Acute Stress Disorder in Children and Adolescents

ICD-10 Code: F43.0

Acute stress disorder (ASD) is part of a cluster of diagnoses called the trauma and stressor-related disorders.  Trauma and stressor-related disorders are a group of psychiatric conditions that include:

  • Posttraumatic stress disorder
  • Acute stress disorder
  • Reactive attachment disorder

These disorders are characterized by an adverse reaction to one or more traumatic or unusually stressful experiences.

The Diagnostic and Statistical Manual of Mental Disorders-5th Edition defines traumatic events as situations in which the individual experiences, is threatened with, or witnesses serious injury, death, or sexual violence.  Repeated exposure to extreme details of traumatic events as part of an individual’s employment (e.g., a police officer or social worker who regularly encounters details of child abuse) also qualifies as a traumatic event.   

PTSD and ASD are both characterized by a set of adverse cognitive, behavioral, and emotional changes that occur after experience of one or more traumatic events.  Both disorders are characterized by intrusive and upsetting memories of the traumatic event(s), adverse cognitive and emotional changes (e.g., very negative beliefs about the world; persistent dysphoria or anger), avoidance behaviors (including avoiding thinking about the event), and increased autonomic reactivity.   Acute stress disorder is diagnosed when the symptoms occur in the month following the traumatic event.  PTSD is diagnosed when the symptoms persist for one month or longer following the traumatic event.

Reactive attachment disorder (RAD) is diagnosed only in children and is characterized by inhibited and emotionally withdrawn behaviors toward the child’s caregiver(s), along with other social and emotional disturbances.  RAD is an adverse reaction to neglect, repeated changes in caregivers (e.g., frequent changes in foster care), or rearing in adverse circumstances (e.g., institutions with inadequate availability of caregivers).

What is Acute Stress Disorder?

ASD is a psychiatric disorder that occurs between 3 days and 1 month after a traumatic event.  The epidemiology of the disorder varies depending on location and context; for example, rates of ASD are likely to be elevated among groups who have recently experienced a major traumatic event (e.g., a terrorist attack or natural disaster).

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Understanding Acute Stress Disorder

ASD severity can range from mild to very severe.  In severe cases, ASD can lead to inability to attend or concentrate at work or school and can interfere with the person’s relationships.  Little is known about the comorbidity of ASD with non-trauma- and stressor-related disorders.  However, ASD is known to be a major risk factor for the development of PTSD.

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How is Acute Stress Disorder Treated?

Little is known about the treatment of ASD in children and adolescents.  Treatment guidelines are available for the treatment of posttraumatic stress disorder in children and adolescents (Society of Clinical Child and Adolescent Psychology; American Academy of Child and Adolescent Psychiatry; National Institute for Clinical Excellence) and for the treatment of ASD in adults (American Psychiatric Association). However, it is not known whether these same interventions would be beneficial for children and adolescents with ASD.

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