[Show abstract][Hide abstract] ABSTRACT: Background:
Although previous research has consistently found considerable rates of acute stress disorder (ASD) in children with accidental injuries, knowledge about determinants of ASD remains incomplete. Guilt is a common reaction among children after a traumatic event and has been shown to contribute to posttraumatic stress disorder. However, its relationship to ASD has never been examined.
This study assessed the prevalence of ASD in children and adolescents following road traffic accidents (RTAs). Moreover, the association between peritraumatic guilt and ASD was investigated relying on current cognitive theories of posttraumatic stress and controlling for female sex, age, socioeconomic status (SES), injury severity, inpatient treatment, pretrauma psychopathology, and maternal posttraumatic stress symptoms (PTSS).
One hundred and one children and adolescents (aged 7-16 years) were assessed by means of a clinical interview approximately 10 days after an RTA. Mothers were assessed by questionnaires.
Three participants (3.0%) met diagnostic criteria for full ASD according to DSM-IV, and 17 (16.8%) for subsyndromal ASD. In a multivariate regression model, guilt was found to be a significant predictor of ASD severity. Female sex, outpatient treatment, and maternal PTSS also predicted ASD severity. Child age, SES, injury severity, and pretraumatic child psychopathology were not related to ASD severity.
Future research should examine the association between peritraumatic guilt and acute stress symptoms in more detail. Moreover, guilt appraisals in the acute phase after an accident might be a relevant target for clinical attention.
European Journal of Psychotraumatology 10/2015; 6:29074. DOI:10.3402/ejpt.v6.29074 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sleep onset and maintenance problems are a frequent complaint after traumatic events in children. However, the association of traumatic experiences and disturbed sleep remains to be explained.
To examine the incidence of sleep onset and maintenance problems in children after road traffic accidents and identify potential predictors of sleep onset and maintenance problems, including putative psychopathological mechanisms as well as stressors affecting the family system.
In 33 children treated for injuries after road traffic accidents, sleep and measures of psychopathology were assessed 10 days, 2 months, and 6 months after hospital admission. The predictive value of four clusters of predictor variables for children's sleep onset and maintenance problems was prospectively tested by multiple regression analyses. These clusters included socio-demographic, injury- and accident-related, and psychopathological variable clusters as well as factors reflecting stressors concerning mothers and family.
Children suffering from posttraumatic stress reported a prolonged subjective sleep latency. The severity of sleep onset and maintenance problems was predicted by female sex and the child's as well as mothers' posttraumatic stress disorder (PTSD) severity.
Sleep onset and maintenance problems in children after trauma appear to result from a complex interaction of multiple factors. Our findings support the transactional model of sleep-wake regulation that bears implications for the development of adequate intervention strategies.
European Journal of Psychotraumatology 06/2012; 3. DOI:10.3402/ejpt.v3i0.8402 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Posttraumatic nightmares are considered as a reexperiencing symptom of the DSM-IV posttraumatic stress disorder (PTSD) diagnosis. Different types of posttraumatic nightmares, however, may differ in their relation to psychopathology. Thirty-two children were longitudinally assessed 10 days, 2 months, and 6 months after traffic accidents. Occurrence and characteristics of nightmares were examined and their relation to psychopathology assessed. Thirty-four percent of children reported posttraumatic nightmares during at least one assessment. Exact replicative nightmares at baseline assessment predicted PTSD symptoms 2 and 6 months postaccident, but not depressive symptoms. Exact replicative nightmares revealed the strongest cross-sectional association with trauma-specific psychopathology but not with depression. The authors conclude that posttraumatic nightmares--especially exact replicative ones--may be closely related to psychopathological mechanisms of posttraumatic stress in children.
[Show abstract][Hide abstract] ABSTRACT: Road traffic accidents (RTAs) are the leading health threat to children in Europe, resulting in 355,000 injuries annually. Because children can suffer significant and long-term mental health problems following RTAs, there is considerable interest in the development of early psychological interventions. To date, the research in this field is scarce, and currently no evidence-based recommendations can be made.
To evaluate the effectiveness of a single-session early psychological intervention, 99 children age 7-16 were randomly assigned to an intervention or control group. The manualised intervention was provided to the child and at least one parent around 10 days after the child's involvement in an RTA. It included reconstruction of the accident using drawings and accident-related toys, and psychoeducation. All of the children were interviewed at 10 days, 2 months and 6 months after the accident. Parents filled in questionnaires. Standardised instruments were used to assess acute stress disorder (ASD), posttraumatic stress disorder (PTSD), depressive symptoms and behavioural problems.
The children of the two study groups showed no significant differences concerning posttraumatic symptoms and other outcome variables at 2 or at 6 months. Interestingly, analyses showed a significant intervention x age-group effect, indicating that for preadolescent children the intervention was effective in decreasing depressive symptoms and behavioural problems.
This study is the first to show a beneficial effect of a single-session early psychological intervention after RTA in preadolescent children. Therefore, an age-specific approach in an early stage after RTAs may be a promising way for further research. Younger children can benefit from the intervention evaluated here. However, these results have to be interpreted with caution, because of small subgroup sizes. Future studies are needed to examine specific approaches for children and adolescents. Also, the intervention evaluated here needs to be studied in other groups of traumatised children.
Clinical Trial Registry: ClinicalTrials.gov: NCT00296842.
Child and Adolescent Psychiatry and Mental Health 02/2010; 4(1):7. DOI:10.1186/1753-2000-4-7
[Show abstract][Hide abstract] ABSTRACT: To study the long-term outcome of surgically treated low-grade cerebellar astrocytomas in children.
We followed 31 consecutive patients under 16 years of age who were diagnosed between 1980 and 2005 in a single institution. In 21 of 31 survivors (median follow-up time 7.9 years; range 5.6-27.4 years) who agreed to participate, tumor control, neurological and cognitive complications, and their impact on behavioral and emotional adjustment and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively.
Neurological sequelae were found in 43%. However, age-appropriate ability to perform daily life activities was normal in all patients. Remarkably, cognitive deficits leading to significant school problems occurred in 19% and behavioral and emotional adjustment disturbances in 27%. In comparison with healthy controls, the survivors rated their HRQoL similarly or even higher.
Childhood low-grade cerebellar astrocytomas have an excellent cure rate by tumor surgery alone. When compared with other pediatric brain tumors, the risk of neurological, cognitive, emotional, and behavioral complications is relatively small. HRQoL is similar to that of healthy controls.
Child s Nervous System 09/2008; 24(12):1447-55. DOI:10.1007/s00381-008-0692-7 · 1.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To study the outcome in children with brain tumours diagnosed in the first year of life, we followed up 27 consecutive children who were diagnosed between 1980 and 2005 in a single institution.
Tumour control and neurological, endocrine and cognitive complications and their impact on behavioural and emotional adjustment and health-related quality of life (HRQoL) were comprehensively assessed in 11 survivors (mean follow-up time 12.3 years).
Persistent neurological complications occurred in 9/11 patients, endocrine and growth complications in 4/11, and cognitive deficits leading to school problems/impaired choice of occupation in 8/10. Behavioural and psychological adjustment problems were reported by 4/6 patients and 7/10 parents. HRQoL as rated by patients and their parents was considerably lower than that of healthy controls. In comparison with healthy controls, social functioning was rated by the patients and the parents as the QoL dimension most affected. HRQoL was lowest for patients with high-grade tumour histology and more intense therapy.
Long-term survivors of brain tumours diagnosed in the first year of life are not only at great risk of neurological and cognitive complications, but also of social isolation thereby substantially decreasing self-rated HRQoL.
Archives of Disease in Childhood 08/2008; 93(7):582-9. DOI:10.1136/adc.2007.116202 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spinal cord compression by pediatric intraspinal tumors may result in persisting neurological deficits. The impact such late effects have on social and psychological adjustment and quality of life has not been documented previously.
To study the long-term outcome of pediatric patients with intraspinal tumors, we followed 28 consecutive patients under 16 years of age who were treated in a single institution from 1975 to 2005. In 20 of 26 survivors (median follow-up time 8.4 years, range 0.8-31.3 years) who agreed to participate, neurological, orthopedic, and cognitive complications and their impact on behavioral and psychological adjustment, and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively. Primary therapy for spinal cord decompression was surgery in ten patients, chemotherapy in nine, and radiotherapy in one.
Tumor control was good (10-year overall survival rate of 96%; 10-year progression-free survival rate of 84%). Persistent neurological complications occurred in 10 (50%) patients (paraparesis, n = 7; monoparesis, n = 3; neurogenic bladder dysfunction, n = 4; neurogenic bowel dysfunction, n = 2). Two of the ten patients with paresis depended on wheelchair. Seven (35%) patients developed scoliosis and six of these required spondylodesis. Survivors reported no major impairments in daily activities and rated their HRQoL only slightly lower than healthy controls. The only statistically significant difference was in emotional functioning.
Most patients with intraspinal tumors have a good chance of cure. Apart from few patients, especially those with severe neurological complications, self-rated HRQoL is comparable to that of healthy controls.
[Show abstract][Hide abstract] ABSTRACT: Early psychological interventions within the first hours, days or weeks after a traumatic event aim to avoid or minimize middle- or long-term mental-health problems. To date, there are no articles in German language available that review the field of early psychological interventions in children. This paper defines this field, summarizes current early psychological interventions and reviews the literature on effectiveness of early interventions. Most of the early psychological interventions in children after trauma that are reported in the literature are not evidence based. Moreover, current knowledge is limited by a number of methodological problems. First, most studies have no control groups and the samples are small. Second, different timeframes and interventions complicate a comparison of different studies. For future research, randomised controlled studies with manualised interventions and repeated follow-ups are demanded. In clinical practice, the lack of studies on effectiveness of early psychological interventions in children leads to a simple transfer of intervention strategies from adults. This practice needs to be questioned. Importantly, the consideration of developmental aspects is crucial. To date, no evidence-based advise can be given with regard to early psychological interventions in children. Moreover, it remains unclear, how to involve the parents.
Praxis der Kinderpsychologie und Kinderpsychiatrie 02/2006; 55(9):675-92. · 0.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Findings about the influence of coping on psychological adjustment in children with different medical conditions are inconsistent and often based on cross-sectional data. This prospective study evaluated the effect of various coping strategies on children's post-traumatic stress symptoms and behavioral problems 1 month and 1 year after an accidental injury or the diagnosis of a chronic disease in 161 pediatric patients 6-15 years of age. Only minor positive effects of coping on psychosocial adjustment were found: Religious coping reduced post-traumatic stress symptoms. Active coping strategies had negative effects on internalizing and externalizing behavioral problems. Support seeking strategies, distraction, and avoidance had no impact on long-term psychosocial adjustment.
Child Psychiatry and Human Development 02/2006; 36(3):351-68. DOI:10.1007/s10578-005-0007-0 · 1.93 Impact Factor