The BFSC shows promise as a measure of benefit finding in children. The measure could be readily adapted for other populations of children experiencing trauma.

Concordance between parent and child reports of child PTSS suggests that data may be obtained with reasonable confidence from either if only one informant is available. Higher levels of PTSS in patients who are recently diagnosed (and their parents) in comparison to long-term survivors, suggest that the symptoms reported reflect primarily a concurrent response to ongoing acute stressors, rather than a post-traumatic re-experiencing of past traumas. This, in combination with the low levels of patient PTSS raise questions regarding the utility of PTSD as a model for understanding patient and parent adjustment to childhood cancer.

A B S T R A C T PurposeTo examine posttraumatic stress disorder and posttraumatic stress symptoms (PTSD/PTSS) in children with cancer using methods that minimize focusing effects and allow for direct comparison to peers without a history of cancer. Patients and MethodsChildren with cancer (n ϭ 255) stratified by time since diagnosis, and demographically matched peers (n ϭ 101) were assessed for PTSD using structured diagnostic interviews by both child and parent reports, and survey measures of PTSS and psychological benefit/growth by child report. ResultsCancer was identified as a traumatic event by 52.6% of children with cancer, declining to 23.8% in those Ն 5 years from diagnosis. By diagnostic interview, 0.4% of children with cancer met criteria for current PTSD, and 2.8% met lifetime criteria by self-report. By parent report, 1.6% of children with cancer met current criteria and 5.9% met lifetime criteria for PTSD. These rates did not differ from controls (all Ps Ͼ.1). PTSS levels were descriptively lower in children with cancer but did not differ from controls when all were referring to their most traumatic event (P ϭ .067). However, when referring specifically to cancer-related events, PTSS in the cancer group were significantly lower than in controls (P ϭ .002). In contrast, perceived growth was significantly higher in the cancer group when referring to cancer (P Ͻ .001). ConclusionThese findings suggest no evidence of increased PTSD or PTSS in youths with cancer. Although childhood cancer remains a significant and challenging event, these findings highlight the capacity of children to adjust, and even thrive, in the face of such challenge.

As a group, parents of children with cancer did not demonstrate any evidence of increased PTSS relative to parents of healthy children. Time since diagnosis, child treatment status, and relapse history are significant determinants of parent PTSS. Only parents of children who experienced a relapse appear to be at increased risk of PTSD. The current results appear discrepant from the existing literature, and possible explanations for these discrepancies are examined.

Parents of children with cancer demonstrate resilience to this challenge.

Objective To examine symptoms of posttraumatic stress (PTSS) in children as a function of health status (cancer vs. healthy) and adaptive style. Methods Children with cancer (N = 199) and healthy acquaintance control children (N = 108) completed a standardized measure of posttraumatic stress symptoms. Measures of trait anxiety and defensiveness were obtained to characterize the adaptive style of respondents. Results Within the cancer group, levels of PTSS did not differ as a function of diagnosis, time since diagnosis, or whether children were on or off treatment. The only cancer-related factor associated with elevated PTSS was a history or relapse or recurrence. Children with cancer reported significantly fewer symptoms of reexperiencing/intrusion than did healthy children, but also reported greater symptoms of numbing/avoidance. However, there were no differences in total PTSS scores between children with cancer and controls. In contrast, a significant effect of adaptive style on PTSS was observed, with children identified as repressors or low anxious obtaining lower scores on total PTSS and all PTSS subscales than high anxious children, regardless of health status. Estimates of the number of children meeting criteria for PTSD did not differ between children with cancer and healthy children, and were low in both groups. Conclusions Children with cancer report levels of PTSS that are no higher than their healthy peers. Personality factors such as adaptive style are a much more salient determinant of PTSS than is health history. These findings raise further questions regarding the value of a traumatic stress model for understanding the experiences of children with cancer.

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PTS and PTG appear to be relatively independent constructs, and their relation is dependent on contextual factors. The majority of youth appear to be resilient, and even those who experience significant distress were able to find benefit.