A core role for cognitive processes in the acute onset and maintenance of post‐traumatic stress in children and adolescents

Abstract

Background Post‐traumatic stress disorder ( PTSD ) is a common reaction to trauma in children and adolescents. While a significant minority of trauma‐exposed youth go on to have persistent PTSD , many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post‐traumatic stress symptoms ( PTSS ). Methods A prospective longitudinal study of youth aged 8–17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2–4 weeks ( N = 226) and 2 months ( N = 208) post‐trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS , depression severity and peritraumatic and post‐traumatic cognitive processes were assessed using self‐report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. Results PTSS decreased between the two assessments. Cognitive processes at the 2‐ to 4‐week assessment accounted for the most variance in PTSS at both the initial and follow‐up assessment. The onset of post‐traumatic stress was associated particularly with peritraumatic subjective threat, data‐driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post‐traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS . Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. Conclusions Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma‐related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS .

A longitudinal study of cognitive predictors of (complex) post‐traumatic stress in young people in out‐of‐home care

“…First, the individual forms negative appraisals about their trauma, which may generalise (e.g. I'll never get over what happened; I can't trust anyone ; Meiser‐Stedman et al, 2019). Second, how the memory was encoded and the resultant memory qualities are said to further maintain an ongoing sense of threat.…”

Commentary: I thought I was going to die and the world is not safe—how to help children recover after trauma? Reflections on Meiser‐Stedman et al. (2019)

“…One related finding from Meiser‐Stedman et al. () study is that the children's efforts to understand the trauma by talking to friends or family was associated with higher levels of PTSS. Although the authors are reluctant to draw clinical implications from this finding, it points to the need to understand how we can help children in their meaning making process after trauma.…”

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Commentary: I thought I was going to die and the world is not safe-how to help children recover after trauma? Reflections on Meiser-Stedman et al (2019)

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“…Meiser‐Stedman et al. () explore this and asks the timely question: Why do only some young people have significant traumatic stress symptoms in the days and weeks immediately post‐trauma while others do not, and why do some youth then recover without treatment while others go on to suffer from persistent PTSD? What is unique in this study is not only the comprehensiveness of variables they examine but also that they try to disentangle what contributes to the development of post‐traumatic stress from what may contribute to its maintenance .…”

Editorial: Improving children's mental health. What does that mean, actually?

“…The article by Eyre et al (2019) shows that irritability is a key contributor to this association. Meiser-Stedman et al (2019) investigated how peri-and posttrauma cognitive processes such as perceived threat, adaptive processing, and dissociation predicted the onset and maintenance of post-traumatic stress. The effect of these cognitive processes was stronger than the effect of objective trauma severity indices, demographic factors, and nonspecific psychosocial factors.…”