Are the dissociative criteria in ASD useful?

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.     

Correlates of acute stress disorder in cancer patients

This study investigated the correlates of acute stress disorder (ASD) following a diagnosis of cancer. Adults diagnosed with first onset head, neck, or lung malignancy (N = 82) were assessed within one month of diagnosis using the ASD Interview, and the Structured Clinical Interview for DSM-IV to index the incidence of ASD and other affective disorders following their cancer diagnosis. Participants were also administered questionnaires that assessed dissociative symptoms, coping strategies, and quality of life. Acute stress disorder was diagnosed in 28% of participants. Acute stress disorder severity was associated with gender, elevated dissociative responses, trait anxiety, and preoccupation with one's diagnosis, and a decline in cognitive functioning. This study provides evidence for identifying recently diagnosed cancer patients who may benefit from psychological assistance.     

The acute stress disorder in the paediatric surgical children and adolescents injured in the Wenchuan earthquake of China

The aim of the present study was to investigate the prevalence and the symptoms of acute stress disorder (ASD) in the paediatric surgical children and adolescents injured in the Wenchuan earthquake of China. One hundred and eighteen children and adolescent inpatients were surveyed by the Acute Stress Disorder Scale (ASDS) within 1 month of the earthquake. Using the validated ASDS score above cut‐off threshold levels, the incidence of ASD in this sample was 54.3 per cent. The morbidity of ASD were 56.1, 24.6 and 19.3 per cent in the child group, in the early adolescent group and in the middle adolescent group, respectively. There was no significant difference among the three age groups about the severity of ASD symptom. The proportions of ASD‐positive were 44.0 per cent in males and 63.6 per cent in females that showed significant difference. The exposure risk factors were being buried in the earthquake, injury of parent, injury of relatives, amputation and operation. These results indicated that ASD was widely prevalent among the children and adolescents wounded in the earthquake, which needed an effective psychosocial intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Acute stress disorder in the paediatric surgical children and adolescents injured during the Wenchuan earthquake in China

The aim of the present study was to investigate the prevalence and symptoms of acute stress disorder (ASD) in the paediatric surgical children and adolescents injured during the Wenchuan earthquake in China. One hundred eighteen children and adolescent inpatients were surveyed by the ASD scale (ASDS) within 1 month of the earthquake. Using the validated ASDS score above cut‐off threshold levels, the incidence of ASD in this sample was 54.3 per cent. The morbidity of ASD were 56.1, 24.6 and 19.3 per cent in the child, in the early adolescent and in the middle adolescent, respectively. There was no significant difference among the three age groups about the severity of ASD symptom. The proportions of ASD positive were 44.0 per cent in boys and 63.6 per cent in girls that showed significant difference. The exposure risk factors were being buried in the earthquake, injury of parent, injury of relatives, amputation and operation. These results indicated that ASD was widely prevalent among the children and adolescents wounded in the earthquake, which needed an effective psychosocial intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Dissociative Symptoms in Acute Stress Disorder

This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.     

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

This project aimed to develop and validate a brief, practical self-report measure of acute stress disorder (ASD) reactions (including ASD diagnostic criteria) in children and adolescents. A draft measure was reviewed for content validity by an expert panel, piloted with youth, and revised for clarity and coverage of key constructs. The new 29-item Acute Stress Checklist for Children (ASC-Kids) was administered to 176 youth age 8 to 17 who had a recent injury or intensive care unit admission. The ASC-Kids demonstrated strong test-retest reliability and internal consistency, as well as concurrent and predictive validity with other traumatic stress measures. Results of exploratory factor analyses were consistent with current conceptualizations of acute traumatic stress reactions. The ASC-Kids is a promising measure of child acute stress reactions.     

Posttraumatic stress and related symptoms among neglected and physically and sexually maltreated adolescents

Posttraumatic stress disorder (PTSD) is common among maltreated youth, but few investigations compare neglect with other maltreatment types. This study examined 84 adolescents who experienced neglect only, physical and/or sexual maltreatment only, or neglect with physical and/or sexual maltreatment. Symptoms of PTSD, dissociation, and depression were measured. Adolescents who experienced physical and/or sexual maltreatment, whether neglected or not, reported significantly greater symptomatology than adolescents who experienced neglect only (η2 = .094). This difference applied to PTSD symptoms, dissociative amnesia, depersonalization and derealization, negative mood, and anhedonia. Adolescents exposed to neglect only displayed substantial psychopathology but less than that of other groups. The findings may reflect emerging cascade models of the etiology of symptoms of PTSD following extensive maltreatment history.     

Predictors of Acute and Posttraumatic Stress Symptoms in Parents Following Their Child's Cancer Diagnosis

This longitudinal study aimed to examine acute and posttraumatic stress symptoms and predictors of traumatic stress symptoms in parents of children recently diagnosed with cancer. The sample comprised 220 parents of 143 children who completed questionnaires at diagnosis (T1) focused on acute stress disorder (ASD); of these, 145 parents of 97 children completed questionnaires 6–8 months later (T2) focused on posttraumatic stress disorder (PTSD). Demographic, psychosocial, and treatment and illness variables were predictors. Results were that 63% of mothers and 60% of fathers met criteria for ASD at T1. At T2, 21% of mothers and 16% of fathers met criteria for PTSD, with 40% of parents reporting significant subthreshold symptoms. Predictors of ASD symptoms were female gender, presence of psychosocial risk factors, trait anxiety, family functioning, and central nervous system tumor diagnosis. Risk factors for PTSD symptoms were younger maternal age, severity of ASD symptoms, and trait anxiety at T1, and parent‐reported quality of life of the child at T2. The results suggest that screening for ASD may help identify parents at increased risk of persistent traumatic stress symptoms who could benefit from preventative, evidence‐based psychosocial interventions.     

Acute stress symptoms during the second Lebanon war in a random sample of Israeli citizens

The aims of this study were to assess prevalence of acute stress disorder (ASD) and acute stress symptoms (ASS) in Israel during the second Lebanon war. A telephone survey was conducted in July 2006 of a random sample of 235 residents of northern Israel, who were subjected to missile attacks, and of central Israel, who were not subjected to missile attacks. Results indicate that ASS scores were higher in the northern respondents; 6.8% of the northern sample and 3.9% of the central sample met ASD criteria. Appearance of each symptom ranged from 15.4% for dissociative to 88.4% for reexperiencing, with significant differences between northern and central respondents only for reexperiencing and arousal. A low ASD rate and a moderate difference between areas subjected and not subjected to attack were found.     

A diagnostic interview for acute stress disorder for children and adolescents

The goal of this study was to develop a semistructured clinical interview for assessing acute stress disorder (ASD) in youth and test its psychometric properties. Youth (N = 168) with an acute burn or injury were administered the acute stress disorder module of the Diagnostic Interview for Children and Adolescents (DICA‐ASD). The DICA‐ASD demonstrated strong psychometric properties, including high internal consistency (α = .97) and perfect diagnostic interrater agreement (κ = 1.00). Participants diagnosed with ASD scored significantly higher than those not diagnosed on validated traumatic stress symptomatology measures but not on other symptomatology measures, providing evidence of convergent and discriminant validity. Preliminary evidence supports the reliability and validity of the first semistructured clinical interview for diagnosing ASD in youth.     

Comparing Trauma Exposure,Mental Health Needs,and Service Utilization Across Clinical Samples of Refugee,Immigrant, and U.S.‐Origin Children

Most mental health services for trauma‐exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee‐origin, immigrant‐origin, and U.S.‐origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee‐origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity‐matched samples of immigrant‐origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.‐origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.‐origin youth (p < .001) or immigrant youth (p ≤ .001). Compared with U.S.‐origin youth, refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (p s ranging from .030 to < .001).This clinic‐referred sample of refugee‐origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning.     

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.     

An investigation of retrieval inhibition in acute stress disorder

Acute stress disorder is characterized by dissociative responses that are theorized to result in deficient encoding and retrieval of trauma-related material. This study examined retrieval inhibition using the list method of the directed forgetting paradigm in traumatized individuals with acute stress disorder (ASD; n = 14), no ASD (n = 14), and a nontraumatized control group (n = 15). Participants were presented with a list of intermixed positive, neutral, and trauma-related words. Instructions to forget that list and instead remember a second list were then given, and a new list presented. ASD participants exhibited poorer recall of to-be-forgotten trauma words than the non-ASD and control groups. The ASD group also demonstrated deficient recognition of to-be-remembered and to-be-forgotten positive words. Severity of acute posttraumatic stress response was associated with retrieval impairments. The cumulative findings suggest that ASD is associated with impoverished memory for trauma-related and positive material.     

High rates of acute stress disorder impact quality-of-life outcomes in injured adolescents: mechanism and gender predict acute stress disorder risk

BACKGROUND: Injury is the leading cause of death and functional disability in adolescent children. Little is known about quality of life and psychological outcomes after trauma in adolescents. The Trauma Recovery Project in Adolescents is a prospective epidemiologic study designed to examine multiple outcomes after major trauma in adolescents aged 12 to 19 years, including quality of life (QoL) and psychological sequelae such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). The specific objectives of the present report are to examine ASD rates and the association of ASD with QoL outcomes in injured adolescents. METHODS: Between April 26, 1999, and November 13, 2002, 401 eligible trauma patients aged 12 to 19 years triaged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study. The admission criteria for patients were as follows: (1) age 12 to 19 years and (2) injury diagnoses excluding severe traumatic brain injury (TBI) or spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range, 0 = death to 1.000 = optimum functioning). ASD (before discharge) was diagnosed with the Impact of Events Scale-Revised. Scores of 24+ were used to diagnose ASD. Patient outcomes were assessed at discharge and at 3, 6, 12, 18, and 24 months after discharge. RESULTS: ASD before discharge was diagnosed in 40% of adolescent trauma survivors. ASD status was associated with large QoL deficits during follow-up, as follows: 3-month, ASD-positive QWB score = 0.667 vs. ASD-negative QWB score = 0.710, p < 0.01; 6-month, ASD-positive QWB score = 0.704 vs. ASD-negative QWB score = 0.742, p < 0.001; 12-month: ASD-positive QWB score = 0.718 vs. ASD-negative QWB score = 0.757, p < 0.01; 24-month, ASD-positive QWB score = 0.725 vs. ASD-negative QWB score = 0.769, p < 0.01. Female sex and violent mechanism predicted ASD risk (47% female vs. 36% male; odds ratio, 1.6; p < 0.05; violence 54% vs. 38%; odds ratio, 1.9; p < 0.01). CONCLUSIONS: Adolescent trauma survivors have high rates of ASD. ASD severely impacts QoL outcomes and is associated with female sex and mechanism of injury in adolescents. Early recognition and treatment of ASD in seriously injured adolescents will improve QoL outcomes.     

Relationships of Dissociation and Childhood Abuse and Neglect with Heart Rate in Delinquent Adolescents

This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.     

Development and Psychometric Evaluation of Child Acute Stress Measures in Spanish and English

Clinicians and researchers need tools for accurate early assessment of children's acute stress reactions and acute stress disorder (ASD). There is a particular need for independently validated Spanish‐language measures. The current study reports on 2 measures of child acute stress (a self‐report checklist and a semistructured interview), describing the development of the Spanish version of each measure and psychometric evaluation of both the Spanish and English versions. Children between the ages of 8 to 17 years who had experienced a recent traumatic event completed study measures in Spanish (n = 225) or in English (n = 254). Results provide support for reliability (internal consistency of the measures in both languages ranged from .83 to .89; cross‐language reliability of the checklist was .93) and for convergent validity (with later PTSD symptoms, and with concurrent anxiety symptoms). Comparing checklist and interview results revealed a strong association between severity scores within the Spanish and English samples. Differences between the checklist and interview in evaluating the presence of ASD appear to be linked to different content coverage for dissociation symptoms. Future studies should further assess the impact of differing assessment modes, content coverage, and the use of these measures in children with diverse types of acute trauma exposure in English‐ and Spanish‐speaking children.     

Symptom Variation on the Trauma Symptom Checklist for Children: A Within‐Scale Meta‐Analytic Review

Trauma exposure in youth is widespread, yet symptom expression varies. The present study employs a within‐scale meta‐analytic framework to explore determinants of differential responses to trauma exposure. The meta‐analysis included 74 studies employing samples of youth exposed to traumatic events and who completed the Trauma Symptom Checklist for Children (TSCC). Mean weighted T scores across all TSCC subscales for U.S. samples ranged between 49 and 52. Youth outside the U.S. reported higher posttraumatic stress, anxiety, and depressive symptoms, whereas those exposed to sexual abuse reported the highest posttraumatic stress, anxiety, depressive, and dissociative symptoms. Higher female representation in samples was associated with higher symptoms on all TSCC subscales except anger. In contrast, ethnic minority representation was associated with lower depressive symptoms. Moderator analyses revealed that sexual abuse, increased percentage of females, and older age were all associated with higher posttraumatic symptoms. The present meta‐analytic results help elucidate some of the divergent findings on symptom expression in youth exposed to traumatic events.     

Dissociative Processes and Symptoms of Posttraumatic Stress in Vietnam Veterans

The diagnostic taxonomy of posttraumatic stress disorder (PTSD) is a contentious issue. Commentators are divided as to whether PTSD should remain grouped with the anxiety disorders or conceptualized as a dissociative disorder. This study sought to clarify the issue by investigating the extent to which anxiety and dissociative processes differentially predict the severity of each of the three symptom clusters in PTSD. Seventy-four Australian veterans of the Vietnam War were assessed on measures of dissociation, trait anxiety, and posttraumatic stress symptomatology. Multiple regression analyses showed that all three symptoms clusters were predicted by anxiety, but the clusters differed in the pattern of their relationship with dissociation variables. The failure of pathological dissociation to predict PTSD symptoms prompts a reconsideration of the point at which dissociative mechanisms may impact on this disorder. The findings are consistent with current classification of combat-related PTSD as an anxiety disorder.     

Peritraumatic Versus Persistent Dissociation in Acute Stress Disorder

The DSM-IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritraumatic, dissociation is associated with posttraumatic psychopathology.     

Bushfire impact on youth

The authors examined the association between disaster‐related traumatic experiences and posttraumatic stress disorder (PTSD) symptoms in 155 youth, aged 8–18 years, from the Lower Eyre Peninsula of South Australia who were affected by January 2005 bushfires. Youth completed measures of PTSD symptoms and disaster experiences 11–5 months postdisaster. Many youth (27%) reported moderate to severe levels of PTSD symptoms; younger children reported greater PTSD symptom severity than older youth. Perceived personal life threat and ongoing loss/disruption were related to greater PTSD symptomatology. Following disasters, it may be helpful to identify young children and youth who perceived that their life was threatened and experienced more ongoing life disruption, as these youth may be at higher risk for persistent PTSD symptoms.