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Posttraumatische stress-stoornis bij kinderen en adolescenten: diagnostiek en hulpverlening
... Naast ptss-klachten kunnen chronische traumatiserende omstandigheden verstrekkende gevolgen hebben voor de persoonlijkheidsontwikkeling en is er vaak sprake van comorbiditeit (Cohen, Mannarino, & Deblinger, 2007;Terr, 1991). Een aantal factoren hangen samen met de reactie op een traumatische gebeurtenis, zoals de aard van de gebeurtenis, de persoonlijke kenmerken van de jongere en de sociale omgeving (De Roos & Eland, 2005). ...
... De meest gangbare traumabehandelingen zijn Traumagerichte Cognitieve Gedragstherapie (cgt) en Eye Movement Desensitization and Reprocessing (emdr). Bij chronisch getraumatiseerden met ernstige psychopathologie is traumabehandeling onderdeel van een breder behandelpakket en spreekt men van een gefaseerde behandeling (Voor een overzicht zie De Roos & Eland, 2005). Het Psychotraumacentrum van Rivierduinen biedt diverse vormen van traumabehandeling, waarbij zowel cgt als emdr een belangrijke plaats innemen. ...
Verschillende cognitieve copingstrategieën werden geïnventariseerd en hun relatie met ptss-klachten en verandering na vier maanden behandeling werden onderzocht. Hiertoe vulden 85 adolescenten (13 jongens, 72 meisjes)
de cerq en de ies in. Na gemiddeld vier maanden behandeling werden dezelfde lijsten ingevuld door 64 adolescenten (10 jongens, 54 meisjes)
om de veranderingen in strategieën, ptss-klachten en prognostische waarde van de strategieën op ptss-klachten te analyseren. Sommige copingstrategieën hingen samen met meer ptss-klachten en met een afname in ptss-klachten gemiddeld vier maanden later, met name een geneigdheid meer te catastroferen, meer te rumineren, minder te kunnen
concentreren op planning en minder te relativeren. Exploratief werd onderzocht of het type trauma van invloed was op de ernst
van de klachten en cognitieve copingstrategieën. Er kon geen verschil worden aangetoond tussen type I en type II trauma.
... Met type I trauma doelt men op de gevolgen van een eenmalige acute gebeurtenis. Type II trauma verwijst naar de gevolgen van een periode waarin langdurig en herhaald sprake is geweest van geweld, gevaar, dreiging, en eventueel ook misbruik (de Roos & Eland, 2005). In het laatste geval hebben de stressoren meer invloed op de persoonlijkheidsontwikkeling van het kind dan bij type I trauma. ...
Het protocol doet aanbevelingen aan verwijzers en behandelaars over screening en diagnostiek van kinderen en adolescenten met aan trauma gerelateerde problematiek.
Although most victims of disasters, terrorism, or other shocking events recover on their own, a sizable amount of these victims develops long-term disaster-related problems. These victims should receive timely and appropriate psychosocial help. This article describes the development of guidelines on psychosocial interventions during the first 6 weeks after a major incident. Scientific literature, expert opinions, and consensus among relevant parties in the clinical field were used to formulate the recommendations. Early screening, a supportive context, early preventive and curative psychosocial interventions, and the organization of interventions are covered. The implications for the clinical field and future research are discussed. It is concluded that the international knowledge base provides valuable input for the development of national guidelines. However, the successful implementation of such guidelines can take place only if they are legitimated and accepted by local key actors and operational target groups. Their involvement during the development process is vital.
attempts to synthesize current knowledge about child and adolescent exposure to traumatic stress into a developmental framework that recognizes the intricate matrix of a changing child and environment, evolving familial and societal expectations, and an essential linkage between disrupted and normal development
this developmental model of traumatic stress in childhood assigns a prominent role to the trauma-related formation of expectations as these are expressed in the thought, emotions, behavior, and biology of the developing child / traumatic experiences can skew expectations about the world, the safety and security of interpersonal life and the child's sense of personal integrity / these expectancies . . . contribute to our inner plans of the world, and shape concepts of self and others and forecasts about the future that have a powerful influence on current and future behavior / after traumatic exposure(s), these altered expectations place the child at risk for proximal and distal developmental disturbances (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proposes a theory of cognitive adaptation to threatening events. It is argued that the adjustment process centers around 3 themes: A search for meaning in the experience, an attempt to regain mastery over the event in particular and over life more generally, and an effort to restore self-esteem through self-enhancing evaluations. These themes are discussed with reference to cancer patients' coping efforts. It is maintained that successful adjustment depends, in a large part, on the ability to sustain and modify illusions that buffer not only against present threats but also against possible future setbacks. (84 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Assessed the amount and severity of exposure to crime and violence in an urban sample of high school students, determined the extent and nature of consequent posttraumatic stress disorder (PTSD) symptoms, and examined moderating effects of social support and coping style on those symptoms. 96 students (aged 14–18 yrs) were assessed using the Survey of Exposure to Community Violence, the Analysis of Social Support in School Transitions, and the Posttraumatic Stress Disorder Reaction Index. More than 93% of Ss reported having witnessed a violent event, and 44% reported having been a victim. The average number of PTSD symptoms reported by Ss exposed to a traumatic event was 10, and 34.5% of Ss met full Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for PTSD. Results are consistent with earlier findings (K. Kaniasty and F. Norris; see record 1992-39580-001 ) that perceived social support is a more effective predictor of positive outcome than social support actually received.
Sexual assault on children and adolescents has become a common topic of study, but there has been little research into the specific characteristics of the population of male victims. A national survey representative of school-age adolescents in France enabled us to study 465 adolescents reporting sexual assault (121 boys, 344 girls; mean age 15.4, SD 2.5 years). Girls were shown to be more frequently affected by certain medicopsychological symptoms: nightmares, multiple somatic complaints and some items concerning mood disorders. On the other hand, behavioural symptoms were much more frequently expressed in boys, in particular: repeated suicide attempts, running away, fits of violence and substance use. Boys presenting these symptoms should be questioned as a matter of routine concerning a history of sexual assault.
Ouders van getraumatiseerde kinderen hebben een dubbele taak. Zij moeten het kind steunen bij de verwerking én hun eigen reactie weten te hanteren. Daarom neemt ouderbegeleiding, in het hieronder beschreven opvangprotocol voor acuut getraumatiseerde kinderen en hun ouders, een belangrijke plaats in.
In this article we propose mechanisms that govern the processing of emotional information, particularly those involved in fear reduction. Emotions are viewed as represented by information structures in memory, and anxiety is thought to occur when an information structure that serves as program to escape or avoid danger is activated. Emotional processing is defined as the modification of memory structures that underlie emotions. It is argued that some form of exposure to feared situations is common to many psychotherapies for anxiety, and that confrontation with feared objects or situations is an effective treatment. Physiological activation and habituation within and across exposure sessions are cited as indicators of emotional processing, and variables that influence activation and habituation of fear responses are examined. These variables and the indicators are analyzed to yield an account of what information must be integrated for emotional processing of a fear structure. The elements of such a structure are viewed as cognitive representations of the stimulus characteristic of the fear situation, the individual’s responses in it, and aspects of its meaning for the individual. Treatment failures are interpreted with respect to the interference of cognitive defenses, autonomic arousal, mood state, and erroneous ideation with reformation of targeted fear structures. Applications of the concepts advanced here to therapeutic practice and to the broader study of psychopathology are discussed.
A sample of 85 children, ages 3 to 12, and sexually abused within the previous 24 months, were avaluated with the Child Behavior Checklist (CBCL). Data relating to the nature of the abuse were also collected. This sample was clearly more deviant behaviorally as measured by the CBCL. Internalizing behavior was related to the frequency of abuse, the sex of the child, the relationship of the perpetrator to the child, and the severity of abuse. Externalizing behavior was related to the duration, perpetrator's relationship, time elapsed, and sex of the child. Sexual behavior in this sample was related to frequency of abuse and number of perpetrators.
This study examined the relationship between the development of PTSD and selected victim and event characteristics. The sample consisted of 69 girls and 21 boys (mean age = 12.4 years) who had been referred to a child witness preparation program following documentation of sexual abuse. Comparisons of PTSD positive (N = 44) and PTSD negative (N = 46) subgroups found significant differences on variables of age, sex, duration of the abuse, and the use of violence or coercion by the offender. Comparisons on psychological test data indicated that the PTSD subgroup significantly differed from the non-PTSD subgroup on the basis of children's abuse-related fears, anxiety, depression, and feelings of guilt related to the abuse. Hierarchical multiple regression analysis indicated that factors related to the nature and severity of the abuse and the child's self-report of guilt feelings each contributed significantly to explaining 37% of the variance in PTSD symptoms, even after the variables of receptive language ability, age, and sex were controlled. Discriminant function analysis correctly classified 78.4% of the respondents. The importance of considering PTSD in relation to child sexual abuse is discussed, along with limitations of the current study.
The authors evaluated the effectiveness of brief trauma/grief-focused psychotherapy among early adolescents exposed to the 1988 earthquake in Armenia.
Posttraumatic stress and depressive reactions among treated and not treated subjects were evaluated pre- and postintervention, at 1 1/2 and 3 years after the earthquake, respectively.
Severity of posttraumatic stress symptoms significantly decreased among the subjects given psychotherapy, while severity of these symptoms increased significantly among the subjects not treated with psychotherapy. The improvement in posttraumatic stress symptoms was attributable to improvement in all three symptom categories (intrusion, avoidance, and arousal) of posttraumatic stress disorder (PTSD). There was no change in severity of depressive symptoms among subjects given psychotherapy. However, depressive symptoms among subjects not treated with psychotherapy significantly worsened over time. The changes in severity of posttraumatic stress and depressive symptoms were positively correlated within both groups.
The findings demonstrate the efficacy of trauma/grief-focused brief psychotherapy in alleviating PTSD symptoms and preventing the worsening of comorbid depression among early adolescents after a catastrophic disaster. The results support the broad use of such school-based interventions after major disasters and demonstrate the cross-cultural applicability of Western psychotherapeutic approaches.
To determine the prevalence of post-traumatic stress disorders (PTSD) in a selected population of paediatric patients and their parents.
Twenty-three high-risk patients (serious accidents, newly diagnosed cancer) and 11 low-risk patients (simple planned surgery) and their parents were consecutively selected and assessed 6-8 weeks after the event with a DSM-IV based diagnostic interview and the PTSD Symptom Scale.
There is a high prevalence of PTSD in children and parents of the high-risk group. In the low-risk group such disorders are almost nonexistent. Parents in both groups report more PTSD symptoms than their children. Sex and age of the child and duration of hospitalisation have no significant influence on the development of PTSD.
The high prevalence of PTSD in high-risk paediatric patients and their parents offers support for the applicability of a post-traumatic stress model for understanding the psychological impact of accidents, severe illnesses and their medical treatment.
This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.
According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with children's stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to children's trauma reactions and adjustment in a group of children from Bosnia.
During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Children's Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers.
In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with children's adjustment and trauma reactions.
Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.
The treatment of traumatic stress responses in children raises issues that transverse the disciplines of neurobiology, psychodynamics, psychosocial influences, and behavioral and cognitive development. Here, the University of California-Los Angeles (UCLA) Neuropsychiatric Institute and Hospital, we have established a research and clinical prevention intervention program in the area of violence, trauma, and sudden bereavement in childhood. We have responded to requests for assistance from numerous communities after extreme acts of violence or disaster.
The past decade has shown that children react to life-threatening Stressors with various forms of distress. Depression, anxiety, fears, and bereavement reactions as well as Posttraumatic stress disorder (PTSD) can occur. The form of PTSD varies according to the age of the child, and, sadly, the internal distress often goes unrecognized for long periods by parents and teachers. Indeed, one of the reasons that there was doubt as to whether PTSD occurred in children was that few investigators had asked the children themselves how they were affected.
Background:
The devastating effects of traumatic events on children are modulated by risk and protective factors. This study examines the differential effects of traumatic displacement of preschool children and their families following Scud missile attacks on Israel during the Persian Gulf War.Methods:
Three groups participated in the study: families displaced after their houses were damaged, undisplaced families from the same neighborhood (without home damage), and families from a distant city that was threatened but not directly attacked. Data concerning the traumatic event, the child (personality, internalizing, externalizing, and stress symptoms), the mother (Symptom Checklist-90—Revised), and the family (Family Adaptability and Cohesion Evaluation Scales) were gathered 6 months after the end of the war.Results:
Displaced children and mothers showed higher externalizing and stress symptom levels compared with undisplaced and threatened subjects. Destruction of the house and displacement, but not mere distance from the missile impact, explained symptomatic behavior. Inadequate family cohesion predicted symptomatic reaction for 3- and 4-year-old children but not for older ones.Conclusions:
Both human and nonhuman factors contribute to the preschool child's adaptive mechanisms that regulate environmental stressful stimuli. These riskmodifying factors become more autonomous of caretakers with increasing age.
• One hundred fifty-nine children (14.5% of the student body) were sampled after a fatal sniper attack on their elementary school playground. Systematic self-reports of posttraumatic stress disorder (PTSD) symptoms were obtained by use of a child PTSD Reaction Index. Analysis of variance revealed significant differences by exposure but not by sex, ethnicity, or age. Additional analyses were conducted of individual item response, overall severity of PTSD reaction, symptom grouping, and previous life events. The results provide strong evidence that acute PTSD symptoms occur in school-age children with a notable correlation between proximity to the violence and type and number of PTSD symptoms. Sampling at approximately one month after the trauma provided adequate delineation among exposure groups. The symptom profile of highly exposed children lends validity to the diagnosis of acute PTSD in childhood.
The following values have no corresponding Zotero field:
ID - 47
Reviews children's psychological responses to disasters and puts relevant work in historical perspective. Common responses include specific fears, separation difficulties, sleep problems, and symptoms associated with posttraumatic stress disorder (PTSD). After severe exposure, diagnosable PTSD, anxiety, and depression may occur. Factors influencing responses include disaster characteristics (exposure severity, extent of bereavement and other losses, separation from significant others), children's age and sex, and characteristics of family and community. Symptoms typically decrease rapidly, and recovery generally is complete by 16 mo to 3 yrs except after severe life-threat or long-term family and community disruption. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A young girl has lost both of her parents, killed in an earthquake. Each afternoon she expectantly awaits their return home, somehow knowing, too, that they never will return. A young boy limps when others run on his school playground, where a few months ago a lone sniper seriously wounded him. He recalls his terror on that day and wonders why he had to be one of the injured. Loss, overwhelming panic and helplessness, and significant and long-lasting bodily injury—these experiences and feelings are part and parcel of disaster and trauma. How as psychotherapists do we address such tragedies and their effects? This chapter delineates approaches to the treatment of children who have experienced a variety of traumatic events.
This book provides a state-of-the-art guide to the rapidly growing field of traumatic stress. It reviews and integrates the many scientific findings from psychology, psychiatry and sociology into an encompassing model. This general model is applicable to the reactions to war stress, disaster, violence, accidents and bereavement. Topics such as normal and disturbed coping patterns, social support and various risk factors are also discussed. In addition to the theoretical model, a number of treatment methods for posttramuatic stress disorders are described. Theoretical and practical issues of these treatments are presented.
The efficiency of the methods is elucidated by the description of a psychotherapy outcome study on these methods. Information on prevention programs for victims of serious life events is also provided.
This integrative approach is of interest to researchers, clinicians, public health workers, physicians, personnel workers, and all other professionals who are involved in research and/or health care with regard to traumatic events. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of the study was to determine the effectiveness of the recently developed Eye Movement Desensitization (EMD) procedure on traumatic memory symptomatology. Twenty-two subjects suffering from symptoms related to traumatic memories were used in the study. All had been victims of traumatic incidents concerning the Vietnam War, childhood sexual molestation, sexual or physical assault, or emotional abuse. Memories of the traumatic incident were pivotal to the presenting complaints which included intrusive thoughts, flashbacks, sleep disturbances, low self-esteem, and relationship problems. Dependent variables were (1) anxiety level, (2) validity of a positive self-statement/assessment of the traumatic incident, and (3) presenting complaints. These measures were obtained at the initial session and at 1- and 3-month follow-up sessions. The results of the study indicated that a single session of the EMD procedure successfully desensitized the subjects' traumatic memories and dramatically altered their cognitive assessments of the situation, effects that were maintained through the 3-month follow-up check. This therapeutic benefit was accompanied by behavioral shifts which included the alleviation of the subjects' primary presenting complaints.
Abstract The Behavior Screening Questionnaire (BSQ) was used to determine whether 21/2–31/2 yr old children living near the TMI nuclear reactor were more disturbed than children living near another nuclear plant or near a fossil-fuel facility in Pennsylvania when assessed 21/2 yr later. The prevalence of behavior problems was 11%. Differences among the sites in overall rates and individual symptoms were small. Perceptions of environmental stress among the TMI sample of mothers were unrelated to BSQ scores, whereas in the comparison sites, where unemployment was rising, economic concerns were meaningfully related to the BSQ.
In this paper, we present a widely applicable technique of interviewing the traumatized child who has recently witnessed an extreme act of violence. This technique has been used with over 200 children in a variety of clinical settings including homicide, suicide, rape, aggravated assault, accidental death, kidnapping, school and community violence. The easily learned, three-stage approach allows for proper exploration, support and closure within a 90-minute initial interview. The format proceeds from a projective drawing and story telling, to discussion of the actual traumatic situation and the perceptual impact, to issues centered on the aftermath and its consequences for the child. Our interview format is conceptualized as an acute consultation service available to assist the child, the child's family, and the larger social network in functioning more effectively following the child's psychic trauma.
Approximately 300 Italian elementary school children who were victims of a devastating earthquake were surveyed in an epidemiological study. The measure used was the Rutter Behavioral Questionnaire for Completion by Teachers. In one village a treatment program was developed and implemented. A frequency count of the expressed earthquake-related fears and anxieties was taken during every treatment session. Treatment consisted of a gradual series of steps that led to a replaying of the earthquake. It was hypothesized that the number of children shown to be at risk for developing neurotic or antisocial problems would be positively correlated with the amount of destruction in a village. This was not verified. It was also hypothesized that treatment would reduce earthquake fears and the number of children at risk. This was verified. The village where treatment was carried out for 1 academic year showed a significant drop in the at-risk scores. Conclusions were that treatment alleviates symptoms but that the number of children at risk seems to be more related to the length of time needed for the community to reorganize after the disaster.
A considerable amount of research has been conducted since posttraumatic stress disorder (PTSD) was included in the American Psychiatric Association's taxonomy of mental disorders. Despite this rapidly expanding literature base, it must be acknowledged that the majority of these studies have involved traumatized adults. It is of interest to observe however that child-clinical investigators have made a number of theoretical and applied contributions involving the treatment of traumatized youth. Whereas different treatment modalities have been applied with differential degrees of efficacy with traumatized youth, this article considers exposure-based interventions that have evinced efficacy over time. Adult studies are also reviewed as the child-adolescent literature has drawn from the adult literature and as comparatively fewer investigations have been conducted with traumatized youth.
Background: Previous investigations suggest that maltreated children with a diagnosis of posttraumatic stress disorder (PTSD) evidence alterations of biological stress systems. Increased levels of catecholaminergic neurotransmitters and steroid hormones during traumatic experiences in childhood could conceivably adversely affect brain development.Methods: In this study, 44 maltreated children and adolescents with PTSD and 61 matched controls underwent comprehensive psychiatric and neuropsychological assessments and an anatomical magnetic resonance imaging (MRI) brain scan.Results: PTSD subjects had smaller intracranial and cerebral volumes than matched controls. The total midsagittal area of corpus callosum and middle and posterior regions remained smaller; while right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Brain volume robustly and positively correlated with age of onset of PTSD trauma and negatively correlated with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal or dissociation correlated positively with ventricular volume, and negatively with brain volume and total corpus callosum and regional measures. Significant gender by diagnosis effect revealed greater corpus callosum area reduction in maltreated males with PTSD and a trend for greater cerebral volume reduction than maltreated females with PTSD. The predicted decrease in hippocampal volume seen in adult PTSD was not seen in these subjects.Conclusions: These data suggest that the overwhelming stress of maltreatment experiences in childhood is associated with adverse brain development.
The author reviews assessment research on posttraumatic stress disorder (PTSD) in children and adolescents. Assessment methods covered include structured interviews, questionnaires, and psychophysiological evaluation. Although initial attempts to evaluate traumatized children were either unstructured or based on incomplete screening for PTSD symptoms, recent research reveals that certain structured interview protocols and questionnaires can distinguish traumatized children with PTSD from those without PTSD. These studies have shown that diverse stressors can produce the syndrome, and that scholastic impairment can result. Suggestions for further research are made.
The verbal and behavioral remembrances of 20 children who suffered psychic trauma before age 5 were compared with documentations of the same events. Ages 28 to 36 months, at the time of trauma, serves as an approximate cut-off point separating those children who can fully verbalize their past experiences from those who can do so in part or not at all. Girls appear better able than boys to verbalize parts of traumas from before ages 28 to 36 months. Short, single traumas are more likely to be remembered in words. At any age. however, behavioral memories of trauma remain quite accurate and true to the events that stimulated them.
This longitudinal study examined the prevalence of posttraumatic phenomena and how they relate to symptomatic and behavioral disorders in a population of schoolchildren exposed to an Australian bushfire disaster. The prevalence of these phenomena did not change over an 18-month period, suggesting that they were markers of significant developmental trauma. The mothers' responses to the disaster were better predictors of the presence of posttraumatic phenomena in children than the children's direct exposure to the disaster. Both the experience of intrusive memories by the mothers and a changed pattern of parenting seemed to account for this relationship.
A 4-year follow-up study of 25 school-bus kidnapping victims and one child who narrowly missed the experience revealed that every child exhibited posttraumatic effects. Symptom severity was related to the child's prior vulnerabilities, family pathology, and community bonding. Important new findings included pessimism about the future, belief in omens and prediction, memories of incorrect perceptions, thought suppression, shame, fear of reexperiencing traumatic anxiety, trauma-specific and mundane fears, posttraumatic play, behavioral reenactment, repetitions of psychophysiological disturbances that began with the kidnapping, repeated nightmares, and dreams of personal death. Brief treatment 5-13 months after the kidnapping did not prevent symptoms and signs 4 years later.
To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence.
Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents.
On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each.
After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents.
Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records.
More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas.
The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.
The objective of this study was to examine urinary catecholamine excretion in a self-selected sample of sexually abused and demographically matched control girls recruited from a prospective, longitudinal study.
Twenty-four--hour urinary catecholamine and metabolite concentrations of epinephrine, norepinephrine, dopamine, 3-methoxy-4-hydroxyphenylglycol, metanephrine, normetanephrine, vanillylmandelic acid, 3,4-dihydroxyphenylacetic acid, and homovanillic acid were measured in 12 sexually abused and 9 control girls, aged 8 to 15 years. Psychiatric profiles also were obtained.
The abused subjects excreted significantly greater amounts of metanephrine, vanillylmandelic acid, homovanillic acid, and total catecholamine synthesis as measured by the sum of epinephrine, norepinephrine, dopamine, and their metabolites compared to values from control subjects. When the means of all significant biochemical measures were adjusted by the covariate effect of height, only homovanillic acid and group interaction remained significant. There were positive trends toward significantly higher urinary excretion of metanephrine, vanillylmandelic acid, and total catecholamine synthesis. Sexually abused girls also had a greater incidence of suicidal ideation, suicide attempts, and dysthymia than control girls.
These findings support the idea that sexually abused girls show evidence of higher catecholamine functional activity compared with controls. The clinical significance of these findings in their similarity to the psychobiology of both post-traumatic stress disorder and major depressive disorder. Results from this pilot study may be of value in understanding the mechanisms of depressive and anxiety disorders and in the clinical treatment of maltreated children.
To assess the long-term effects of a traumatic bus-train collision and to examine the effect of levels of exposure and immediate reactions on long-term adjustment.
Seven years after the accident, 389 subjects, all doing compulsory army service, filled out self-report questionnaires assessing symptoms of posttraumatic stress disorder (PTSD), psychiatric symptomatology, and military functioning. In addition, subjects were questioned about their immediate reactions to the traumatic event.
The most highly exposed subjects reported the highest levels of somatization, depression, phobic anxiety, and psychoticism and more PTSD symptoms. Acute stress symptoms and manifestations of fear immediately after the accident were strongly related to long-term maladjustment
The results suggest that the investigation and assessment of long-term adjustment after traumatic events should take into account both contextual factors, such as the level of exposure to the event, and personal factors, such as the victims' immediate reactions.
Longitudinal studies of children exposed to traumatic events show contrasting findings regarding their symptomatic change over time. The present study reports on a 30-month follow-up of preschool children and their mothers who had been exposed to Scud missile attacks.
Families displaced during the Gulf War after their homes had been damaged by the missile attack and a control group whose homes remained intact were interviewed about posttraumatic and general symptomatology, the mothers' capacity to control images, and the children's adaptive behavior.
Stress symptoms decreased in the displaced children but not in their mothers. Both reported more posttraumatic symptoms than did the control group. No differences in the children's adaptive behavior were observed. Posttraumatic symptoms of the displaced children correlated with the mothers' avoidant symptoms. The mothers' avoidant symptoms at follow-up were statistically explained by the mothers' symptoms during the war and their capacity for image control, the duration of displacement, and the cohesion of the family.
The maternal stress-buffering capacity constitutes a central element in children's protective matrix and is crucial in minimizing long-term internal suffering of traumatized preschool children.
This investigation evaluated the extent and nature of posttraumatic symptomatology (PTS) in children and adolescents 9 months after an industrial fire at the imperial Foods chicken-processing plant in Hamlet, North Carolina, caused extensive loss of life.
Using a PTS self-report measure plus self- and teacher reports of comorbid symptoms the authors surveyed 1,019 fourth- to ninth-grade students in the community where the fire occurred.
Three factors comprising PTS were identified: reexperiencing, avoidance and hyperarousal. Reexperiencing and avoidance were positively correlated; hyperarousal proved weakly correlated with reexperiencing, perhaps because exposure was largely indirect. Using a T score cutoff of 65 on the reexperiencing factor as indicative of PTS 9.7% of subjects met criteria for PTS; 11.9% met criteria for posttraumatic stress disorder (PTSD) using DSM-III-R PTSD criteria. Degree of exposure was the most powerful predictor of PTS. Race (African-American) and gender (female) posed significant risk factors for PTS. Self-reported internalizing symptoms and teacher-reported externalizing symptoms were positively predicted by intercurrent PTS, and independently of PTS, by degree of exposure. Comorbid symptoms showed interesting interactions with exposure, race, and gender. Lack of self-attributed personal efficacy predicted PTS but did not moderate the effects of race or gender on PTS risk.
This study, which used a population-based sampling strategy, strengthens and extends findings from earlier literature on pediatric PTSD in showing that (1) PTS and comorbid internalizing and externalizing symptoms rise in direct proportion to degree of exposure; (2) gender and race show variable effects on risk for PTS and comorbid symptoms; and (3) comorbid symptoms are positively correlated with PTS and may represent primary outcomes of traumatic exposure in their own right.
Epidemiologic surveys in the general population documented a higher rate of posttraumatic stress disorder (PTSD) in women than in men. To date, the finding has received little scientific attention. This study examines the extent to which sex differences in PTSD might be explained by previously identified risk factors and whether the sex difference in PTSD varied by age at exposure to traumatic events.
The NIMH-DIS (NIMH Diagnostic Interview Schedule, Version III Revised) was used to measure DSM-IIIR disorders in a random sample of 1007 young adults. Cox proportional hazards models were used to estimate changes in the hazards ratio for PTSD associated with sex when potential risk factors were included.
Lifetime prevalence of exposure to traumatic events and number of traumatic events did not vary by sex. The prevalence of PTSD was higher for women than for men exposed to traumatic events (hazards ratio, 2.3; 95% confidence interval, 1.5-3.6). Preexisting anxiety disorders or major depressive disorders played a part in the observed sex difference in PTSD. Family history of anxiety disorder and early separation from parents, although significant risk factors for PTSD in subjects of both sexes, were unrelated to the sex difference in PTSD. The sex difference in PTSD was markedly greater if exposure occurred in childhood than later on.
Posttraumatic stress disorder is more likely to develop in females than in males after exposure to a traumatic event. Susceptibility to PTSD in females might be greater in childhood than after age 15 years. Explanations of the sex difference might involve characteristics of individuals and of the traumatic experiences.
To describe the diagnostic comorbidity and clinical correlates of posttraumatic stress disorder (PTSD) in adolescent psychiatric inpatients.
Seventy-four adolescent inpatients were given a structured diagnostic interview, the revised version of the Diagnostic Interview for Children and Adolescents, and a battery of standard self-report measures to assess general trauma exposure, posttraumatic stress symptoms, suicidal behavior, dissociation, and depression.
Ninety-three percent of subjects reported exposure to at least one traumatic event such as being a witness/victim of community violence, witnessing family violence, or being the victim of physical/sexual abuse. Thirty-two percent of subjects met diagnostic criteria for current PTSD, with sexual abuse cited as the most common traumatic stressor in 69% of PTSD cases. Girls were significantly more likely to develop PTSD than boys, although the total number of types of trauma did not differ by gender. Compared with psychiatric controls, male youngsters with PTSD were significantly more likely to have comorbid diagnoses of eating disorders, other anxiety disorders, and somatization disorder. Furthermore, male and female youngsters with PTSD were significantly more likely to have attempted suicide and report greater depressive and dissociative symptoms.
In clinical populations of hospitalized adolescents exposed to multiple forms of trauma, PTSD is a common, but highly comorbid disorder. Specific multimodal assessments and treatments targeted to both PTSD and its comorbidity profile are warranted.
This investigation examined the relationship between trauma, psychiatric symptoms and urinary free cortisol (UFC) and catecholamine (epinephrine [EPI], norepinephrine [NE], dopamine [DA]) excretion in prepubertal children with posttraumatic stress disorder (PTSD) secondary to past child maltreatment experiences (n = 18), compared to non-traumatized children with overanxious disorder (OAD) (n = 10) and healthy controls (n = 24).
Subjects underwent comprehensive psychiatric and clinical assessments and 24 hour urine collection for measurements of UFC and urinary catecholamine excretion. Biological and clinical measures were compared using analyses of variance.
Maltreated subjects with PTSD excreted significantly greater concentrations of urinary DA and NE over 24 hours than OAD and control subjects and greater concentrations of 24 hour UFC than control subjects. Post hoc analysis revealed that maltreated subjects with PTSD excreted significantly greater concentrations of urinary EPI than OAD subjects. Childhood PTSD was associated with greater co-morbid psychopathology including depressive and dissociative symptoms, lower global assessment of functioning, and increased incidents of lifetime suicidal ideation and attempts. Urinary catecholamine and UFC concentrations showed positive correlations with duration of the PTSD trauma and severity of PTSD symptoms.
These data suggest that maltreatment experiences are associated with alterations of biological stress systems in maltreated children with PTSD. An improved psychobiological understanding of trauma in childhood may eventually lead to better treatments of childhood PTSD.
Twenty-seven of 40 Khmer adolescent youths who had survived the horrors of the Pol Pot regime (1975-1979) as children and 4 of 6 who had escaped this war were reinterviewed for the fourth time, during the summer of 1996, to determine their diagnostic status for posttraumatic stress disorder (PTSD) and/or depression and their functional status with regard to occupational and/or educational pursuits. They had been interviewed initially in 1983-1984 and again 3 (1987) and 6 (1990-1991) years later.
PTSD was determined using the Diagnostic Interview for Children and Adolescents, and depression was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children.
The point prevalence rates of PTSD were comparable with those found 6 years earlier, and rates of depression were much lower but had increased somewhat over the ensuing 6 years. The onset of PTSD was quite variable, with 18% of subjects (7/40) developing PTSD at least 5 years after cessation of the Pol Pot hostilities. Subjects with PTSD were more likely to recall specifically traumatic war memories, whereas those without PTSD were more likely to recall memories of loss and/or displacement. Most subjects were functioning well, regardless of diagnostic status.
Although its onset is quite variable, PTSD persists in war-traumatized Cambodian refugee youths. PTSD and depression appear to follow different pathways over time. PTSD need not be associated with major functional impairment.
The Challenger space shuttle explosion in January 1986 offered an opportunity to determine what, if any, symptoms of posttraumatic stress disorder (PTSD) and bereavement normal latency-age children and adolescents would develop after a distant, horrifying event.
With a structured interview, the authors assessed the symptoms of 153 randomly selected children from Concord, N.H., and Porterville, Calif. Responses were statistically compared between East Coast children, who saw the event on television and who generally cared more about the teacher aboard Challenger, and West Coast children, who heard about it first; between latency-age children and adolescents; and between children seen 5-7 weeks later and those same children seen 14 months later.
More than 60% of the subjects feared at least one stimulus related to Challenger within the first 5-7 weeks of the explosion. The East Coast and latency-age groups appeared significantly more symptomatic than did the West Coast and adolescent groups. Over the 14-month study period, most symptoms dramatically faded. However, adolescents' diminished expectations for the future in general increased, and latency-age children's changed approach to space careers held relatively steady. Three East Coast latency-age children met the DSM-III-R symptom requirements for PTSD in 1986; no children met these in 1987.
Children's symptomatic patterns after Challenger relate to the patterns for PTSD listed in diagnostic manuals and to three symptoms not in the DSM-IV list. To the authors, distant traumas appear to be one of a newly defined spectrum of trauma-related conditions that include relatively evanescent symptoms and a few longer-lasting ones. These symptoms may affect large numbers of normal children.
Effective psychological intervention is needed to help children recover from disaster-related posttraumatic stress disorder (PTSD). This controlled study evaluated the effectiveness of a brief intervention for disaster-related PTSD. At one-year follow-up of a prior intervention for disaster-related symptoms, some previously treated children were still suffering significant trauma symptoms. Using a randomized lagged-groups design, we provided three sessions of Eye Movement Desensitization and Reprocessing (EMDR) treatment to 32 of these children who met clinical criteria for PTSD. The Children's Reaction Inventory (CRI) was the primary measure of the treatment's effect on PTSD symptoms. Associated symptoms were measured using the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Treatment resulted in substantial reductions in both groups' CRI scores and in significant, though more modest, reductions in RCMAS and CDI scores. Gains were maintained at six-month follow-up. Health visits to the school nurse were significantly reduced following treatment. Psychosocial intervention appears useful for children suffering disaster-related PTSD. Conducting controlled studies of children's treatment in the postdisaster environment appears feasible.
This paper describes the clinical and research evidence for the importance of the relational context of posttraumatic stress disorder in young children. We review 17 studies that simultaneously assessed parental and child functioning following trauma. In many studies, despite limitations, an association between undesirable parental/family variables and maladaptive child outcomes has been consistently found. We present a model of the parental/family variables as moderators and vicarious traumatic agents for symptoms in young children. Also, a Compound Model is proposed, with three distinctive patterns of the parent-child relationship that impact on posttraumatic symptomatology in young children. Implications for clinical practice and research directions are discussed.