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Eilers R, Ertl V, Kasparik B, Kost A, Rosner R. [Posttraumatic stress disorder in children and adolescents: results of a cross-sectional study on the effects of the newly formulated PTSD and CPTSD diagnoses in the ICD-11]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:409-418. [PMID: 38498186 PMCID: PMC10995073 DOI: 10.1007/s00103-024-03860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND ICD-11 presents narrowed criteria for posttraumatic stress disorder (PTSD) and introduces complex PTSD (CPTSD) with additional difficulties in self-organization (DSO). These changes can have significant effects on the frequency of the diagnosis. The aim of this study was to investigate which ICD-11 symptom clusters cause children and adolescents to miss the diagnosis and whether caregivers are more likely to attribute changes in DSO to developmental level or to the traumatic event, and how these attributions are in turn related to symptom severity. METHODS N = 88 German-speaking children and adolescents (age: 7-17 years) after traumatic events and N = 79 caregivers participated between September 2019 and November 2020 in a survey on PTSD symptom severity (CATS-2) and attribution of DSO symptoms (caregiver questionnaire). RESULTS The ICD-11 criteria (CATS‑2 and a developmentally adapted version) showed lower frequency rates for PTSD as compared to DSM‑5 and ICD-10. The ICD-11 clusters re-experiencing and hyperarousal were met the least often. Changes in DSO symptoms were predominantly rated as event-related. This attribution was associated with higher PTSD and DSO symptom severity in caregiver reports. The age-related attribution was associated with higher DSO-symptom severity, but not PTSD symptom severity in caregiver reports. DISCUSSION In the context of the diagnostic process and the revision of diagnostic instruments for ICD-11 (C)PTSD, development-specific symptoms should be taken into account. The trauma-related differentiation of DSO symptom changes as compared to development-related fluctuations is challenging and therefore requires several sources of information.
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Affiliation(s)
- Rebekka Eilers
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Verena Ertl
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland.
- Katholische Universität Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Deutschland.
| | - Barbara Kasparik
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Anne Kost
- Altonaer Kinderkrankenhaus, Kinder- und Jugendsomatik, Hamburg, Deutschland
| | - Rita Rosner
- Institut für Psychologie, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
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2
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Bailey M, Meiser‐Stedman R, Hiller R, Haag K, Lobo S, Halligan SL. Child posttraumatic stress symptoms in an acute injury sample: Patterns of associations among child report, parent report, and child heart rate parameters. J Trauma Stress 2023; 36:333-345. [PMID: 36787341 PMCID: PMC10946953 DOI: 10.1002/jts.22913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 02/15/2023]
Abstract
Parent-child agreement on measures of child posttraumatic stress disorder (PTSD) is moderate at best, and understanding of this discrepancy is limited. To address this, we conducted an item-level investigation of parent-child symptom agreement to examine the potential influence of parental posttraumatic stress symptoms (PTSS) on parents' reports of their child's PTSS. We also examined heart rate (HR) indices as possible independent indicators of child PTSD, examining patterns of association with parent versus child report. Parent-child dyads (N = 132, child age: 6-13 years, 91.7% White) were recruited after the child's hospital admission following an acute, single-incident traumatic event. At 1-month posttrauma, questionnaires assessing children's PTSS (self- and parental reports) and parental PTSS were administered. For a subset of participants (n = 70), children's HR recordings were obtained during a trauma narrative task and analyzed. Parent and child reports of child PTSS were weakly positively correlated, r = .25. Parental PTSS were found to be stronger positive predictors of parental reports of child PTSS than the children's own symptom reports, β = 0.60 vs. β = 0.14, and were associated with higher parent-reported child PTSS relative to child reports. Finally, children's self-reported PTSS were associated with HR indices, whereas parent reports were not, βs = -.33-.30 vs. βs = -.15-.01. Taken together, children's self-reported PTSS could be a more accurate reflection of their posttrauma physiological distress than parent reports. The potential influence of parental PTSS on their perceptions of their child's symptoms warrants further consideration.
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Affiliation(s)
- Megan Bailey
- Department of PsychologyUniversity of BathBathUnited Kingdom
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical SchoolUniversity of East AngliaUnited Kingdom
| | - Rachel Hiller
- Division of Psychology & Language SciencesUniversity College LondonLondonUnited Kingdom
- Anna Freud National Centre for Children & FamiliesLondonUnited Kingdom
| | - Katharina Haag
- Department of PsychologyUniversity of BathBathUnited Kingdom
| | - Sarah Lobo
- Department of PsychologyUniversity of BathBathUnited Kingdom
| | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUnited Kingdom
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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Olivier E, de Roos C, Bexkens A. Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation. Child Psychiatry Hum Dev 2022; 53:1391-1404. [PMID: 34487289 DOI: 10.1007/s10578-021-01237-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.
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Affiliation(s)
- Eline Olivier
- GGZ Delfland, Delft, The Netherlands.
- Psymens, Korenmolenlaan 1D, 3447 GG, Woerden, The Netherlands.
| | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry Levvel, Amsterdam University Medical Centre (Location AMC), Amsterdam, The Netherlands
| | - Anika Bexkens
- GGZ Delfland, Delft, The Netherlands
- Department of Psychology, Leiden University, Leiden, The Netherlands
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Hahnefeld A, Münch K, Aberl S, Henningsen P, Mall V. Versorgung traumatisierter Vorschulkinder. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Kakaje A, Al Zohbi R, Alyousbashi A, Abdelwahed RNK, Hosam Aldeen O, Alhalabi MM, Ghareeb A, Latifeh Y. Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study. Psychol Med 2022; 52:1923-1933. [PMID: 33267935 DOI: 10.1017/s0033291720003761] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria. METHODS This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters. RESULTS This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lowerPTSD scores but was associated with a worse physical component of HRQL. CONCLUSION This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.
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Affiliation(s)
- Ameer Kakaje
- Faculty of Medicine, Damascus University, Damascus, Syria
| | | | | | | | | | | | - Ayham Ghareeb
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Youssef Latifeh
- Psychiatry Department, Al-Mowasat University Hospital, Damascus, Syria
- Department of Internal Medicine, Syrian Private University, Damascus, Syria
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Mertin P, Wijendra S, Loetscher T. Posttraumatic Stress Symptoms and Correlates in Women and Children From Backgrounds of Domestic Violence. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:391-400. [PMID: 35600536 PMCID: PMC9120313 DOI: 10.1007/s40653-021-00396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 06/03/2023]
Abstract
Ongoing research has continued to inform our understanding of the effects of living with domestic violence on both women and children. The majority of this research, however, has tended to focus on each population separately, with only a relatively few studies to date assessing the relationship between maternal and child emotional functioning, particularly for symptoms of posttraumatic stress (PTSS). This study was designed to investigate trauma symptomatology in mother-child dyads from backgrounds of domestic violence, where the children are able to self-report on their own symptoms. In addition, the study examined anxiety and depression as important correlates of PTSD in children. Participants were recruited by staff at two metropolitan Domestic Violence Services and interviewed by the first author using standardised PTSD scales and trauma inventories. Results found no significant relationship between trauma symptoms in the mother and those in her child. With respect to children who met the criteria for a diagnosis of posttraumatic stress disorder (PTSD), they were more likely to have higher levels of anxiety and depression when compared to children who did not meet PTSD criteria. Results suggest that the emotional responses of older children may tend to reflect their own experiences rather than being a reflection of maternal distress as seems more likely with younger children. Implications of these findings include the importance of independent assessments of older children, and that older children may profit from early therapeutic interventions in their own right.
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Affiliation(s)
- Peter Mertin
- Private Practice, Adelaide, South Australia Australia
| | - Shankari Wijendra
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Tobias Loetscher
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
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7
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Woolgar F, Garfield H, Dalgleish T, Meiser-Stedman R. Systematic Review and Meta-analysis: Prevalence of Posttraumatic Stress Disorder in Trauma-Exposed Preschool-Aged Children. J Am Acad Child Adolesc Psychiatry 2022; 61:366-377. [PMID: 34242737 PMCID: PMC8885427 DOI: 10.1016/j.jaac.2021.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/13/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Trauma exposure is common in preschool-aged children. Understanding the psychological impact of such exposure and the prevalence of posttraumatic stress disorder (PTSD) in this population is important for provision of appropriate and timely intervention. This pre-registered (PROSPERO: CRD41019133984) systematic review and meta-analysis examined the prevalence of PTSD in trauma-exposed preschool-aged children. METHOD Literature searches were conducted of PubMed (Medline), PsycINFO and PILOTS, alongside reference lists of relevant reviews. Studies were selected if they comprised trauma-exposed samples with a mean age of less than 6.5 years, and PTSD was assessed using standardized interviews at least 1-month post trauma. Information on sample characteristics, trauma exposure, PTSD measurement, and diagnostic criteria were extracted. For studies that applied more than one PTSD diagnostic algorithm, the most age-appropriate criteria were used to estimate pooled prevalence estimate across studies. A random-effects model was used for meta-analysis. RESULTS Eighteen studies were included (N = 1941). The pooled PTSD prevalence was 21.5% (95% CI = 13.8%-30.4%) when using the most developmentally appropriate diagnostic algorithm that was available. When focusing on the subset of studies that reported both standard adult criteria and age-appropriate criteria (k = 12), a pooled estimate of 4.9% (95% CI = 2.5%-8.0%) was obtained for standard adult criteria (DSM-IV), and 19.9% (95% CI = 12.1%-29.0%) was obtained for age-appropriate criteria (PTSD-AA). Prevalence was 3-fold higher following interpersonal and repeated trauma exposure, compared to non-interpersonal or single-event trauma, respectively. Higher prevalence was found when age-appropriate diagnostic tools were used. There was significant heterogeneity across studies and a lack of studies conducted in low-income countries and applying age-appropriate diagnostic algorithms. CONCLUSION Preschool-aged children are vulnerable to developing PTSD following trauma exposure. Younger children show prevalence trends similar to those of older youths and adults following different types of trauma. Age-appropriate diagnostic criteria are essential to ensure that appropriate identification and early support are provided.
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Affiliation(s)
| | | | - Tim Dalgleish
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, United Kingdom
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8
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Yrondi A, Colineaux H, Claudet I, Sales de Gauzy J, Huo S, Taib S, Bui E, Birmes P. Prevalence and prediction of PTSD and depression in mothers of children surviving a motor vehicle crash. Eur J Psychotraumatol 2022; 13:2121014. [PMID: 36212115 PMCID: PMC9543172 DOI: 10.1080/20008066.2022.2121014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Few studies have examined the psychopathological consequences for parents of children who were survivors of a motor vehicle crash (MVC). This study assessed the impact of dissociation and peritraumatic distress on the severity of PTSD and post-traumatic major depressive episode (MDE) symptoms in mothers during the first years after the MVC and the role that cortisol response might play in this association. Methods: 125 mothers were included. Peritraumatic distress and dissociation were assessed. Morning salivary cortisol was tested at the baseline. Participants were assessed for a probable diagnosis of PTSD and MDE at 5 weeks, 6 months and 12 months. Results: At 5 weeks, 12 (13.6%) mothers exhibited probable PTSD. During the first year, the PCL score was higher when the (i) Peritraumatic Distress Inventory (PDI) score increased and (ii) the Peritraumatic Dissociation Experience Questionnaire (PDEQ) score increased. Cortisol levels were lower when the PDI score increased. Conclusion: This is the first study to assess the mothers of MVC survivors for one year following the trauma. We confirm that peritraumatic responses are useful for predicting the severity of PTSD symptoms. These results could encourage the implementation of follow-up programmes not only for survivors but also for their mothers. HIGHLIGHTS Mothers of children involved in motor vehicle accident are at risk for developing PTSD.Peritraumatic responses (distress and dissociation) are associated to the severity of PTSD symptoms.Low salivary cortisol levels were associated with high peritraumatic distress.
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Affiliation(s)
- Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hopital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Hélène Colineaux
- UMR1027, Université Toulouse III, Inserm, Toulouse, France.,Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Isabelle Claudet
- Département des Urgences Pédiatriques, CHU Toulouse, Toulouse, France
| | - Jérome Sales de Gauzy
- Département de chirurgie orthopédique, Hopital des enfants, CHU Toulouse, Toulouse, France
| | - Samantha Huo
- Département d'Epidemiologie, CHU Toulouse, Toulouse, France
| | - Simon Taib
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Eric Bui
- Université de Caen Normandie et CHU Caen, Caen, France.,Massachusetts General Hospital, Boston
| | - Philippe Birmes
- Toulouse NeuroImaging Centre, University of Toulouse, Inserm, UPS, Toulouse, France
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9
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Post-traumatic Stress Disorder in Parents Following Their Child's Single-Event Trauma: A Meta-Analysis of Prevalence Rates and Risk Factor Correlates. Clin Child Fam Psychol Rev 2021; 24:725-743. [PMID: 34554357 PMCID: PMC8541994 DOI: 10.1007/s10567-021-00367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
Evidence suggests parents of children who experience a trauma may develop Post-Traumatic Stress Disorder (PTSD), which can have significant consequences for their own and their child’s functioning. As such, identifying the rates and possible correlates for the development of PTSD in parents is of clinical and theoretical importance, and would enhance our understanding of how best to support families in the aftermath of trauma. This meta-analysis of 41 studies (n = 4370) estimated the rate of PTSD in parents following their child’s single-incident trauma to be 17.0% (95% CI 14.1–20.0%); when removing samples which were mixed, or not exclusively single-incident traumas the prevalence estimate dropped to 14.4% (95% CI 10.8–18.5%). Pooled effect sizes of 32 potential correlates for parents developing PTSD were also identified. Medium-to-large effects were found for factors relating to the parent’s post-traumatic cognition, psychological functioning and coping strategies alongside child PTSD. Small effects were found for pre-trauma factors, objective trauma-related variables and demographic factors for both parent and child. Results are consistent with cognitive models of PTSD, suggesting peri- and post-trauma factors are likely to play a substantial role in its development. These findings indicate the clinical need for screening parents most vulnerable to adverse post-traumatic reactions within the context of child trauma and tailoring interventions to include the family where necessary.
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10
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De Young AC, Paterson RS, Brown EA, Egberts MR, Le Brocque RM, Kenardy JA, Landolt MA, Marsac ML, Alisic E, Haag AC. Topical Review: Medical Trauma During Early Childhood. J Pediatr Psychol 2021; 46:739-746. [PMID: 34283235 DOI: 10.1093/jpepsy/jsab045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Early childhood is a high-risk period for exposure to traumatic medical events due to injury/illness. It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. The aim of this topical review is to evaluate empirical literature on the psychological impact of medical trauma during early childhood (0-6 years) to inform models of clinical care for assessing, preventing, and treating traumatic stress following injury/illness. METHODS Topical review of empirical and theoretical literature on pediatric medical traumatic stress (PMTS) during early childhood. RESULTS There are important developmental factors that influence how infants and young children perceive and respond to medical events. The emerging literature indicates that up to 30% of young children experience PMTS within the first month of an acute illness/injury and between 3% and 10% develop posttraumatic stress disorder. However, significant knowledge gaps remain in our understanding of psychological outcomes for infants and young children, identification of risk-factors and availability of evidence-based interventions for medical trauma following illness. CONCLUSIONS This topical review on medical trauma during early childhood provides: (a) definitions of key medical trauma terminology, (b) discussion of important developmental considerations, (c) summary of the empirical literature on psychological outcomes, risk factors, and interventions, (d) introduction to a stepped-model-of-care framework to guide clinical practice, and (e) summary of limitations and directions for future research.
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Affiliation(s)
- Alexandra C De Young
- School of Psychology, University of Queensland.,Child Health Research Centre, Faculty of Medicine, University of Queensland.,Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Services
| | - Rebecca S Paterson
- School of Psychology, University of Queensland.,Child Health Research Centre, Faculty of Medicine, University of Queensland
| | - Erin A Brown
- Child Health Research Centre, Faculty of Medicine, University of Queensland
| | - Marthe R Egberts
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University
| | | | | | - Markus A Landolt
- Department of Psychosomatics and Psychiatry and Children's Research Center, University Children's Hospital Zurich.,Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital.,College of Medicine, University of Kentucky
| | - Eva Alisic
- Child and Community Wellbeing Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne
| | - Ann-Christin Haag
- Department of Counseling and Clinical Psychology, Columbia University Teachers College
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Szota K, Schulte KL, Christiansen H. Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.
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12
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Hahnefeld A, Sukale T, Weigand E, Münch K, Aberl S, Eckler LV, Schmidt D, Friedmann A, Plener PL, Fegert JM, Mall V. Survival states as indicators of learning performance and biological stress in refugee children: a cross-sectional study with a comparison group. BMC Psychiatry 2021; 21:228. [PMID: 33941110 PMCID: PMC8091678 DOI: 10.1186/s12888-021-03233-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/22/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Our goal was to accurately detect young children at risk for long-term psychiatric disturbances after potentially traumatic experiences in the course of relocation. In addition to detailed assessment of parent-rated parent and child symptomatology, we focused on disruptive behaviors in the education environment summarized as survival states, as these frequently lead to clinical referral. METHODS We screened 52 refugee children aged 3-7 (M = 5.14 years, SD = 1.17) for symptoms of Posttraumatic Stress Disorder (PTSD) with the Child and Adolescent Trauma Screening (CATS) in parent rating. The parents' mental health was assessed using the Refugee Health Screener (RHS-15). Furthermore, the child's educators were asked to evaluate the pathological survival states of the child and we made a general assessment of the children's symptoms with the Strengths and Difficulties Questionnaire (SDQ) rated by parents and educators. Children in the refugee sample completed a working memory learning task (Subtest Atlantis from the Kaufmann Assessment Battery for Children, KABC-II) and delivered saliva samples for testing of the cortisol level. RESULTS The parental rating of their child's PTSD symptoms was significantly related to their own mental well-being (r = .50, p < .001). Children with survival states in educator ratings exhibited weaker learning performance (F = 3.49, p < .05) and higher evening cortisol levels (U = 113, z = - 1.7, p < .05, one-tailed). CONCLUSIONS Survival states are promising indicators for children's learning performance and distress level complementary to parent rating of child PTSD, which is highly intercorrelated with the parents' own symptom load. TRIAL REGISTRATION Trial registration number: DRKS00021150 on DRKS Date of registration: 04.08.2020 retrospectively registered.
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Affiliation(s)
- Andrea Hahnefeld
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377, Munich, Germany. .,kbo Kinderzentrum, Heiglhofstr. 65, 81377, Munich, Germany.
| | - Thorsten Sukale
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Elena Weigand
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Katharina Münch
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany ,kbo Kinderzentrum, Heiglhofstr. 65, 81377 Munich, Germany
| | - Sigrid Aberl
- Munich Municipal Hospital Group, Department of Child and Adolescent Psychosomatic Medicine, Kölner Platz 1, 80804 Munich, Germany
| | - Lea V. Eckler
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Davin Schmidt
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Anna Friedmann
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany ,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18-20, 1090 Wien, Austria
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Volker Mall
- Chair of Social Pediatrics, TUM School of Medicine, Technical University of Munich, kbo Kinderzentrum, Heiglhofstrasse 65, 81377 Munich, Germany ,kbo Kinderzentrum, Heiglhofstr. 65, 81377 Munich, Germany
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13
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Meentken MG, van der Ende J, del Canho R, van Beynum IM, Aendekerk EWC, Legerstee JS, Lindauer RJL, Hillegers MHJ, Helbing WA, Moll HA, Utens EMWJ. Psychological outcomes after pediatric hospitalization: the role of trauma type. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1890077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Riwka del Canho
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ingrid M. van Beynum
- Department of Pediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Elisabeth W. C. Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jeroen S. Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ramón J. L. Lindauer
- de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H. J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Cardiology, Radboud UMC – Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics, Division of General Pediatrics, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Elisabeth M. W. J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
- de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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14
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Haag AC, Landolt MA, Kenardy JA, Schiestl CM, Kimble RM, De Young AC. Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial. J Child Psychol Psychiatry 2020; 61:988-997. [PMID: 31912485 DOI: 10.1111/jcpp.13193] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children. METHODS Injured children (1-6 years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8 days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete. RESULTS One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n = 62) or TAU (n = 71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b = 60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M = 11.02, SD = 10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M = 17.30, SD = 13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj. = .055, d = 0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties. CONCLUSIONS This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.
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Affiliation(s)
- Ann-Christin Haag
- Department of Psychosomatics and Psychiatry, and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Couseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Markus A Landolt
- Department of Psychosomatics and Psychiatry, and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Justin A Kenardy
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Clemens M Schiestl
- Division of Plastic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Child Health Research, University of Queensland, Brisbane, QLD, Australia.,The Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Alexandra C De Young
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Centre for Children's Burns and Trauma Research, Centre for Child Health Research, University of Queensland, Brisbane, QLD, Australia
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15
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Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents : A systematic review. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:68-75. [PMID: 32372291 PMCID: PMC8245387 DOI: 10.1007/s40211-020-00349-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Abstract
Anxiety disorders are one of the most prevalent mental disorders in children and adolescents which may effectively be treated by several forms of exposure therapy. An emerging approach to exposure is virtual reality exposure therapy (VRET), but a literature search synthesis focusing specifically on the use of VRET in children and adolescents is still lacking. This systematic review sets out to provide an overview concerning VRET for the treatment of anxiety disorders in this age group. Four published trials covering an overall sample of 100 participants between the ages of 8 and 16 years were found during a systematic literature search and were included in the current review. Results reveal that participants show clinical improvements regarding anxiety symptoms after VRET. Nevertheless, the high potential of virtual reality as a tool for treating children and adolescents with anxiety disorders is contrasted by a considerable lack of controlled trials. Despite the evidence of VRET in adult samples, there is a need for more research with younger cohorts in order to be able to support this promising field of application.
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16
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Lempertz D, Wichmann M, Enderle E, Stellermann-Strehlow K, Pawils S, Metzner F. Pre-Post Study to Assess EMDR-Based Group Therapy for Traumatized Refugee Preschoolers. JOURNAL OF EMDR PRACTICE AND RESEARCH 2020. [DOI: 10.1891/1933-3196.14.1.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cross-culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensitization and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4–6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2–4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 1½–5), pre- and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers' perspective, the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.
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17
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Kothgassner OD, Goreis A, Kafka JX, Van Eickels RL, Plener PL, Felnhofer A. Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. Eur J Psychotraumatol 2019; 10:1654782. [PMID: 31489138 PMCID: PMC6713125 DOI: 10.1080/20008198.2019.1654782] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/01/2023] Open
Abstract
Contrary to specific phobias, for which Virtual Reality Exposure Therapy (VRET) constitutes an effective treatment, uncertainty still exists regarding the usefulness of VRET for posttraumatic stress disorder (PTSD). Therefore, this meta-analysis investigated the efficacy of VRET for PTSD as compared to waitlist and active comparators. A literature search yielded nine controlled studies encompassing 296 participants (124 VRET, 172 controls). The differences between conditions regarding the primary outcome of PTSD symptom severity and the secondary outcome of depressive and anxiety symptoms post-treatment were calculated using Hedges' g. Compared to waitlist controls, VRET showed a significantly better outcome for PTSD symptoms (g = 0.62, p = .017) and depressive symptoms (g = 0.50, p = .008). There was no significant difference between VRET and active comparators regarding PTSD symptoms (g = 0.25, p = .356) and depressive symptoms (g = 0.24, p = .340) post-treatment. No significant effects emerged for anxiety symptoms. These findings suggest that VRET may be as effective as active comparators for PTSD patients. However, the results must be interpreted with caution due to the limited number of trials and the substantial number of - predominantly male - military service members studied. Additional controlled trials, considering a wider range of trauma types and balanced gender, are required to strengthen the evidence.
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Affiliation(s)
- Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria
| | - Andreas Goreis
- Department of Applied Psychology: Health, Development, Enhancement and Intervention, Faculty of Psychology, University of Vienna, Wien, Austria
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Johanna X. Kafka
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria
| | - Rahel L. Van Eickels
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Wien, Austria
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Wien, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien, Austria
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18
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Smith P, Dalgleish T, Meiser‐Stedman R. Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents. J Child Psychol Psychiatry 2019; 60:500-515. [PMID: 30350312 PMCID: PMC6711754 DOI: 10.1111/jcpp.12983] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 01/19/2023]
Abstract
Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.
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Affiliation(s)
- Patrick Smith
- Department of PsychologyInstitute of Psychiatry Psychology & NeuroscienceKing's College LondonLondonUK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology, Norwich Medical SchoolUniversity of East AngliaNorwichUK
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19
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Dai W, Liu A, Kaminga AC, Deng J, Lai Z, Wen SW. Prevalence of Posttraumatic Stress Disorder among Children and Adolescents following Road Traffic Accidents: A Meta-Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:798-808. [PMID: 30081648 PMCID: PMC6309043 DOI: 10.1177/0706743718792194] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Children and adolescents are among the most vulnerable road users, and road traffic accidents (RTAs) can lead to not only physical injuries but also adverse psychological outcomes, particularly posttraumatic stress disorder (PTSD). However, estimates of the prevalence of PTSD among children and adolescents following RTAs varied considerably across studies. Therefore, this study aimed to estimate the pooled prevalence of PTSD among this population. METHODS A systematic search for literature was performed in the electronic databases of PubMed, Web of Science, PsycINFO, and Embase. Heterogeneity was assessed using the Cochran's chi-square test and quantified by the I2 value. Meta-regression analyses were carried out to identify the effects of some potential moderators on the overall heterogeneity. Subgroup analyses were performed to estimate the pooled prevalence of PTSD according to some sample characteristics. RESULTS Eleven eligible studies with a total of 1532 children and adolescents who were involved in RTAs were included. The overall heterogeneity (I2 = 89.7, P < 0.001) was high across the eligible studies, and the pooled prevalence of PTSD was 19.95% (95% confidence interval, 13.63% to 27.09%) by a random-effects model. No significant moderators of the overall heterogeneity were identified using meta-regression analyses. Subgroup analyses showed that the pooled prevalence of PTSD differed significantly according to the study location and gender (P < 0.05). CONCLUSIONS One-fifth of children and adolescents developed PTSD in the aftermath of RTAs, indicating the need for regular assessment of PTSD and timely and effective psychological interventions among this population. Furthermore, more population-based studies with a large sample size are warranted. The protocol was registered in the PROSPERO database (No. CRD42018087941).
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Affiliation(s)
- Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Obstetrics and Gynecology, Faculty of Medicine, OMNI Research Group, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Mathematics, Mzuzu University, Mzuzu, Malawi
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zhiwei Lai
- Immunization Programme Department, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Shi Wu Wen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Obstetrics and Gynecology, Faculty of Medicine, OMNI Research Group, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health, and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide a summary of the current evidence pertaining to the course of acute and chronic posttraumatic stress, the diagnosis of acute stress disorder (ASD), and treatment of acute stress disorder and prevention of posttraumatic stress disorder (PTSD). RECENT FINDINGS Although acute stress disorder was introduced partly to predict subsequent PTSD, longitudinal studies indicate that ASD is not an accurate predictor of PTSD. Recent analytic approaches adopting latent growth mixture modeling have shown that trauma-exposed people tend to follow one of four trajectories: (a) resilient, (b) worsening, (c) recovery, and (d) chronically distressed. The complexity of the course of posttraumatic stress limits the capacity of the ASD diagnosis to predict subsequent PTSD. Current evidence indicates that the treatment of choice for ASD is trauma-focused cognitive behavior therapy, and this intervention results in reduced chronic PTSD severity. Recent attempts to limit subsequent PTSD by early provision of pharmacological interventions have been promising, especially administration of corticosterone to modulate glucocorticoid levels. Although the ASD diagnosis does not accurately predict chronic PTSD, it describes recently trauma-exposed people with severe distress. Provision of CBT in the acute phase is the best available strategy to limit subsequent PTSD.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
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21
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Abstract
PURPOSE OF REVIEW This review summarizes the latest evidence and developments in the validation of PTSD diagnostic criteria for children 6 years and under (PTSD<6Y), discusses the limitations of the current diagnostic criteria, and highlights areas for future research. RECENT FINDINGS Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).
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Affiliation(s)
- Alexandra C De Young
- Child Health Research Centre, The University of Queensland, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
| | - Markus A Landolt
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
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22
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Addressing the Needs of Preschool Children in the Context of Disasters and Terrorism: Assessment, Prevention, and Intervention. Curr Psychiatry Rep 2017; 19:40. [PMID: 28536808 DOI: 10.1007/s11920-017-0792-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review the research literature regarding the needs of preschoolers in the context of disasters and terrorism with the aim of understanding the existing methods for assessment, prevention, and intervention to provide recommendations and point out required research and development. RECENT FINDINGS We differentiate between screening tools that provide initial evaluation and assessment tools for diagnosing preschooler children's pathology and review possible interventions that address the preschool child's needs before, during, and after the incident itself. We also emphasize the lack of dissemination and research of prevention programs and mass interventions for preschoolers. Programs for community mass prevention and intervention for preschoolers should be developed and evaluated and interventions should be adapted for individual and group delivery. Moreover, the increase in the number of children refugees requires cultural adaptations of assessment measures and interventions.
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23
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The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma. CHILDREN-BASEL 2017; 4:children4030016. [PMID: 28264496 PMCID: PMC5368427 DOI: 10.3390/children4030016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 01/22/2023]
Abstract
Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.
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