Child and adolescent internalizing and externalizing problems 12 months postburn: the potential role of preburn functioning, parental posttraumatic stress, and informant bias

Abstract

Adjustment after pediatric burn injury may be a challenge for children as well as their parents. This prospective study examined associations of internalizing and externalizing problems in children and adolescents 12 months postburn with preburn functioning, and parental acute and chronic posttraumatic stress symptoms (PTSS) from different perspectives. Child, mother, and father reports of 90 children (9–18 years), collected within the first month and 12 months postburn, were analyzed. Results indicated that overall, child and parental appraisals of pre- and postburn behavioral problems were not significantly different from reference data. Rates of (sub)clinical postburn behavioral problems ranged from 6 to 17 %, depending on the informant. Pre- and postburn behavioral problems were significantly related, but only from the parents’ perspective. Path models showed an association between parental PTSS 12 months postburn and parental reports of child internalizing problems, as well as a significant indirect relationship from parental acute stress symptoms via PTSS 12 months postburn. Notably, no associations between parental PTSS and child reports of postburn behavioral problems were found. In conclusion, parental observations of child externalizing problems appear to be influenced by their perspectives on the child’s preburn functioning, while parental observations of internalizing problems are also related to long-term parental PTSS. However, these factors seem of no great value in predicting behavioral problems from the child’s perspective, suggesting substantial informant deviations. To optimize adjustment, clinical burn practice is recommended to adopt a family perspective including parent perception of preburn functioning and parental PTSS in assessment and intervention.

Parents’ posttraumatic stress after burns in their school-aged child: A prospective study.

“…This study is part of a large prospective study on child (Age 8 to 18 years) and parental adjustment following a pediatric burn event. Earlier articles on this cohort report on behavioral problems (Egberts et al, 2016) and health-related quality of life (Pan et al, 2015) of the child. A study with the same design was conducted earlier in a group of young children (Age 0 to 4 years) and their parents (e.g., Bakker et al, 2013).…”

Posttraumatic stress and medication adherence in pediatric transplant recipients

“…The IES 46 is a 15-item self-report of trauma-related distress used to screen for PTSD. 47 It has been widely used to assess caregiver distress related to pediatric medical illness [48][49][50] and is composed of a seven-item Intrusion subscale and an eight-item Avoidance subscale with satisfactory validity and reliability. 47,51 For this study, caregivers were instructed to consider questions in the context of their child's transplant.…”

Bayesian Versus Frequentist Estimation for Structural Equation Models in Small Sample Contexts: A Systematic Review

“…All of these issues might be circumvented by using Bayesian estimation (see e.g., Muthén & Asparouhov, 2012;Wagenmakers et al, 2008). This is a welcoming feature of Bayesian estimation, especially in the social sciences where it can be challenging to collect enough data due to naturally small populations (e.g., Egberts et al, 2016), hard to access target groups (e.g., Coleman et al, 2002), or financial constraints may exist (e.g., van Lier et al, 2017). 2 Recommendations to use Bayesian over frequentist estimation in small sample contexts are common in the literature.…”