Acute stress disorder symptoms in children and their parents after pediatric traffic injury.

Abstract

Objective. The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events, such as traffic crashes. One challenge in effectively iden- tifying children and their parents with troubling psycho- logical responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events, making identification of adverse child responses difficult. Within the first month after a trau- matic event, individuals may display reexperiencing, avoidance, and hyperarousal symptoms as well as disso- ciation (eg, feelings of unreality or emotional numbing). The presence of these responses, collectively known as acute stress disorder (ASD), alerts providers to those who may be at risk for ongoing difficulties. For beginning to develop an evidence base to guide pediatric care provid- ers in addressing acute traumatic responses, the aim of the current investigation was to describe systematically the range and type of symptoms of ASD in children and their parents after pediatric traffic injury. Methods. A prospective cohort study was conducted of traffic-injured children, who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes, and their parents. All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study. After consent/ assent was obtained, children and their custodial parents (or guardians) were interviewed within 1 month after injury via a structured assessment to determine the cir- cumstances of the crash and the presence of ASD symp- toms. Relevant demographic and clinical information (eg, age, race, gender, date of injury) was abstracted from the medical records of subjects. A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian. All children completed the Child Acute Stress Questionnaire, and all parents completed the Stanford Acute Stress Reaction Questionnaire. Responses were scored for the presence of dissociation, reexperiencing, avoidance, and/or hyper- arousal symptoms as well as broad distress (symptoms present in every category). Results. Symptoms of ASD were commonly observed in the children and parents. Eighty-eight percent of chil- dren and 83% of parents reported having at least 1 clin- ically significant symptom; this affected 90% of the fam- ilies. Broad distress was observed for a large minority: 28% of children and 23% of parents. No statistically sig- nificant association was found between child broad dis- tress and either child age (r 0.12) or child injury severity score (r 0.05). 2 analyses revealed no signif- icant association between broad distress and child gen- der, child race, or mechanism of injury. No statistically significant association was found between parent broad distress and child age (r 0.06) or child injury severity score (r 0.09). 2 analyses revealed no significant asso- ciation between parent broad distress and child gender or parent presence at the crash scene. Associations were found between parent broad distress and race in that fewer white parents reported broad distress. In addition, mechanism of injury was associated with parent broad distress: more parents reported broad distress when their children were involved in pedestrian-motor vehicle crashes, and fewer parents reported broad distress when their children were injured in a bicycle fall. Conclusions. Pediatric care providers can expect to see some ASD symptoms in most children and parents in the immediate aftermath of traffic-related injury. Brief education is appropriate to explain that these symptoms are normal reactions that are likely to resolve. If symp- toms persist for >1 month or are particularly distressing