[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 01/2012; 3.
[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.
Journal of Traumatic Stress 04/2010; 23(2):232-9. · 2.72 Impact Factor
[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; 4:7.
[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. · 1.93 Impact Factor
[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