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.
The prevalence of posttraumatic stress disorder (PTSD) in very young children depends on the diagnostic criteria. Thus far, studies have investigated the International Classification of Diseases ...(11th rev.; ICD‐11) criteria for PTSD only in samples of children older than 6 years of age. The aim of this study was to test the diagnostic agreement between the ICD‐11 and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM‐5) criteria for children who are 6 years old and younger. Caregivers of children aged 3–6 years in foster care in Germany (N = 147) and parents of children aged 1–4 years who had attended a hospital in Switzerland following burn injuries (N = 149) completed a questionnaire about children's PTSD. Rates of PTSD were calculated according to ICD‐11 (considering a specific and a more general conceptualization of intrusive memories) and DSM‐5 criteria and were compared using McNemar's tests and Cohen's kappa. The proportion of children who met the ICD‐11 criteria was 0.6–25.8% lower than the proportion of PTSD cases according to the DSM‐5 criteria. The diagnostic agreement between each ICD‐11 algorithm and DSM‐5 was moderate, κ = 0.52–0.66. A systematic investigation of adaptions of the ICD‐11 avoidance cluster identified alternative symptom combinations leading to higher agreement with the DSM‐5 requirements. Furthermore, DSM‐5 had higher predictive power for functional impairment than the ICD‐11 algorithms. In conclusion, the findings suggest that the ICD‐11 criteria show less sensitivity in very young children, which can be explained by the more stringent avoidance cluster.
Resumen
Spanish s by Asociación Chilena de Estrés Traumático (ACET)
Trastorno de estrés postraumático en niños muy pequeños: Acuerdos diagnósticos entre el CIE‐11 y el DSM‐5
TEPT EN NIÑOS MUY PEQUEÑOS: CIE‐11 Y DSM‐5
La prevalencia del trastorno de estrés postraumático (TEPT) en niños muy pequeños depende de los criterios de diagnóstico. Hasta el momento, los estudios han investigado el criterio propuesto en la Clasificación Internacional de Enfermedades (11ª rev.; CIE‐11) para el TEPT solo en muestras de niños mayores de 6 años. El objetivo de este estudio fue probar el acuerdo de diagnóstico entre los criterios del CIE‐11 y el Manual Diagnóstico y Estadístico de los Trastornos Mentales (5ª ed., DSM‐5 en su sigla en inglés) para niños de hasta 6 años. Cuidadores de niños de 3–6 años en hogares de acogida en Alemania (n = 147) y niños de 1 a 4 años que habían asistido a un hospital en Suiza debido a lesiones por quemaduras (n = 149) completaron un cuestionario sobre TEPT infantil. Las tasas de TEPT se calcularon de acuerdo a los criterios CIE‐11 (considerando una conceptualización específica y una más general sobre los recuerdos intrusivos) y los criterios DSM‐5 y fueron comparadas usando las pruebas de McNemar y la kappa de Cohen. La proporción de niños que cumplieron los criterios de la CIE‐11 fue 0.6 ‐ 25.8% más baja que la proporción de casos de TEPT según el criterio DSM‐5. El acuerdo de diagnóstico entre cada algoritmo CIE‐11 y DSM‐5 fue moderado, κs = 0.52 ‐ 0.66. Una investigación sistemática de las adaptaciones del clúster de evitación CIE‐11 identificó las combinaciones de síntomas alternativos llevando a un mayor acuerdo con los requerimientos DSM‐5. Además, el DSM‐5 tuvo mayor poder predictivo para deterioro funcional que los algoritmos CIE‐11. En conclusión, los hallazgos sugieren que los criterios CIE‐11 planeados muestran menos sensibilidad en niños muy pequeños, lo que puede explicarse por el clúster de evitación más estricto.
抽象
Traditional and Simplified Chinese s by the Asian Society for Traumatic Stress Studies (AsianSTSS)
簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯
Posttraumatic Stress Disorder in Very Young Children: Diagnostic Agreement between ICD‐11 and DSM‐5
Traditional Chinese
標題: 年紀很小的兒童的創傷後壓力症:ICD‐11 與DSM‐5的診斷吻合度
撮要: 要得出幼兒的創傷後壓力症(PTSD)普遍率, 視乎用以診斷的準則。目前為止的研究只檢視對6歲以上兒童採用第十一版國際疾病分類(ICD‐11)提出的PTSD準則的效果。本研究旨在測試對6歲或以下兒童來說, 使用ICD‐11和精神疾病診斷與統計手冊第五版(DSM‐5)的準則是否能取得吻合的診斷。德國兒童寄養所裡3–6歲兒童的照顧者(n = 147), 以及瑞士一醫院裡1–4歲燒傷兒童的照顧者(n = 149), 均完成了有關兒童PTSD的問卷。我們根據ICD‐11 (考慮到特殊與較普遍的侵擾記憶概念) 和DSM‐5的準則取得PTSD比率, 並以McNemar檢定法和Cohen's kappa係數分析進行比較。以ICD‐11得出的兒童PTSD比率, 比用DSM‐5低0.6–25.8%。每項ICD‐11與DSM‐5計算法的診斷吻合度為中等(κs = 0.52–0.66)。我們對ICD‐11的迴避聚類進行系統性調查, 發現有其他症狀組合跟DSM‐5準則較為吻合。此外, 相比ICD‐11, DSM‐5對功能性損傷有較強的預測力。總結, 較具體的迴避聚類反映, ICD‐11提出的準則對幼兒的敏感度較低。
Simplified Chinese
标题: 年纪很小的儿童的创伤后压力症:ICD‐11 与DSM‐5的诊断吻合度
撮要: 要得出幼儿的创伤后压力症(PTSD)普遍率, 视乎用以诊断的准则。目前为止的研究只检视对6岁以上儿童采用第十一版国际疾病分类(ICD‐11)提出的PTSD准则的效果。本研究旨在测试对6岁或以下儿童来说, 使用ICD‐11和精神疾病诊断与统计手册第五版(DSM‐5)的准则是否能取得吻合的诊断。德国儿童寄养所里3–6岁儿童的照顾者(n = 147), 以及瑞士一医院里1–4岁烧伤儿童的照顾者(n = 149), 均完成了有关儿童PTSD的问卷。我们根据ICD‐11 (考虑到特殊与较普遍的侵扰记忆概念) 和DSM‐5的准则取得PTSD比率, 并以McNemar检定法和Cohen's kappa系数分析进行比较。以ICD‐11得出的儿童PTSD比率, 比用DSM‐5低0.6–25.8%。每项ICD‐11与DSM‐5计算法的诊断吻合度为中等(κs = 0.52–0.66)。我们对ICD‐11的回避聚类进行系统性调查, 发现有其他症状组合跟DSM‐5准则较为吻合。此外, 相比ICD‐11, DSM‐5对功能性损伤有较强的预测力。总结, 较具体的回避聚类反映, ICD‐11提出的准则对幼儿的敏感度较低。
Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing further victimization in adolescence. Associations between CSA and several forms of cyber and in-person peer ...bullying victimization were assessed in a prospective, longitudinal study. Females exposed to substantiated CSA and a matched comparison group (N = 422) were followed over a two-year period. Bullying experiences were assessed in both survey and qualitative interviews. Qualitative data were coded and used to describe the types (e.g., cyber, physical, verbal), and foci (e.g., threats, physical appearance) of bullying victimization. Logistic regression was used to assess the odds that CSA was associated with subsequent bullying victimization, adjusted for demographics, social networking use, and prior bullying. CSA-exposed females were at an increased risk of multiple forms of bullying victimization with a persistent risk of bullying victimization over time. Specifically, they had 2.6 times higher odds of experiencing any bullying at follow-up, 2.9 times higher odds of experiencing cyberbullying at follow-up, and 2 times higher odds of experiencing combined cyber/in-person bullying at follow-up. CSA-exposed females were more likely than comparison females to experience bullying regarding their appearance/weight and dating relationships. Findings provide further insight into the unique circumstances of the cyberbullying and in-person bullying experienced by CSA-exposed females. Females exposed to child sexual abuse (CSA) are at an increased risk of experiencing bullying victimization, specifically cyberbullying and combined cyber/in-person bullying, as well as bullying about their appearance and dating relationships. These findings indicate that bullying prevention needs to include trauma-focused components to target these uniquely vulnerable females.
Although injury severity and parental stress are strong predictors of posttraumatic adjustment in young children after burns, little is known about the interplay of these variables. This study aimed ...at clarifying mediation processes between injury severity and mother's, father's, and young child's acute stress.
Structural equation modeling was used to examine the relationships between injury severity and parental and child acute stress. Parents of 138 burn-injured children (ages 1-4 years) completed standardized questionnaires on average 19 days postinjury.
Sixteen children (11.7%) met Diagnostic and Statistical Manual of Mental Disorders, 5th edition, preschool criteria for posttraumatic stress disorder (excluding time criterion). The model revealed a significant mediation of maternal acute stress, with the effect of injury severity on a child's acute stress mediated by maternal acute stress. Paternal acute stress failed to serve as a mediating variable.
Our findings confirm mothers' crucial role in the posttraumatic adjustment of young children. Clinically, mothers' acute stress should be monitored.
Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial ...risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12-16 years (
= 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.
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.
Flexible self-regulation has been shown to be an adaptive ability. This study adapted and validated the adult Flexible Regulation of Emotional Expression (FREE) Scale for use with youth (FREE-Y) in ...community and maltreatment samples. The FREE-Y measures the ability to flexibly enhance and suppress emotion expression across an array of hypothetical social scenarios. Participants (N = 654, 8–19 years) were included from three studies. Confirmatory factor analysis (CFA) confirmed a theoretically appropriate higher order factor structure. Using multiple-group CFAs, measurement invariance was achieved across maltreatment status, age, and gender. Reliabilities were adequate and construct validity was demonstrated through associations with measures of emotion regulation, psychopathology, IQ, and executive functioning. Group comparisons indicated lower Suppression and Flexibility scores for maltreated versus comparison participants. Findings suggest that the FREE-Y is a valid measure of expressive regulation ability in youth that can be applied across a range of populations.
Objective: Cognitive models of posttraumatic stress disorder highlight posttraumatic cognitions (PTCs) as a crucial mechanism of trauma adjustment. So far, only dysfunctional PTCs have been ...investigated in detail. Research on functional PTCs is scarce. This study addresses this gap by developing and validating a self-report measure called Functional Posttraumatic Cognitions Questionnaire (FPTCQ) in children and adolescents. Method: The questionnaire was administered to 114 children and adolescents aged 7 to 15 years who had experienced an acute accidental potentially traumatic event, such as a road traffic accident or a burn injury, and as a result received medical treatment. In addition to classical item analysis and exploratory factor analysis, reliability and construct validity of the FPTCQ were investigated. Results: The exploratory factor analysis revealed a one-factor structure of the FPTCQ. The final 11-item questionnaire displayed satisfactory internal consistency (Cronbach's α = .78), irrespective of age. Functional PTCs were inversely related to dysfunctional PTCs, r = −.44, p < .001, posttraumatic stress symptoms, r = −.35, p < .001, depression symptoms, r = −.22, p < .05, and anxiety symptoms, r = −.43, p < .001, thus supporting construct validity. Conclusions: The FPTCQ is a reliable and valid measure for standardized assessment of functional PTCs among children and adolescents.
Clinical Impact Statement
The newly developed self-report measure Functional Posttraumatic Cognitions Questionnaire seems to be a reliable and valid measure for standardized assessment of functional posttraumatic cognitions (PTCs) in children and adolescents. Functional PTCs were significantly inversely related to dysfunctional PTCs, posttraumatic stress symptoms, depression, and anxiety symptoms in children and adolescents exposed to an acute accidental potentially traumatic event.
Child sexual abuse (CSA) is associated with revictimization and sexual risk-taking behaviours. The Internet has increased the opportunities for teens to access sexually explicit imagery and has ...provided new avenues for victimization and exploitation. Online URL activity and offline psychosocial factors were assessed for 460 females aged 12-16 (CSA = 156; comparisons = 304) with sexual behaviours and Internet-initiated victimization assessed 2 years later. Females who experienced CSA did not use more pornography than comparisons but were at increased odds of being cyberbullied (odds ratio = 2.84, 95% confidence interval = 1.67-4.81). These females were also more likely to be represented in a high-risk latent profile characterized by heightened URL activity coupled with problematic psychosocial factors, which showed increased odds of being cyberbullied, receiving online sexual solicitations and heightened sexual activity. While Internet activity alone may not confer risk, results indicate a subset of teens who have experienced CSA for whom both online and offline factors contribute to problematic outcomes.
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