Child posttraumatic stress symptoms in an acute injury sample: Patterns of associations among child report,parent report,and child heart rate parameters

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.     

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.     

Maternal Symptomatology and Parent–Child Relationship Functioning in a Diverse Sample of Young Children Exposed to Trauma

Children under the age of 6 years are disproportionately exposed to interpersonal trauma. Research describing type and frequency of exposure to trauma among this young population is limited. Additionally, few studies have assessed the role of multiple indicators of parental functioning on children's behavior following trauma exposure. The current study was conducted with 216 ethnically and socioeconomically diverse mother–child dyads to examine the impact of maternal symptoms and parent–child functioning on child's behavior after trauma exposure. Children experienced an average of over 5 traumatic events prior to age 6 years, and mothers had experienced an average of over 13 traumatic events during their lifetime. With child's trauma history in the model, maternal depressive symptomatology (β = .30) and parent–child dysfunction (β = .32) each uniquely accounted for variance in children's behavioral and emotional functioning. The findings of this study underscore the need for clinical interventions that address the parent–child relationship and parental symptomatology following young children's exposure to trauma.     

Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.

Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia. Methods After ethics committee approval 40 children aged 2–10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)( 2 ) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer ( 3 ). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)( 4 ) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)( 5 ). Normally distributed data were analysed by a two-sample t-test, categorical data by Pearson's Chi-squared test and non-parametric data by the Wilcoxon rank-sum test. Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationship to child and level of education. There were no significant differences in child anxiety or cooperation during induction measured by mYPAS and ICC between the control and intervention groups. More parents in the preparation group distracted their child than those without preparation but this did not reach significance. Parental anxiety immediately postinduction was similar between groups as was the level of parental satisfaction. The incidence of development of new negative postoperative behaviour of the child at one week was not significantly different between groups. Discussion This study shows that giving an active role for parents in the induction room, particularly by instructing them on distracting techniques for their child, does not reduce their child's anxiety compared to conventional parental presence. We conclude resources should not be directed at this type of parental preparation. Further work should examine the usefulness of distraction by nursing staff or play specialists during anaesthetic induction.     

Association Between Parents’ PTSD Severity and Children's Psychological Distress: A Meta‐Analysis

The authors conducted a meta‐analysis of studies on the correlation between parents’ PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty‐two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self‐report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent–child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent–child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.     

Development and Evaluation of the Thinking About Recovery Scale: Measure of Parent Posttraumatic Cognitions Following Children's Exposure to Trauma

Researchers have recently suggested that parent posttraumatic appraisals potentially contribute to the development of posttraumatic stress in both parents and children following children's exposure to trauma. However, a single‐instrument, multidimensional measure of parent posttraumatic cognitions as they relate to their child's recovery has yet to be operationalized. This study described the development and evaluation of a parent‐report questionnaire of parent posttraumatic cognitions, designed to be used after a child's exposure to trauma. We generated an initial pool of items in reference to existing theories and subjected this list to an iterative process of item writing and revision. Items were subjected to expert review to maximize construct validity. The 33‐item Thinking About Recovery Scale (TARS), which measures three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated good internal consistency (Cronbach's α = .74‐88) and convergent validity (r ² range = .08‐.40) when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. The TARS augments the available literature by providing a brief measure of parent posttraumatic cognitions, an area which is currently understudied in childhood posttraumatic stress and could have broad clinical and research use.     

Parenting stress in caregivers of children with chronic physical condition—A meta‐analysis

On the basis of the parenting stress model we compared levels of parenting stress in families with and without a child with a chronic physical condition and analysed correlates of parenting stress in families with a child with a chronic condition. A systematic search through electronic databases identified 547 relevant studies that were included in a random‐effects meta‐analysis. Parents of children with a chronic condition showed small to moderate elevations of general parenting stress and stress related to the parent–child relationship in particular. They showed moderate to large elevations in health‐related parenting stress. Parents of children with cancer, cerebral palsy, HIV infection or AIDS, and spina bifida showed the highest levels of parenting stress. Stress levels also varied by illness severity and duration, child age, parental gender and mental health, marital status, marital quality, and levels of perceived support. Behaviour problems of the child and low parental mental health were the strongest correlates of parenting stress. The present results assist with identifying parents at highest needs for interventions aimed at reducing parenting stress. These interventions should address the reduction of child behaviour problems, the promotion of parental mental health, the increase in marital quality and social support in general, and skills for dealing with stressors.     

Developmental Trauma and Its Correlates: A Study of Chinese Children With Repeated Familial Physical and Sexual Abuse in Hong Kong

The present study examined the relevance of the developmental trauma disorder (DTD) framework (van der Kolk, 2005 ) in Hong Kong Chinese children with repeated familial physical and/or sexual abuse. Self‐reports of (a) key dimensions of DTD including emotion regulation, attribution and perceptions in self and relationships, belief in future victimization, behavioral difficulties, and self‐esteem; and (b) attachment styles and posttraumatic stress disorder (PTSD) reactions were obtained from children aged 9–15 years in clinical and school settings. Children were categorized into an abused trauma group (n = 82), a nonabused trauma group (n = 83), and a no‐trauma control group (n = 201). The findings indicated that the DTD framework was applicable to abused children who showed a lower level of attachment security (Cohen's d from 0.50–0.61) and a higher level of PTSD reactions (Cohen's d = 0.71) than the comparison groups. After adding attachment security and emotion dysregulation to the model, there were no longer significant group differences in most of the variables.     

The (TAAAA)n polymorphism of sex hormone‐binding globulin gene is not associated with testicular maldescent

The aim of this family‐based study was to investigate the potential association/genetic linkage of the (TAAAA)_n polymorphism of sex hormone‐binding globulin gene proximal promoter with testicular maldescent (TMD). Genomic DNA was extracted from the peripheral blood of 487 subjects (174 index families): (i) 180 children with all phenotypes of TMD, (ii) 307 parents (156 mothers and 151 fathers). Conventional polymerase chain reaction amplification products were electrophoresed on 10% nondenaturating polyacrylamide gel and visualised by silver staining. After excluding ambiguous parental–child trios and most cases of index families with missing parental genotypes, 429 individuals were left for analysis: 138 completely typed nuclear families (five included a second affected child) and five child–parent couples (one parent missing). Eight fathers presented history of TMD, that is, a total of 156 cases with TMD were analysed. Alleles were analysed with the affected family‐based control method and logistic regression‐based extension of the transmission disequilibrium test for multiallelic loci. (ΤΑΑΑΑ)_n polymorphism analysis revealed six alleles based on repeat numbers (n = 5–10). No association/genetic linkage between the (TAAAA)_n polymorphism and TMD was detected. Other factors should be investigated to potentially explain the genetic predisposition that seems to exist in at least a subgroup of these patients.     

Patterns of Multiple Victimization Among Maltreated Children in Navy Families

The current study examined the cumulative risk associated with children's exposure to multiple types of parent‐inflicted victimization. The sample was comprised of 195 children who were 7 to 17 years old (64.1% female and 48.2% non‐White) at the time of referral to the United States Navy's Family Advocacy Program due to allegations of sexual abuse, physical abuse, or parental intimate partner violence. We conducted an exploratory latent class analysis to identify distinct subgroups of children based on lifetime victimization. We hypothesized that at least 2 classes or subgroups would be identified, with 1 characterized by greater victimization and poorer outcomes. Results indicated that 3 classes of children best fit the data: (a) high victimization across all 3 categories, (b) high rates of physical abuse and witnessing intimate partner violence, and (c) high rates of physical abuse only. Findings indicated that the high victimization class was at greatest risk for alcohol and substance use, delinquent behavior, and meeting criteria for posttraumatic stress disorder (PTSD) and/or depression 1 year later (odds ratio = 4.53). These findings highlight the serious mental health needs of a small but significantly high‐risk portion of multiply victimized children entering the child welfare system.     

Parent Discrepancies in Ratings of Child Behaviors Following Wartime Deployment

Researchers have shown that parents often disagree in their ratings of their children's behavior, and that these discrepancies are typically related to child and family characteristics (e.g., child's age, parent psychopathology). Few studies, however, have examined discrepancies in how mothers and fathers rate child behavior during a stressful family context such as a parent's wartime deployment. The present study of 174 military families (children aged 6 to 11 years; 54.0% female) examined whether family factors (parental sense of control, marital satisfaction) and contextual risk factors related to a parent's wartime deployment (number and length of deployments, battle experiences, and posttraumatic stress disorder [PTSD] symptoms) were associated with discrepancies in how mothers and fathers rated internalizing and externalizing behaviors in their children. Using a latent congruency model, our results showed that when parents self‐reported higher levels of PTSD symptoms, both mothers, β = ?.33, p = .021, and fathers, β = .41, p = .026, tended to also report higher levels of internalizing symptoms in their child, relative to what their spouse reported. In comparison to mothers, fathers also tended to report higher levels of child externalizing symptoms, β = .44, p = .019. Our findings may help clinicians understand how parent mental health within a stressful family context relates and/or informs a parent's ratings on assessments of his or her child's internalizing and externalizing symptoms.     

Children's Memories of Removal: A Test of Attachment Theory

We report a study of parents’ attachment orientations and children's autobiographical memory for an experience that according to Bowlby's (1982) attachment theory should be particularly threatening—children's forced separation from their parents. It was hypothesized that individual differences in parents’ attachment orientations would be associated with children's distress and memory for this highly traumatic event. Children (n = 28) were observed during forced removal from home or school by Child Protective Services due to allegations of child maltreatment. Children's memory for the removal was tested 1 week later, and biological parents (n = 28) completed an adult attachment measure. Parental attachment anxiety significantly predicted children's distress during less stressful phases of the removal, R² = .25, and parents’ attachment‐related avoidance predicted fewer correct memory reports from the children (i.e., fewer hits to open‐ended questions, R² = .16, and fewer hits to direct questions, R² = .27). The findings indicate that attachment theory provides important guidance for understanding children's autobiographical memory for traumatic events.     

Association of Posttraumatic Growth and Illness‐Related Burden With Psychosocial Factors of Patient,Family, and Provider in Pediatric Cancer Survivors

Research has indicated that childhood cancer may lead to posttraumatic growth (PTG), given cancer's association with posttraumatic stress. PTG may be associated with family/home and health care dynamics, as well as parental resilience, distress, and coping. This cross‐sectional study investigated the associations of psychosocial factors of the patient, family, and health care team with PTG and illness‐related burden (IRB) in childhood cancer survivors. The sample comprised 61 children and adolescents (7–18 years of age), their parents, and their nurses. Respondents completed their assessment an average of 1.73 years after the end of treatment for the child's disease, which was either leukemia, a solid tumor, or lymphoma. Regression analyses showed that PTG was positively associated with the patients’ posttraumatic stress symptoms. It was also positively associated with the parents’ religious coping, and with measures of stronger family and oncologist relationships (R² = .32). IRB was positively associated with patient‐reported posttraumatic stress symptoms, negatively associated with the nurse's trust in the family, and positively associated with parent‐reported mental distress, lower family socioeconomic status, and female gender (R² = .53). There was no significant association with parenting style or parent‐reported posttraumatic stress symptoms in the child. The findings suggested that the young cancer patient's psychosocial and resource milieu (e.g., financial) may be instrumental in PTG and IRB. Psychosocial interventions with high‐risk families and their health care teams could increase growth and reduce burden.     

Investigating the Association Between Parental Absence and Developmental Trauma Disorder Symptoms

The importance of parent‐child relationships in social and emotional development is well established. The current study examined the vulnerability to developmental trauma disorder (DTD) symptoms for children who were left behind by their parents due to migration. Using samples from China, we investigated the change pattern of DTD symptoms with respect to scales for affect–physical dysregulation, self‐dysregulation, and behavioral dysregulation among left‐behind children in comparison to their peers. The results of a hierarchical linear model analysis indicated that there were no statistically significant differences in affect‐physical dysregulation, self‐dysregulation, or behavioral dysregulation between left‐behind children and their counterparts at age 13, η_p² = .00–.013. However, DTD symptoms worsened over time for left‐behind children, with a larger mean score difference in DTD symptoms at 18 years of age, η_p² = .24–.43. The results suggest a possible link between impaired caregiving systems and DTD symptoms. Early prevention efforts would benefit these children before they develop more serious psychosocial problems in the future.     

Pediatric Health‐Related Quality of Life: Feasibility,Reliability and Validity of the PedsQL™ Transplant Module

The measurement properties of the newly developed Pediatric Quality of Life Inventory? (PedsQL?) 3.0 Transplant Module in pediatric solid organ transplant recipients were evaluated. Participants included pediatric recipients of liver, kidney, heart and small bowel transplantation who were cared for at seven medical centers across the United States and their parents. Three hundred and thirty‐eight parents of children ages 2–18 and 274 children ages 5–18 completed both the PedsQL? 4.0 Generic Core Scales and the Transplant Module. Findings suggest that child self‐report and parent proxy‐report scales on the Transplant Module demonstrated excellent reliability (total scale score for child self‐report α= 0.93; total scale score for parent proxy‐report α= 0.94). Transplant‐specific symptoms or problems were significantly correlated with lower generic HRQOL, supporting construct validity. Children with solid organ transplants and their parents reported statistically significant lower generic HRQOL than healthy children. Parent and child reports showed moderate to good agreement across the scales. In conclusion, the PedsQL? Transplant Module demonstrated excellent initial feasibility, reliability and construct validity in pediatric patients with solid organ transplants.     

Acute stress disorder and posttraumatic stress disorder in parents of injured children

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.     

Parental Wartime Deployment and Socioemotional Adjustment in Early Childhood: The Critical Role of Military Parents’ Perceived Threat During Deployment

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3–6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers’ trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers’ perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, β = .36, p = .007. The association between fathers’ perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent–child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.     

Psychological characteristics and physiological reactivity to acute stress in mothers of children with autism spectrum disorder

Stress related to parenting a child with autism spectrum disorder can differently affect caregiver's physiological reactivity to acute stress. Here, parental stress levels, psychological characteristics, and coping strategies were assessed alongside measures of heart rate, heart rate variability, and cortisol during a psychosocial stress test in mothers of children with ASD (M‐ASD, n = 15) and mothers of typically developing children (n = 15). M‐ASD reported significantly higher levels of parental stress, anxiety, negative affectivity, social inhibition, and a larger preference for avoidance strategies. M‐ASD showed larger heart rate and cortisol responses to the psychosocial stress test. A positive relationship was found between parental stress levels and the magnitude of the cortisol stress response in both groups. The present findings indicate exaggerated physiological reactivity to acute psychosocial stress in M‐ASD and prompt further research to explore the role of individual differences in mediating the effects of parental stress on physiological stress responses.     

Narrative exposure therapy for 7‐ to 16‐year‐olds: A randomized controlled trial with traumatized refugee children

The authors examined the effectiveness of narrative exposure therapy for children (KIDNET) in treating posttraumatic stress disorder (PTSD) in refugee children living in exile. Twenty‐six children traumatized by organized violence were randomly assigned to KIDNET or to a waiting list. Significant treatment by time interactions on all PTSD‐relevant variables indicated that the KIDNET group, but not the controls, showed a clinically significant improvement in symptoms and functioning. Success of the KIDNET group remained stable at 12‐month follow‐up. This study confirms previous findings that, if left untreated, PTSD in children may persist for an extended period. However, it also shows that it is possible to effectively treat chronic PTSD and restore functioning in traumatized refugee children in only 8 treatment sessions.