Clinical Predictors of Posttraumatic Stress Disorder After Closed Head Injury in Children

Duke University, Durham, North Carolina, United States
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 03/2002; 41(2):157-65. DOI: 10.1097/00004583-200202000-00009
Source: PubMed


To describe injury, demographic, and neuropsychiatric characteristics of children who develop posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) after closed head injury (CHI).
Ninety-five children with severe CHI and amnesia for the event were prospectively followed for 1 year. Structured interviews were administered twice to the parents: shortly after injury to cover the child's premorbid status, and 1 year after injury. The child was also interviewed twice: shortly after injury to cover current status, and 1 year after injury. Outcome measures were diagnostic status (PTSD by parent or child) and symptom severity (PTSS by parent or child).
Twelve children developed PTSD by 1 year after injury, 5 according to parent report, 5 according to child report, and 2 according to both parent and child report. Predictors of PTSD at 1 year post-CHI included female gender and early post-CHI anxiety symptoms. Predictors of PTSS at 1 year post-CHI were (1) premorbid psychosocial adversity, premorbid anxiety symptoms, and injury severity; and (2) early post-CHI depression symptoms and nonanxiety psychiatric diagnoses.
PTSD developed in 13% of children with severe CHI accompanied by traumatic amnesia. Predictors of PTSD and PTSS after CHI, according to parent and child report, are consistent with predictors of PTSD and PTSS that develop after non-head injury trauma.

6 Reads
    • "Another significant limitation is that we did not control for premorbid behavior and other individual characteristics such as psychiatric diagnoses, intellectual disabilities, or other preexisting behavioral problems, which will have likely affected the results of the current study. For instance, research has noted that premorbid anxiety symptoms and nonanxiety diagnoses (Gerring et al., 2002) and also internalizing disorders at time of injury (Max et al., 1998) significantly predict anxiety symptomatology following TBI. Moreover, we did not control for non-neurological medical illnesses in our sample. "
    [Show abstract] [Hide abstract]
    ABSTRACT: While the presence of externalizing behavioral problems following traumatic brain injury (TBI) has been well established in the literature, less is known regarding internalizing disorders, and more specifically anxiety disorders, in such a population. This study explored the presence, rate, and incidence of internalizing behavior problems, including anxiety, depression, somatic complaints, avoidant personality symptomatology, and overall internalizing behavior problems in university students aged 18-25 years. A convenience sample of 247 university students (197 non-TBI, 47 mild TBI, 2 moderate TBI, 1 severe TBI) aged 18-25 years was utilized. Participants completed a self-report measure on behavioral functioning, the Adult Self Report (ASR), to identify internalizing behaviors, and a questionnaire to identify TBI history. Raw scores of behavior indicated that participants with a history of childhood TBI reported significantly higher levels of withdrawal, somatic complaints, and internalizing behavioral problems than the non-TBI participants. When analyzing standardized T-scores for borderline and clinically elevated ASR syndromes and Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scales, individuals in the TBI group were significantly more likely to have higher rates of borderline anxiety, somatic complaints, avoidant personality problems, and overall internalizing disorders, and clinically elevated somatic complaints. Adults with a history of childhood TBI were also significantly more likely to report at least 1 or more DSM disorders. These results clearly suggest that individuals with a childhood history of TBI are at a heightened risk for a range of internalizing disorders in early adulthood, which is particularly troubling in a university sample pursuing tertiary education.
    Journal of Clinical and Experimental Neuropsychology 09/2015; 37(7):776-84. DOI:10.1080/13803395.2015.1053843 · 2.08 Impact Factor
  • Source
    • "parent report of children ' s anxiety symptoms . Questionnaires and interviews examin - ing anxiety and internalizing disorders which are completed by different respondents yield different profiles . Indeed , there is often a low to moderate correlation of symptoms between child and parent report based on either interview or questionnaire format ( Gerring et al . 2002 ; Langer et al . 2010 ; Manassis et al . 2009 ) . Parents make judgments and inferences based on observation of the child ' s behavior and verbalizations ; self - report of internalizing symptoms relies on description of subjective experiences ( Levi et al . 1999 ) ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic brain injury (TBI) and orthopedic injury (OI) patients are prone to anxiety and mood disorders. In the present study, we integrated anatomical and diffusion tensor neuroimaging to investigate structural properties of the amygdala and hippocampus, gray matter regions implicated in anxiety and mood disorders. Children and adolescents were evaluated during the late sub-acute phase of recovery following trauma resulting from either moderate to severe TBI or OI. Mean diffusivity (MD) of the amygdala and hippocampus was elevated following TBI. An interaction of hemisphere, structure, and group revealed that MD of the right amygdala was elevated in females with TBI. Self-reported anxiety scores were not related to either volume or microstructure of the hippocampus, or to volume or fractional anisotropy of the amygdala. Left amygdala MD in the TBI group accounted for 17.5% of variance in anxiety scores. Anxiety symptoms may be mediated by different mechanisms in patients with TBI or OI.
    Brain Imaging and Behavior 03/2012; 6(1):36-48. DOI:10.1007/s11682-011-9140-5 · 4.60 Impact Factor
Show more