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.

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    • "√ √ √ √ √ √ [32] Max et al. (1998) √ √ √ √ √ [33] Levi & Drotar (1999) √ √ √ √ √ √ [34] Gerring et al. (2002) √ √ √ √ √ [35] Herskovits et al. (2002) √ √ √ √ √ [36 ]Mather et al. (2003) √ √ √ √ [37] Grados et al. (2008) √ √ √ √ √ [38] Luis & Mittenberg (2002) √ √ √ √ √ √ [39] "
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    ABSTRACT: The aim of this chapter is to systematically review the research exploring the relationship between TBI and anxiety disorders in children and adolescents. A literature search was conducted using Google Scholar,. The search returned 346 articles, and 11 of these met the inclusion criteria. Anxiety disorders were often found to be a negative outcome following childhood TBI, with a higher incidence of disorders including GAD, ASD, PTSD, PD, OCD, simple/specific phobia, social phobia and SAD found in children following their injury. In most cases, this relationship was strongest for children with severe TBI who sustained their injury at a younger age. Psychosocial adversity was found to be a consistently significant predictor for the likelihood of children developing anxiety following TBI. It is concluded that children who have suffered from a TBI (mild, moderate or severe), are at a higher risk of developing subsequent anxiety disorders, even 1 year following the injury event, and children with more severe injuries, greater psychosocial adversity, and younger age at injury are considered to be the most vulnerable.
    Full-text · Chapter · Sep 2015
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    • "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 ) ."
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    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.
    Full-text · Article · Mar 2012 · Brain Imaging and Behavior

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