Trauma in Early Childhood: A Neglected Population

Abstract

Infants, toddlers and preschoolers are a high risk group for exposure to trauma. Young children are also vulnerable to experiencing adverse outcomes as they are undergoing a rapid developmental period, have limited coping skills and are strongly dependent on their primary caregiver to protect them physically and emotionally. However, although millions of young children experience trauma each year, this population has been largely neglected. Fortunately, over the last 2 decades there has been a growing appreciation of the magnitude of the problem with a small but expanding number of dedicated researchers and clinicians working with this population. This review examines the empirical literature on trauma in young children with regards to the following factors: (1) how trauma reactions typically manifest in young children; (2) history and diagnostic validity of posttraumatic stress disorder (PTSD) in preschoolers; (3) prevalence, comorbidity and course of trauma reactions; (4) developmental considerations; (5) risk and protective factors; and (6) treatment. The review highlights that there are unique developmental differences in the rate and manifestation of trauma symptomatology, the current Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV-TR) PTSD criteria is not developmentally sensitive and the impact of trauma must be considered within the context of the parent-child relationship. Recommendations for future research with this population are also discussed.

The relationship between behavioural problems in preschool children and parental distress after a paediatric burn event

“…In contrast to internalising symptoms, the variables under study explained only a minor part of externalising symptoms and we could not find specific factors that contributed to the decrease in externalising symptoms over time. Other factors beyond the scope of this study, such as family functioning [11], parenting behaviour [40], and, although speculative, parent's posttraumatic symptoms of hyperarousal after the burn event, might have contributed stronger to the child's externalising symptoms.…”

“…Shared factors related to the event and injury and a shared biological vulnerability might contribute to this phenomenon [39]. Moreover, it has been hypothesised that parents who are traumatised themselves may fall short in providing an emotionally safe environment and adequate parenting practices for the child resulting in poorer child recovery of trauma [40]. Scheeringa and Zeanah [40] hypothesised that behaviour of family members may exacerbate the responses of other family members.…”

“…Moreover, it has been hypothesised that parents who are traumatised themselves may fall short in providing an emotionally safe environment and adequate parenting practices for the child resulting in poorer child recovery of trauma [40]. Scheeringa and Zeanah [40] hypothesised that behaviour of family members may exacerbate the responses of other family members. Apart from resemblance and potential dynamics within the family in terms of posttrauma reactions, it may be conceivable that parents who are more distressed themselves observe more behavioural and emotional problems in their child.…”

“…Where girls tended to show more overall internalising problems than boys, they also showed a greater decrease in symptoms. Although one study reported that young traumatised girls exhibited somewhat more PTSD symptoms than boys [45], overall there seems no consistent evidence for gender differences regarding trauma reactions in preschool traumatised children [40]. The CBCL manual reports no general gender effects [30].…”

Evaluation of an Early Risk Screener for PTSD in Preschool Children After Accidental Injury

“…Due to very limited evidence in preschool-aged children, 15 however, research in schoolchildren had to be additionally consulted to select important risk factors. The following risk factors were included: (1) preexisting child behavioral problems, 15 (2) parental preexisting chronic mental 15 or physical 16 illness, (3) pretraumatic life events in the family, 17 (4) parental feelings of guilt, 18 and (5) parental posttraumatic stress.…”