Pediatric health care networks serve millions of children each year. Pediatric illness and injury are among the most common potentially emotionally traumatic experiences for children and their ...families. In addition, millions of children who present for medical care (including well visits) have been exposed to prior traumatic events, such as violence or natural disasters. Given the daily challenges of working in pediatric health care networks, medical professionals and support staff can experience trauma symptoms related to their work. The application of a trauma-informed approach to medical care has the potential to mitigate these negative consequences. Trauma-informed care minimizes the potential for medical care to become traumatic or trigger trauma reactions, addresses distress, provides emotional support for the entire family, encourages positive coping, and provides anticipatory guidance regarding the recovery process. When used in conjunction with family-centered practices, trauma-informed approaches enhance the quality of care for patients and their families and the well-being of medical professionals and support staff. Barriers to routine integration of trauma-informed approaches into pediatric medicine include a lack of available training and unclear best-practice guidelines. This article highlights the importance of implementing a trauma-informed approach and offers a framework for training pediatric health care networks in trauma-informed care practices.
The extant literature indicates that parent and child posttraumatic stress symptoms (PTSS) are associated. However, the magnitude of this association at different time points and in the context of ...covariates has been difficult to quantify due to the methodological limitations of past studies, including small sample sizes. Using data from the Prospective studies of Acute Child Trauma and Recovery Data Archive, we harmonized participant‐level parent and child data from 16 studies (N = 1,775 parent–child dyads) that included prospective assessment of PTSS during both the acute and later posttrauma periods (i.e., 1–30 days and 3–12 months after exposure to a potentially traumatic event, respectively). Parent and child PTSS demonstrated small‐to‐moderate cross‐sectional, ρs = .22–.27, 95% CI .16, .32, and longitudinal associations, ρ = .30, CI .23, .36. Analyses using actor–partner interdependence models revealed that parent PTSS during the acute trauma period predicted later child PTSS. Regression analyses demonstrated that parent gender did not moderate the association between parent and child PTSS. The findings suggest that parent PTSS during the acute and later posttrauma periods may be one of a constellation of risk factors and indicators for child PTSS.
Background
The latest version of the International Classification of Diseases (ICD‐11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom ...clusters re‐experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification.
Methods
We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated.
Results
The PTSD re‐experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms.
Conclusions
Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between‐subject with within‐subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.
With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute ...Stress Checklist for Children in English (ASC‐Kids) and Spanish (Cuestionario de Estrés Agudo‐Niños CEA‐N), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6‐item and 3‐item short forms. Across samples, both short forms (ASC‐6/ASC‐3 in English; CEA‐6/CEA‐3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians’ and researchers’ ability to screen for acute posttraumatic stress in children.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
Breves Detectores para Estrés Traumático Agudo
Con millones de niños experimentando eventos traumáticos agudos, se necesita herramientas de evaluación validadas tanto en contextos de investigación como de servicios. Nuestro objetivo fue identificar y evaluar las versiones cortas de la Lista de Chequeo de Estrés Agudo para los niños en Inglés (ASC‐Kids) y Español (CEA‐N), utilizando datos de 4 muestras (Ns de 254, 225, 176 y 80) de niños con trauma agudo reciente. Los análisis factoriales confirmatorios de la lista de chequeo completa en la muestra más grande guiaron la selección de ítems para las versiones cortas de 6 y 3 ítems. En las muestras, ambas formas cortas (ASC‐6 / ASC‐3 en Inglés; CEA‐6 / CEA‐3 en español) se correlacionaron con la gravedad de los síntomas en la lista de chequeo completa del trastorno de estrés agudo (TEA) (r = .79 a .92) y en una medida de entrevista (r = .52 a .62). Los análisis de Curva Operativa del Receptor para cada forma corta que detectaba el estado actual de trastorno de estrés agudo, mostraron áreas altas bajo la curva (ABC; .76 a .95). Los puntajes de corte identificados basados en la Muestra 1 proveyeron aceptables sensibilidad (.59 a 1.00) y especificidad (.57 a .86) en las muestras. Los niños con puntajes por encima del punto de corte en cada lista reportaron un mayor deterioro concomitante por los síntomas de TEA y estrés postraumático más severo tres meses más tarde. Estas medidas muy breves podrían ampliar la habilidad de los clínicos e investigadores de detectar estrés postraumático agudo en los niños.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題: 為找出兒童的急性創傷後壓力症狀、簡單實用的英語和西班牙語篩選項目
撮要: 由於數百萬兒童曾經歷急性創傷事件, 我們在研究和服務領域都需要受驗證有效的篩選工具。我們旨在製造簡短的兒童急性壓力量表(英語版) (ASC‐Kids)及兒童急性壓力量表(西班牙語版) (CEA‐N), 並對其作評估。我們利用4組樣本的數據(Ns = 254, 225, 176 和 80), 樣本為近期經歷急性創傷的兒童。我們以最大樣本對完整量表進行驗證性因素分析, 以此引導我們為6項及3項的簡短版作項目選擇。各個樣本中, 兩種量表的簡短版(英語版: ASC‐6 / ASC‐3; 西班牙語版: CEA‐6 / CEA‐3)都跟完整量表裡(r = .79 至 .92)和面談測量裡(r = .52 至 .62)的急性歷力症(ASD)症狀嚴重度有關。為查出當前ASD狀況, 我們對每個簡短版進行接收者操作曲線分析, 分析顯示曲線下的範圍為高(AUC; .76 至 .95)。我們以樣本1得出取錄分數, 這取錄分數為我們提供不同樣本間可接受的敏感度(.59 至 1.00)和特殊性(.57 至 .86)。在每個篩選項目裡, 分數高於取錄線的兒童有較多ASD症狀同時引致的功能損傷, 並在三個月後有較嚴重的創傷後壓力。這些非常簡短的測量方法, 可進一步幫助臨床治療師和研究人員篩選兒童的急性創傷後壓力。
标题: 为找出儿童的急性创伤后压力症状、简单实用的英语和西班牙语筛选项目
撮要: 由于数百万儿童曾经历急性创伤事件, 我们在研究和服务领域都需要受验证有效的筛选工具。我们旨在制造简短的儿童急性压力量表(英语版) (ASC‐Kids)及儿童急性压力量表(西班牙语版) (CEA‐N), 并对其作评估。我们利用4组样本的数据(Ns = 254, 225, 176 和 80), 样本为近期经历急性创伤的儿童。我们以最大样本对完整量表进行验证性因素分析, 以此引导我们为6项及3项的简短版作项目选择。各个样本中, 两种量表的简短版(英语版: ASC‐6 / ASC‐3; 西班牙语版: CEA‐6 / CEA‐3)都跟完整量表里(r = .79 至 .92)和面谈测量里(r = .52 至 .62)的急性历力症(ASD)症状严重度有关。为查出当前ASD状况, 我们对每个简短版进行接收者操作曲线分析, 分析显示曲线下的范围为高(AUC; .76 至 .95)。我们以样本1得出取录分数, 这取录分数为我们提供不同样本间可接受的敏感度(.59 至 1.00)和特殊性(.57 至 .86)。在每个筛选项目里, 分数高于取录线的儿童有较多ASD症状同时引致的功能损伤, 并在三个月后有较严重的创伤后压力。这些非常简短的测量方法, 可进一步帮助临床治疗师和研究人员筛选儿童的急性创伤后压力。
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) were examined in 334 parents of children with traffic‐related injuries. In the first month after their child's injury, 12% of ...parents had ASD and another 25% had partial ASD. Among 251 parents assessed again approximately 6 months postinjury, 8% had PTSD and another 7% had partial PTSD. The ASD and PTSD severity were associated (r = .54), but ASD status was not a sensitive predictor of later PTSD. Independent predictors of ASD severity included prior trauma exposure, peritrauma exposure and perceptions of the child's pain and life threat, and child ASD severity. Independent predictors of PTSD severity included prior trauma exposure, parent ASD severity, and parent‐rated child physical health at follow‐up.
After pediatric injury, transient traumatic stress reactions are common, and about 1 in 6 children and their parents develop persistent posttraumatic stress (PTS) symptoms that are linked to poorer ...physical and functional recovery. Meta-analytic studies identify risk factors for persistent PTS, including preinjury psychological problems, peritrauma fear and perceived life threat, and posttrauma factors such as low social support, maladaptive coping strategies, and parent PTS symptoms. There is growing prospective data indicating that children’s subjective appraisals of the injury and its aftermath influence PTS development. Secondary prevention of injury-related PTS often involves parents and focuses on promoting adaptive child appraisals and coping strategies. Web-based psychoeducation and targeted brief early intervention for injured children and their parents have shown a modest effect, but additional research is needed to refine preventive approaches. There is a strong evidence base for effective psychological treatment of severe and persistent PTS via trauma-focused cognitive behavioral therapy; evidence is lacking for psychopharmacological treatment. Pediatric clinicians play a key role in preventing injury-related PTS by providing “trauma-informed” pediatric care (ie, recognizing preexisting trauma, addressing acute traumatic stress reactions associated with the injury event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referral).
The field of trauma and traumatic stress is dominated by studies on treatments for those who experience adversity from traumatic experiences. While this is important, we should not neglect the ...opportunity to consider trauma in a public health perspective. Such a perspective will help to develop prevention approaches as well as extend the reach of early interventions and treatments. The purpose of this paper is to provide an introduction to a public health approach to trauma and traumatic stress and identify key opportunities for trauma professionals and our professional societies (such as the International Society for Traumatic Stress Studies ISTSS and the European Society for Traumatic Stress Studies ESTSS) to increase our societal impact by adopting such an approach.
This paper reviews and summarizes key findings related to the public health impact of trauma. The special case of children is explored, and a case example of the Norwegian terrorist attacks in 2011 illustrates the potential for improving our response to community level traumatic events. We also discuss how professional organizations such as ESTSS and ISTSS, as well as individual trauma professionals, can and should play an important role in promoting a public health approach.
Trauma is pervasive throughout the world and has negative impacts at the personal, family, community, and societal levels. A public health perspective may help to develop prevention approaches at all of these levels, as well as extend the reach of early interventions and treatments.
Professional organizations such as ESTSS and ISTSS can and should play an important role in promoting a public health approach. They should promote the inclusion of trauma in the global public health agenda and include public health in their activities.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Exposure to acute, potentially traumatic events is an unfortunately common experience for children and adolescents. Posttraumatic stress (PTS) responses following acute trauma can have an ongoing ...impact on child development and well-being. Early intervention to prevent or reduce PTS responses holds promise but requires careful development and empirical evaluation.
The aims of this review paper are to present a framework for thinking about the design, delivery, and evaluation of early interventions for children who have been exposed to acute trauma; highlight targets for early intervention; and describe next steps for research and practice.
Proposed early intervention methods must (1) have a firm theoretical grounding that guides the design of intervention components; (2) be practical for delivery in peri-trauma or early post-trauma contexts, which may require creative models that go outside of traditional means of providing services to children; and (3) be ready for evaluation of both outcomes and mechanisms of action. This paper describes three potential targets for early intervention-maladaptive trauma-related appraisals, excessive early avoidance, and social/interpersonal processes-for which there is theory and evidence suggesting an etiological role in the development or persistence of PTS symptoms in children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This editorial argues that it is time for the traumatic stress field to join the growing international movement towards Findable, Accessible, Interoperable, and Re-usable (FAIR) research data, and ...that we are well-positioned to do so. The field has a huge, largely untapped resource in the enormous number of rich potentially re-usable datasets that are not currently shared or preserved. We have several promising shared data resources created via international collaborative efforts by traumatic stress researchers, but we do not yet have common standards for data description, sharing, or preservation. And, despite the promise of novel findings from data sharing and re-use, there are a number of barriers to researchers' adoption of FAIR data practices. We present a vision for the future of FAIR traumatic stress data, and a call to action for the traumatic stress research community and individual researchers and research teams to help achieve this vision.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
The revision of Acute Stress Disorder (ASD) in the DSM‐5 (DSM‐5, 2013) proposes a cluster‐free model of ASD symptoms in both adults and youth. Published evaluations of competing models of ...ASD clustering in youth have rarely been examined.
Methods
We used Confirmatory Factor Analysis (combined with multigroup invariance tests) to explore the latent structure of ASD symptoms in a trauma‐exposed sample of children and young people (N = 594). The DSM‐5 structure was compared with the previous DSM‐IV conceptualization (4‐factor), and two alternative models proposed in the literature (3‐factor; 5‐factor). Model fit was examined using goodness‐of‐fit indices. We also established DSM‐5 ASD prevalence rates relative to DSM‐IV ASD, and the ability of these models to classify children impaired by their symptoms.
Results
Based on both the Bayesian Information Criterion, the interfactor correlations and invariance testing, the 3‐factor model best accounted for the profile of ASD symptoms. DSM‐5 ASD led to slightly higher prevalence rates than DSM‐IV ASD and performed similarly to DSM‐IV with respect to categorising children impaired by their symptoms. Modifying the DSM‐5 ASD algorithm to a 3+ or 4+ symptom requirement was the strongest predictor of impairment.
Conclusions
These findings suggest that a uni‐factorial general‐distress model is not the optimal model of capturing the latent structure of ASD symptom profiles in youth and that modifying the current DSM‐5 9+ symptom algorithm could potentially lead to a more developmentally sensitive conceptualization.
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