Invisible injuries: Posttraumatic stress in children, adolescents and their parents following accidents

Accidents are a major cause of injury in children and can have great impact on the lives of children and their parents. The aims of this research project were (1) to evaluate the utility in the Netherlands of the STEPP, a screening instrument to identify children (aged 8-18) and parents at risk for Posttraumatic Stress Disorder (PTSD) following child accidental injury, and (2) to examine short (3 months) and long-term (2–4 years) posttraumatic stress in children and parents following child accidental injury, including possible associated factors. An exploratory study directed at children below the age of 8 was also included. The prevalence of PTSD in children was 11.6% at 3 months, and 11.4% 2–4 years after the accident. In parents, this was 9.6% and 5.8%, respectively. With adjusted cut-off scores, the STEPP correctly identified 82% of the children and 92% of the parents with a subsequent positive diagnosis. In children, severe acute pain was associated with short-term PTSD and the presence of permanent physical impairment was associated with long-term PTSD. In parents, acute stress was significantly associated with severity of posttraumatic stress symptoms (short and long-term), as was the child’s permanent physical impairment (long-term). At 3 months, parental and child posttraumatic stress were significantly associated. The findings in this thesis support an active approach to prevent PTSD and promote resilience. Findings on associated factors such as severe acute pain and permanent physical impairment provide an opportunity to improve the care for accidentally injured children and their parents

Effects of psychotherapy on regional cerebral blood flow during trauma imagery in patients with post-traumatic stress disorder: a randomized clinical trial

BACKGROUND: Functional brain-imaging studies in post-traumatic stress disorder (PTSD) have suggested functional alterations in temporal and prefrontal cortical regions. Effects of psychotherapy on these brain regions have not yet been examined.METHOD: Twenty civilian PTSD out-patients and 15 traumatized control subjects were assessed at baseline using psychometric ratings. Cerebral blood flow was measured using trauma script-driven imagery during 99mtechnetium hexamethyl-propylene-amine-oxime single-photon emission computed tomography scanning. All 20 out-patients were randomly assigned to treatment or wait-list conditions. Treatment was brief eclectic psychotherapy (BEP) in 16 weekly individual sessions. RESULTS: At baseline, greater activation was found in the right insula and right superior/middle frontal gyrus in the PTSD group than in the control group. PTSD patients treated with BEP significantly improved on all PTSD symptom clusters compared to those on the waiting list. After effective psychotherapy, lower activation was measured in the right middle frontal gyrus, compared to the PTSD patients on the waiting list. Treatment effects on PTSD symptoms correlated positively with activation in the left superior temporal gyrus, and superior/middle frontal gyrus. CONCLUSIONS: BEP induced clinical recovery in PTSD patients, and appeared to modulate the functioning of specific PTSD-related sites in the prefrontal cortical region

A parental tool to screen for posttraumatic stress in children: first psychometric results.

The Children's Revised Impact of Event Scale (CRIES-13) is a brief self-report measure designed to screen children for posttraumatic stress disorder (PTSD). This study investigates the psychometric properties of a Dutch version of the CRIES-13-parent version and evaluates its correlation with the child version. A sample of 59 trauma-exposed children (8 years-18 years) and their parents completed an assessment including the CRIES-13 (child/parent version) along with the Anxiety Disorders Interview Schedule for DSM-IV: Parent version. Results demonstrated good internal consistency (α = .87) with acceptable values for the 3 subscales. A strong correlation (r = .73) with another measure of PTSD and lower correlations with a behavioral measure (r = .15 to .38) were found, confirming the convergent/divergent validity. A cutoff score ≥ 31 emerged as the best balance between sensitivity and specificity, and correctly classified 83.6% of all children as having a diagnosis of PTSD. This study provides support for the reliability and validity of the CRIES-13-parent version as a screening measure for posttraumatic stress in children