TJ, Siegel CH (1995). Therapeutic approaches to posttraumatic stress disorder in infants
and toddlers. Infant Mental Health Journal, 16, 292-305.
McMillen C, North C, Mosley M, Smith, E (2002). Untangling the psychiatric comorbidity of posttraumatic
stress disorder in a sample of flood survivors. Comprehensive Psychiatry, 43, 478-85.
Scheeringa MS (2011). PTSD in Children Younger Than Age of 13: Towards a Developmentally
Sensitive Diagnosis. Journal of Child & Adolescent Trauma, 4(3), 181-197
Scheeringa MS, Haslett N (2010). The reliability and criterion validity of the Diagnostic Infant and
Preschool Assessment: A new diagnostic instrument for young children. Child Psychiatry &
Human Development, 41(3), 299-312.
Scheeringa MS, Salloum A, Arnberger RA, Weems CF, Amaya-Jackson L, Cohen JA (2007). Feasibility
and Effectiveness of Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder in
Preschool Children: Two Case Reports. Journal of Traumatic Stress, 20(4), 631-636.
Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D (2011). Trauma-focused cognitivebehavioral therapy for posttraumatic stress disorder in three through six year-old children: A
randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853-860.
Scheeringa MS, Zeanah CH (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of
disorders in preschool children and their caregivers following Hurricane Katrina. Journal of
Clinical Child and Adolescent Psychology, 37(3), 508-518.
Scheeringa MS, Zeanah CH, Cohen JA (2011). PTSD in children and adolescents: Towards an
empirically based algorithm. Depression and Anxiety, 28(9), 770-782.
Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2005). Predictive validity in a prospective follow-up of
PTSD in preschool children. Journal of the American Academy of Child and Adolescent
Psychiatry, 44(9), 899-906
Zoellner et al., (2001). Cognitive-behavioral approaches to PTSD. In JP Wilson, MJ Friedman, JD
Lindy, Treating Psychological Trauma and PTSD (pp. 159-182). Guilford: New York, NY.
Prepared by Michael Scheeringa, MD, MPH and Stacy Drury, MD, PhD
Traumatic Stress Clinic, Child Counseling Associates, LLC
(504) 842-3200 ccanola.com
1315 Jefferson Highway, New Orleans, LA 70124