The present paper reviews pediatric posttraumatic stress disorder, emphasizing the relational basis of the disorder and highlighting the missing link between juvenile delinquency and trauma. The first part of the paper defines trauma and the diagnostic criteria for PTSD, noting child-specific features. The second part reviews the literature emphasizing the relational and attachment relevant nature of trauma. The third part explores psychological mechanisms for how attachment relations could affect trauma responses. Attachment relations (1) shape core schemas of the world, others, and the self and (2) foster emotional engagement or disengagement, both of which have been associated with traumatic responses. The most empirically supported pediatric trauma treatment, trauma-focused cognitive behavioral therapy (TF-CBT), acknowledges the attachment figure's influence and includes treating and training the parent and conjoint child-parent discussion. The next section reviews the noteworthy link between juvenile delinquency and trauma history. More awareness of trauma and PTSD in children and adolescents is recommended to effectively address juvenile delinquency. The review ends with a few helpful points for practicing pediatricians regarding childhood trauma. 1. Introduction Trauma and PTSD in children occur in the context of the ongoing parent-child relation, and this lens may offer insights to the correlations which previous studies have uncovered, integrating the findings and adding a fuller contour to the picture of pediatric PTSD. This paper aims to review and integrate an understanding of PTSD in children and adolescents in an attachment context and organizes the article in several sections: defining PTSD in children; a review of parental influences on pediatric PTSD; psychological mechanisms for how attachment relations affect trauma responses; the link between PTSD and juvenile delinquency; a few take-away points for pediatricians. 2. Defining PTSD in Children Trauma is a profound experience of the loss of security and welfare evoking feelings of fear, helplessness, horror, and possibly disorganized agitation in children [1]. The description of PTSD in the Diagnostic and Statistical Manual of Mental Disorders has increasingly taken into account child-specific features of PTSD, and PTSD has evolved from a disorder first associated with Vietnam veterans in the 1970s [2] to one which has now been well documented in the general population at an estimated 7.8% [3] and in specific groups of children, particularly high-risk children such as adolescent
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