Topic: Assessment, Treatment, & Prevention of Posttraumatic Stress Disorder in Children and Adolescents Population: Children and adolescents through 17 years with a DSM-5 PTSD diagnosis or with elevated risk of developing PTSD. Questions:

1. What is the comparative accuracy of approaches that can be used to screen for or diagnose PTSD?
2. What are the comparative effectiveness and safety of pharmacologic and/or non-pharmacologic treatments for PTSD in improving outcomes associated with PTSD? How do these outcomes vary by patient characteristics, disorder characteristics, history of previous treatment, and comorbid conditions?
3. What factors convey excess risk for the development of DSM-5 PTSD?
4. What is the effectiveness and safety of pharmacologic and/or non-pharmacologic approaches to the prevention of DSM-t PTSD?

PTSD is a common mental illness associated with a broad range of adverse sequelae. The overall lifetime prevalence of PTSD in the general population of children and youth is estimated at between 3 and 9%. In trauma-exposed youth, the overall rate of PTSD based upon well-established diagnostic interviews is estimated at 16%, with the rate varying according to type of trauma and gender. Girls exposed to interpersonal trauma appear to have the highest rates. Many more trauma-exposed youth develop clinically significant trauma-related symptoms without meeting full diagnostic criteria; research has suggested that these children have comparable functional impairments to those with a diagnosis of PTSD. Trauma exposure is common - It is estimated that between 60 and 90% of youth presenting for outpatient mental health treatment may have been exposed to at least one traumatic stressor. Outcomes of trauma exposure vary from resilience to psychopathology to death by suicide. When psychopathologic outcomes are present, comorbidity is the rule, including anxiety, mood, disruptive behavior, psychotic, somatic symptom, and substance abuse disorders. PTSD symptoms and impairment may persist for decades and cause impairment in multiple domains of life, including academic and work accomplishment, interpersonal relationships, and parenting abilities. The most recent US clinical practice guidelines were published in 2012 by the American Academy of Child & Adolescent Psychiatry (AACAP). These parameters were developed in advance of the new guidelines for guidelines developed by the Institute of Medicine to increase the rigor and transparency of clinical practice guidelines. Accordingly, there is an urgent need to critically appraise the extant literature regarding this topic so that the AACAP clinical practice guidelines can be updated based upon a more rigorous systematic review process.

The answers to the research questions will serve as the basis for updated clinical practice guidelines pertaining to the assessment, treatment, and prevention of PTSD in children and adolescents that will be published by the American Academy of Child & Adolescent Psychiatry in the Journal of the American Academy of Child and Adolescent Psychiatry and on the AACAP website as an AACAP Official Action.

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Physician and Co-Chair, Committee on Quality Issues, American Academy of Child & Adolescent Psychiatry

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American Academy of Child & Adolescent Psychiatry

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Invitation to nominate review topic from Associate Director, AHRQ EPC Program