Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults or motor vehicle accidents

Objective: The authors investigated acute stress disorder and later posttraumatic stress disorder (PTSD) in children and adolescents who had been involved in assaults or motor vehicle accidents. Method: They interviewed 93 patients 10-16 years old who were seen in an emergency department for having been assaulted or involved in a motor vehicle accident within 4 weeks after the assault or accident to assess acute stress disorder. At 6 months, they reinterviewed 64 (68.8%) of the patients to assess PTSD. Results: At initial interview, 18 (19.4%) of the 93 patients had acute stress disorder and 23 (24.7%) met all acute stress disorder criteria except dissociation. At 6 months, eight of the 64 patients (12.5%) had PTSD. Acute stress disorder and PTSD did not differ in prevalence between patients who had been assaulted and those who had been in accidents. Sensitivity and specificity statistics and regression modeling revealed that the diagnosis of acute stress disorder was a good predictor of later PTSD but that dissociation did not play a significant role. Conclusions: Acute stress disorder has merit as a predictor of later PTSD in children and adolescents, but dissociation has questionable utility

Diagnostic, demographic, memory quality, and cognitive variables associated with acute stress disorder in children and adolescents

To date, no studies have investigated factors associated with acute stress disorder (ASD) in children and adolescents. Relationships between ASD and a number of demographic, trauma, cognitive, and trauma memory variables were therefore investigated in a sample (N=93) of children and adolescents involved in assaults and motor vehicle accidents. Several cognitive variables and the quality of trauma memories, but not demographic or trauma variables, were correlated with ASD and also mediated the relationship between peritraumatic threat and ASD. Finally, nosological analyses comparing ASD with indexes of posttraumatic stress disorder in the month posttrauma revealed little support for the dissociation mandate that uniquely characterizes ASD. The results are discussed with respect to assessment and treatment for the acute traumatic stress responses of children and young people

Thought control strategies and rumination in youth with acute stress disorder and posttraumatic stress disorder following single-event trauma

Objective: Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. Methods: In a prospective longitudinal study of 10-16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. Results: Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. Conclusions: The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth

Development and validation of the child post-traumatic cognitions inventory (CPTCI)

Background: Negative trauma-related cognitions have been found to be a significant factor in the maintenance of post-traumatic stress disorder (PTSD) in adults. Initial studies of such appraisals in trauma-exposed children and adolescents suggest that this is an important line of research in youth, yet empirically validated measures for use with younger populations are lacking. A measure of negative trauma-related cognitions for use with children and adolescents, the Child Post-Traumatic Cognitions Inventory (CPTCI), is presented. The measure was devised as an age-appropriate version of the adult Post-Traumatic Cognitions Inventory (Foa et al., 1999). Methods: The CPTCI was developed and validated within a large (n = 570) sample, comprising community and trauma-exposed samples of children and adolescents aged 6-18 years. Results: Principal components analysis suggested a two-component structure. These components were labelled 'permanent and disturbing change' and 'fragile person in a scary world', and were each found to possess good internal consistency, test-retest reliability, convergent validity, and discriminative validity. The reliability and validity of these sub-scales was present regardless of whether the measure was completed in the acute phase or several months after a trauma. Scores on these sub-scales did not vary with age. Conclusions: The CPTCI is a reliable and valid measure that is not specific to the type of trauma exposure, and shows considerable promise as a research and clinical tool. The structure of this measure suggests that appraisals concerning the more abstract consequences of a trauma, as well as physical threat and vulnerability, are pertinent factors in trauma-exposed children and adolescents, even prepubescent children

The trauma memory quality questionnaire:Preliminary development and validation of a measure of trauma memory characteristics for children and adolescents

It has been suggested that post-traumatic stress is related to the nature of an individual's trauma memories. While this hypothesis has received support in adults, few studies have examined this in children and adolescents. This article describes the development and validation of a measure of the nature of children's trauma memories, the Trauma Memory Quality Questionnaire (TMQQ), that might test this hypothesis and be of clinical use. The measure was standardised in two samples, a cross-sectional sample of non-clinic referred secondary school pupils (n=254), and a sample participating in a prospective study of children and adolescents who had attended a hospital Accident and Emergency department following an assault or a road traffic accident (n=106). The TMQQ was found to possess good internal consistency, criterion validity, and construct validity, but test-retest reliability has yet to be established

Evaluation of pilot community art-based workshops designed for Ukrainian refugee children

ObjectivesApproximately 8 million Ukrainians have been displaced by the war in Ukraine and five million children had their education disrupted. Here, we report an evaluation of (1) the feasibility (i.e., recruitment), (2) the acceptability (i.e., attendance, participants' views) and (3) the influence of a pilot community art-based project on the well-being, health behaviour and socialisation of Ukrainian refugee children in London, UK.MethodsTwenty-two refugee children aged 4–14 years from St Mary's Ukrainian school in London took part in five weekly art workshop group sessions led by a team of volunteer independent artists based in a community art studio in West London in collaboration with Children and War UK. Analyses were conducted on measures of the children's psychological well-being, health behaviour, and socialisation; collected from participating children and their parents through the workshops.ResultsThe community art workshops received sufficient interest from parents during recruitment. Child participants and their parents expressed overwhelmingly positive views and high satisfaction towards the workshops and their activities. While the workshops were conducted without a control group, changes in psychological well-being and health behaviour and socialisation were in the expected direction. The workshops were associated with reduced impact of intrusive re-experiencing of traumatic events (p = .021), negative emotion (ps = .006–.043; rated by children and by their parents, respectively), and sleep disturbance (p = .015). Mood and motivational states increase relative to before activities within sessions (ps = .001–.023).ConclusionsThe artist-led workshops are a valuable community project associated with high satisfaction and potentially increased well-being in Ukrainian refugee children. A provision for a larger number of participants should be considered

The impact of fathers' military deployment on child adjustment. The support needs of primary school children and their families separated during active military service: A pilot study

BACKGROUND: Although direct exposure to war-related trauma negatively impacts children's psychological well-being, little is known about this impact within the context of parental military deployment to a combat zone and 'indirect' experience of the effects of armed conflict. This study investigates the impact of father's military deployment to Afghanistan on child well-being in primary schoolchildren and compares measures of adjustment with a matched group of children with fathers deployed on military training (non-combat) deployment. METHOD: Data were collected within primary schools in 2011-2012 from 52 children aged 8-11 years with fathers deploying to Afghanistan ( n = 26) and fathers deploying on military training ( n = 26) via self-completion of questionnaires assessing symptoms of anxiety, depression, stress and levels of self-esteem. Data were collected in both groups, at pre-, mid- and post-parental deployment. Class teachers and parents (non-deployed) completed a measure of child behaviour and parents completed a measure of parenting stress and general health. RESULTS: Unexpectedly child adjustment difficulties were not significantly raised in children whose parents deployed to Afghanistan. Ratings of behavioural difficulties and depression were low in both groups. However, clinically elevated levels of anxiety and stress symptoms were reported by both groups of children at each stage of deployment. No associations between parental stress, parental mental health and child adjustment were found. CONCLUSION: High levels of children's anxiety and stress reported during fathers' active military service warrant further investigation. Implications for school and health monitoring and CAMHS community liaison work are discussed

Dissociative symptoms and the acute stress disorder diagnosis in children and adolescents:A replication of the Harvey and Bryant (1999) study

Acute stress disorder (ASD) is a good predictor of posttraumatic stress disorder in adult populations, although the emphasis on dissociation symptoms within the diagnosis has been questioned. Recent studies suggest that ASD may also have application to children and adolescents. The present study examined properties of ASD within youth. A large (N = 367) multisite sample of 6- to 17-year-old children and adolescents exposed to motor vehicle accidents completed interviews or self-report questionnaires regarding their acute stress symptoms. The study found evidence supporting the suggestion that the dissociative criterion of ASD is excessively strict in youth, and that there is less overlap between dissociative symptoms than in adults. The implications of these findings for how ASD is applied to youth are discussed

The natural history of ataxia-telangiectasia (A-T): A systematic review

Background: Ataxia-telangiectasia is an autosomal recessive, multi-system, and life-shortening disease caused by mutations in the ataxia-telangiectasia mutated gene. Although widely reported, there are no studies that give a comprehensive picture of this intriguing condition. Objectives: Understand the natural history of ataxia-telangiectasia (A-T), as reported in scientific literature. Search methods: 107 search terms were identified and divided into 17 searches. Each search was performed in PubMed, Ovid SP (MEDLINE) 1946-present, OVID EMBASE 1980 -present, Web of Science core collection, Elsevier Scopus, and Cochrane Library. Selection criteria: All human studies that report any aspect of A-T. Data collection and analysis: Search results were de-duplicated, data extracted (including author, publication year, country of origin, study design, population, participant characteristics, and clinical features). Quality of case-control and cohort studies was assessed by the Newcastle-Ottawa tool. Findings are reported descriptively and where possible data collated to report median (interquartile range, range) of outcomes of interest. Main results: 1314 cases reported 2134 presenting symptoms. The most common presenting symptom was abnormal gait (1160 cases; 188 studies) followed by recurrent infections in classical ataxia-telangiectasia and movement disorders in variant ataxia-telangiectasia. 687 cases reported 752 causes of death among which malignancy was the most frequently reported cause. Median (IQR, range) age of death (n = 294) was 14 years 0 months (10 years 0 months to 23 years 3 months, 1 year 3 months to 76 years 0 months). Conclusions: This review demonstrates the multi-system involvement in A-T, confirms that neurological symptoms are the most frequent presenting features in classical A-T but variants have diverse manifestations. We found that most individuals with A-T have life limited to teenage or early adulthood. Predominance of case reports, and case series demonstrate the lack of robust evidence to determine the natural history of A-T. We recommend population-based studies to fill this evidence gap

Predictors of posttraumatic stress symptom trajectories in parents of children exposed to motor vehicle collisions

Following child trauma, parents are at risk of developing posttraumatic stress disorder (PTSD), either owing to their direct involvement or from hearing of their child's involvement. Despite the potential impact of a parent's development of PTSD on both the parent and child, little is known about what may place a parent at increased risk.   METHOD: PTSD symptoms were assessed ≤4 weeks, 6 months, and 3 years post-trauma, along with a range of potential risk factors, in a sample of parents of 2-10-year-old children who were involved in a motor vehicle collision.   RESULTS AND CONCLUSIONS: Two symptom trajectories were identified: Those parents whose symptoms remained low across all time points and those whose symptoms remained elevated at 6 months post-trauma and declined by 3 years. Subjective threat, thought suppression, and maladaptive cognitions about damage to the child were identified as key predictors of poorer outcomes