Acute Stress Disorder in children and adolescents: A systematic review and meta-analysis of prevalence following exposure to a traumatic event

Background: Acute stress disorder (ASD) was proposed to encapsulate traumatic stress reactions within the first few months of exposure to trauma. The present systematic review and meta-analysis aimed to estimate the prevalence of ASD in children and adolescents, and the extent to which assessment, demographic and trauma variables moderate this. Method: Searches of EMBASE, MEDLINE (PubMed), PsycINFO, PsycARTICLES and PILOTS were conducted to identify studies published between 1 ^st January 1994 and 1 ^st January 2018. Seventeen studies were identified as meeting inclusion criteria (N=2918 participants). Results: The pooled prevalence estimate for ASD was 16.5% (95% CI 10.6–23.4%), with considerable heterogeneity between studies (Q[16]=261.12, p < .001, I ²=95.3%). Risk of bias was unrelated to prevalence estimates. Studies that used a clinical interview (k=8) yielded a higher estimate (24.0%, 95% CI 13.8–36.0%) than those that used a questionnaire which adhered to the diagnostic algorithm for DSM-IV ASD (k=6; 6.8%, 95% CI 3.6–10.9%). Studies comprising older participants yielded greater prevalence estimates. Prevalence was significantly greater in studies where the majority of participants had been exposed to interpersonal trauma (27.9%, 95% CI 15.1–42.8%; k=5) compared to non-interpersonal trauma (12.8%, 95% CI 7.2–19.7%; k=12). Conclusions: This review suggests that a significant minority of trauma-exposed children and adolescents meet criteria for ASD (in particular youth exposed to interpersonal trauma), but the findings are limited by a large degree of heterogeneity. DSM-IV ASD-specific self-report questionnaire measures may be too insensitive for identifying youth with this disorder.