Acute Stress Disorder Symptoms in Children and Their Parents After Pediatric Traffic Injury

Abstract

ABSTRACT. Objective. The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events, such as traffic crashes. One challenge in effectively identifying children and their parents with troubling psychological responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events, making identification of adverse child responses difficult. Within the first month after a traumatic event, individuals may display reexperiencing, avoidance, and hyperarousal symptoms as well as dissociation (eg, feelings of unreality or emotional numbing). The presence of these responses, collectively known as acute stress disorder (ASD), alerts providers to those who may be at risk for ongoing difficulties. For beginning to develop an evidence base to guide pediatric care providers in addressing acute traumatic responses, the aim of the current investigation was to describe systematically the range and type of symptoms of ASD in children and their parents after pediatric traffic injury.Methods. A prospective cohort study was conducted of traffic-injured children, who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes, and their parents. All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study. After consent/ assent was obtained, children and their custodial parents (or guardians) were interviewed within 1 month after injury via a structured assessment to determine the circumstances of the crash and the presence of ASD symptoms. Relevant demographic and clinical information (eg, age, race, gender, date of injury) was abstracted from the medical records of subjects. A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian. All children completed the Child Acute Stress Questionnaire, and all parents completed the Stanford Acute Stress Reaction Questionnaire. Responses were scored for the presence of dissociation, reexperiencing, avoidance, and/or hyperarousal symptoms as well as broad distress (symptoms present in every category).Results. Symptoms of ASD were commonly observed in the children and parents. Eighty-eight percent of children and 83% of parents reported having at least 1 clinically significant symptom; this affected 90% of the families. Broad distress was observed for a large minority: 28% of children and 23% of parents. No statistically significant association was found between child broad distress and either child age (r ‫؍‬ ؊0.12) or child injury severity score (r ‫؍‬ ؊0.05). 2 analyses revealed no significant association between broad distress and child gender, child race, or mechanism of injury. No statistically significant association was found between parent broad distress and child age (r ‫؍‬ ؊0.06) or child injury severity score (r ‫؍‬ 0.09). 2 analyses revealed no significant ...

Complex Trauma in Children and Adolescents

“…In these instances, personal distress can limit parents' ability to provide adequate care to their children (Winston et al, 2002). However, Finkelhor & Kendall-Tackett (1997) note that it is not parental distress per se that is necessarily detrimental to the child, but more specifically, when the parent's distress overrides or diverts attention away from the needs of the child that children are negatively affected.…”

Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System

“…79 Unrecognized and untreated, acute stress symptoms can cause lifelong behavioral and mental health problems attributable to changes in neurodevelopment and function. [80][81][82][83][84][85][86] Children with a history of a traumatic experience, be it from unintentional injury, violence, or sexual or physical abuse, can be expected to have more acute stress symptoms in the immediate aftermath of a specific event. 87 Shemesh et al 88 identified PTSD in 29% of the patients in a small convenience sample of pediatric patients who presented to a pediatric ED.…”

Gene-environment interaction in posttraumatic stress disorder

“…Attempts to resolve this apparent discrepancy have highlighted the importance of time lapsed between traumatic exposure and assessment [106]. Studies examining acute distress levels soon after the trauma typically find no association between parent and child PTSS [16,137], while longitudinal studies show increases in parent-child PTSS associations over time [79,103,124]. Initial symptoms in the child have been found to impact subsequent symptoms in the parent [79] and initial parent symptoms have been found to predict subsequent child symptoms [31,93,100].…”