Posttraumatic Stress Symptoms in Children after Mild to Moderate Pediatric Trauma: A Longitudinal Examination of Symptom Prevalence, Correlates, and Parent-Child Symptom Reporting

Department of Surgery, University of California, San Francisco, San Francisco, California, United States
The Journal of trauma (Impact Factor: 2.96). 03/2005; 58(2):353-63. DOI: 10.1097/01.TA.0000152537.15672.B7
Source: PubMed


Full recovery from injury may be hindered by both physical ailments and psychologic distress. Little information is available on the psychologic response of children to physical trauma, although long-term dysfunction may result if psychologic needs are not identified and addressed. This study examined the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms in children and adolescents after an acute traumatic event resulting in mild to moderate physical injury. We were also interested in analyzing the discrepancies between parent/child reporting of the child's PTSD symptomatology. Because of the paucity of research evaluating interventions for pediatric PTSD, and as a secondary objective for this study, we collected preliminary data on the effectiveness of a single-session art therapy intervention designed to reduce PTSD symptoms.
From July 1998 through October 2000, 83 children/adolescents between the ages of 7 and 17 and their caregivers were interviewed within 24 hours of hospital admission and assessed for PTSD symptomatology, trauma history, and other measures of child and family functioning. Interviews were repeated at 1 month, 6 months, and 18 months after the initial hospitalization. Patients with at least mild symptomatology at the initial interview were randomized to receive either an art therapy intervention or standard hospital services alone.
A total of 69% of children were found to have at least mild PTSD symptoms at baseline, 57% at 1 month, 59% at 6 months, and 38% at 18 months postinjury. Younger age and the severity of parental PTSD symptoms were correlated with symptom presence in children. Parents initially underreported their child's symptom severity when compared with the child's report, but assessments converged over time. The art therapy intervention showed no sustained effects on the reduction of PTSD symptoms.
The presence of PTSD symptoms in children after traumatic injury is very high. Parental distress and characteristics of the family environment appear to be more relevant to the presence of child symptoms than the family make-up, course of hospitalization, or extent of the child's injuries. Parents may not initially recognize the degree to which their children experience such symptoms. The high presence of symptoms in this population underscores the need for treatment efficacy studies and parent/medical staff education in identification of PTSD.

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    • "These findings are consistent with prior reports in the reference literature. Significant discrepancies have been found between parent and child reports of the number of traumatic events previously experienced by the child (Schreier et al., 2005; Stover et al., 2010). Parents' reports of children's exposure to violence have repeatedly been shown to underestimate the child's level of exposure (Ceballo et al., 2001; Hungerford et al., 2010; Richters and Martinez, 1993; SelnerO'Hagan et al., 1998). "
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    ABSTRACT: The purpose of this study was to investigate the agreement between parent and child report of potential traumas experienced, to look at the agreement by interpersonal versus non-interpersonal traumas and by gender. A birth cohort of 1723 children and their parents was followed from three months until 12 years after birth (South East Sweden Birth Cohort (SESBiC) study). At 12-year follow-up, 1174 children, 875 mothers and 601 fathers completed the Life Incidence of Traumatic Events (LITE) questionnaire. Cohen's kappa was used to assess the agreement between parent and child reports of traumas experienced by the child. The group was split by gender and kappa statistics were computed to determine the level of agreement between the different informants. The sample was also analysed according to the nature of the traumatic event: interpersonal or non-interpersonal. Agreement was low across most types of traumas reported between parents and children and moderate between mothers and fathers. Agreement was lower when the trauma was interpersonal. No significant discrepancies in general were found on gender. The study highlights the importance of from whom the researcher collects information. In future research, it is important to study the significance the choice of information source might have on reported symptoms and behavioural problems.
    Child Abuse Review 09/2013; 24(3). DOI:10.1002/car.2287 · 0.56 Impact Factor
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    • "No brief early intervention (intervention more than 6 weeks after the event or more than 6 intervention sessions) Schreier et al., 2005 Unsatisfactory methodological quality Silverman et al., 2008 Review Stuber et al., 2002 Unsatisfactory methodological quality Vila et al., 1999 Unsatisfactory methodological quality Yule & Udwin, 1991 Same sample as included study "
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    ABSTRACT: Single traumatising events are associated with an elevated rate of psychological disorders in children and adolescents. To date, it remains unclear whether early psychological interventions can reduce longer term psychological maladjustment. To systematically review the literature to determine the characteristics and efficacy of early psychological interventions in children and adolescents after a single, potentially-traumatising event. Systematic searches were conducted of all relevant bibliographic databases. Studies on early psychological interventions were included if the first session was conducted within 1 month of the event. Two independent observers assessed each study for eligibility, using pre-determined inclusion and exclusion criteria, and rated the study's methodological quality. A meta-analysis was conducted on the group effects between individuals allocated to intervention versus control groups. Hence, effect sizes (ES) and confidence intervals were computed as well as heterogeneity and analogue-to-the ANOVA analyses. Seven studies (including four randomised controlled trials) met the inclusion criteria. Depending on the specific outcome variable (e.g., dissociation, anxiety and arousal), small to large beneficial ES were noted. Although the meta-analysis revealed unexplained heterogeneity between the ES of the included studies, and although studies varied greatly with regards to their methodological quality and the interventions tested, findings suggest that early interventions should involve psycho-education, provide individual coping-skills and probably involve some kind of trauma exposure. Also, a stepped procedure that includes an initial risk screen and the provision of multiple sessions to those children at risk may be a promising strategy. To date, research on the effectiveness of early interventions in children after a potentially traumatising event remains scarce. However, our review suggests that early interventions may be helpful.
    European Journal of Psychotraumatology 12/2011; 2. DOI:10.3402/ejpt.v2i0.7858 · 2.40 Impact Factor
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    • "Nine studies used multiple participants for data reporting, including the youth incurring the trauma, as well as mothers, fathers, and siblings (Alderfer et al., 2009; Barakat et al., 1997; Boyer, Hitelman, et al., 2003; Boyer, Ware, et al., 2003; Brown et al., 2003; Harris & Zakowski, 2003; Kazak et al., 1997; Kiliç et al., 2003; Ozono et al, 2007). Six studies used only one member of the family in reporting some data, even though the sample had multiple family members available (Khamis, 2005; Laor et al., 2001; Meiser-Stedman et al., 2006; Otto et al., 2007; Pelcovitz et al., 1998; Schreier et al., 2005). One study was not entirely clear about who reported on the family phenomena measure (Connolly et al., 2004). "
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    ABSTRACT: Youth face trauma that can cause posttraumatic stress (PTS). (1) To identify the family phenomena used in youth PTS research; and(2) to critically examine the research findings regarding the relationship between family phenomena and youth PTS. Systematic literature review in PsycInfo, PILOTS, CINAHL, and MEDLINE. Twenty-six empirical articles met inclusion criteria. Measurement of family phenomena included family functioning,support, environment, expressiveness, relationships, cohesion, communication, satisfaction, life events related to family, parental style of influence, and parental bonding. Few studies gave clear conceptualization of family or family phenomena. Empirical findings from the 26 studies indicate inconsistent empirical relationships between family phenomena and youth PTS, although a majority of the prospective studies support a relationship between family phenomena and youth PTS. Future directions for leadership by psychiatric nurses in this area of research and practice are recommended.
    Journal of Child and Adolescent Psychiatric Nursing 02/2011; 24(1):38-50. DOI:10.1111/j.1744-6171.2010.00258.x
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