Posttraumatic Stress Symptoms In Children Research Articles

The Effect of Parent Group Sandplay Therapy on the Nepal Earthquake Survivors: Post-Traumatic Stress Symptoms, Parenting Stress and Psychological Well-Being of Parents as well as Post-Traumatic Stress Symptoms in Children*

People who have experienced property damage and loss from the Nepal earthquake in 2015 are living in a temporary tent area. These earthquake survivors experience symptoms of post-traumatic stress and exhibit altered thoughts and behaviors. This study was conducted on parents who reside in the tent city at Chuchepati and who have children aged from 7 to 17. For the group sandplay therapy program, the Impact of Events Scale-Revised, Child Report of Post-traumatic Symptoms, and the Parent Report of Post-traumatic Symptoms were administered. There were 24 individuals who agreed to participate in this study and whose child received 19 or more points from child post-traumatic symptom reports, along with 16 or more points from parent post-traumatic symptom reports, and 33 points from the IES-R. The results of this study indicate that parent group sandplay therapy is effective in reducing the symptoms of post-traumatic stress and parenting stress, and also in enhancing the psychological well-being of parents.

Posttraumatic Stress Symptom Trajectories Among Children After Disaster Exposure: A Review.

Natural disasters, such as hurricanes and floods, are increasing in frequency and scope. Youth exposed to disasters are at risk for developing posttraumatic stress symptoms (PTSS). However, not all youth who report initially elevated PTSS report persistent PTSS that last beyond the first three to six months postdisaster. Thus, it is crucial to understand how and why youth differ in their patterns of PTSS. This study reviewed the literature on children's postdisaster PTSS, evaluating the typical number and types of patterns for children's PTSS trajectories, as well as risk and protective factors predicting trajectory membership. This review identified eight empirical studies on youth PTSS trajectories following natural disasters; these studies included 8,306 children aged 3 to 18 years. All studies identified resilience, recovery, and chronic trajectories. Evidence for a delayed trajectory was mixed. Proportions of children falling into each trajectory varied widely across studies, but overall, resilience was the most prevalent trajectory. These findings were consistent across study factors (i.e., analytic strategy, assessment timing, and study selection criteria). Female gender, disaster exposure, negative coping, and lack of social support were significant risk factors for chronic trajectories across several studies. Future research should combine individual level participant data across studies of children's responses to disasters to better understand PTSS trajectories.

Posttraumatic Stress Symptoms in Preschool Children in Foster Care: The Influence of Placement and Foster Family Environment.

Children in foster care often experience traumatic events which increase their risk for posttraumatic stress symptoms (PTSS). Until now, no research has investigated the developmentally sensitive PTSS criteria for preschoolers among children in foster care. The current study estimated the prevalence of potentially traumatic experiences and clinical PTSS in German foster care children aged 3 to 7 years. The foster parents of 324 children completed questionnaires about children's PTSS, foster parental stress, parenting, and family functioning. Linear regression models tested trauma-related variables, placement history, and foster family characteristics as predictors of PTSS. Approximately 45.4% of the foster children had experienced at least one traumatic event and 15.4% had clinical PTSS. Physical abuse, β = .34, p<.001; hospitalization, β = -.17, p = .026; witnessing someone being hurt, β = -.15, p = .047; and parental stress, β = .43, p<.001, were significantly associated with PTSS. Results demonstrate the impact the foster family has on children who are coping with trauma, and suggest the necessity of trauma-sensitive trainings for foster parents, with stress management as an important component.

Respiratory Sinus Arrhythmia in Cognitive Behavioral Therapy for Posttraumatic Stress Symptoms in Children: Preliminary Treatment and Gender Effects.

Cognitive behavioral therapy (CBT) is an efficacious treatment for posttraumatic stress disorder (PTSD) symptoms, but the effect of CBT on physiological indicators is largely unknown. Respiratory sinus arrhythmia (RSA) is an established parasympathetic marker of self-regulatory capacity and stress responsivity. The present study tested if and how resting RSA and RSA reactivity changed following treatment among a sample of children (n = 48) who experienced at least one traumatic event and presented with PTSD symptoms. RSA reactivity was measured in response to personalized trauma-related scripts. Results indicated that changes in RSA after treatment were dependent on pretreatment resting levels of RSA, with individuals with high and low pretreatment resting RSA levels appearing to converge over time in both resting RSA and RSA reactivity by the 3-month follow up. Specific to RSA reactivity, a sex difference was evident, as following treatment, females showed less RSA withdrawal whereas males showed more RSA withdrawal. PTSD symptoms were significantly reduced after CBT but symptom change was not associated with pretreatment resting RSA levels. Overall, these results suggest that there may be multiple physiological patterns within children with PTSD and the direction of the physiological changes after CBT may depend on initial differences in resting RSA levels.

Hair cortisol in relation to acute and post-traumatic stress symptoms in children and adolescents

ABSTRACTBackground: We report on the preliminary results of two independent studies that (1) compare the hair cortisol concentrations (HCC) of healthy controls with patients displaying post-traumatic stress symptoms (PTSS, study 1+2), (2) investigate whether pre-trauma HCC are predictive for the development of acute stress symptoms (ASS) and PTSS (study 1) and (3) determine whether HCC correlate with PTSS in a clinical sample of children (study 2).Methods: In study 1, the clinical symptoms of 35 minors were examined one (T1) and seven weeks (T2) after surgery following an accident. Hair samples were taken after the accident that reflect cortisol secretion over the past three months before the accident (healthy controls). In study 2, HCC and PTSS symptoms were cross-sectionally assessed in 22 minors who had experienced a psychological trauma.Results: The HCC of patients with PTSS were lower than the HCC of healthy controls (study 1+2). Secondary analyses showed that HCC were significantly lower in male PTSS patients than in male healthy controls, whereas the HCC in females were comparably low in both groups. Pre-trauma HCC did not predict the total ASS and PTSS scores (study 1) and HCC were not directly related to the total PTSS scores (study 2).

Increasing Resource Parents\u2019 Sensitivity towards Child Posttraumatic Stress Symptoms: a Descriptive Study on a Trauma-Informed Resource Parent Training

Resource parents are often insufficiently prepared for recognizing and managing posttraumatic stress symptoms (PTSS) in their traumatized foster children, which can put a successful foster placement at risk. The Resource Parent Curriculum (RPC) developed by the National Child Traumatic Stress Network is designed to increase resource parents’ sensitivity towards child PTSS. This study explores the effect of the RPC on resource parents’ recognition of child PTSS, resource parents’ perceived upbringing stress in caring for their foster child, and child PTSS before entering the RPC (T0), after completing the RPC (T1) and at six-month follow-up (T2). Results (n = 108) show an increase in recognition of child PTSS and a decrease in resource parents’ experienced upbringing stress and child PTSS over time. Findings suggest that the RPC increases resource parents’ trauma sensitivity. However, child PTSS severity remains high. To address foster children’s PTSS, child trauma-focused treatment appears needed in addition to the RPC.

The Network Structure of Posttraumatic Stress Symptoms in Children and Adolescents Exposed to Disasters

To evaluate current theoretical assumptions about the nature of pediatric posttraumatic stress disorder (PTSD) by examining the network structure of PTSD in a sample of youth exposed to disasters and testing for age differences. Network analysis provides the opportunity to identify "central" symptoms that might hold an outsized influence over others and are important targets for research and treatment. The authors hypothesized that particular symptoms would exhibit greater influence over others. They further hypothesized marked differences in symptom networks across children and adolescents. Participants were 786 youth 8 to 13 years old (children) and 14 to 18 years old (adolescents) exposed to Hurricanes Katrina and Gustav who were assessed for PTSD symptoms using the University of California-Los Angeles PTSD Reaction Index for Children. Network models were computed and constructed using the R-package qgraph, which estimates associations between symptoms and forms graphic network models. Consistent with the hypotheses, the symptom network demonstrated meaningful variability across age, particularly in the strength of associations, and the relative importance of individual symptoms to the network as a whole. Results further demonstrated that symptoms cluster together in a manner that adds a unique perspective to current model conceptualizations. Network analysis is a potentially important additional conceptualization of psychopathology with related data analytic techniques. Results suggest that PTSD can be characterized as a web of interactions between symptoms. This work illuminates differences in the PTSD symptom network across development, such as the link between numbness of negative affect and amnesia in children, but not in teens, and how the critical symptoms within that network differ across childhood and adolescence. Network analysis could allow the re-envisioning of the nature of this complex disorder with new avenues for research and clinical practice.

Posttraumatic Growth in Children and Adolescents Exposed to the 2010 Earthquake in Chile and Its Relationship with Rumination and Posttraumatic Stress Symptoms

The aim of this study was to assess a predictive model of posttraumatic growth and posttraumatic stress symptoms in children and adolescents exposed to the earthquake in Chile in 2010. 325 children (47.4% male), aged between 10 and 15 years, were surveyed 12 months after the earthquake. The following tests were administered: the posttraumatic growth inventory for children in its brief version of Kilmer et al., the child PTSD symptom scale of Foa et al., the rumination scale for children of Crider et al., along with a scale to assess the trauma severity and a socio-demographic questionnaire. The model was assessed through a path analysis, which showed that deliberate rumination mediated the relationship between trauma severity and intrusive rumination with posttraumatic growth, that intrusive rumination mediated the relationship between the severity of the event and posttraumatic stress symptoms and that the latter mediated the relationship between intrusive rumination and posttraumatic growth. The sex was included as control variable in the path model. The final model achieved adequate fit indexes. The relevance of rumination processes for the development of the psychological consequences in children and adolescents following a natural disaster and their implications for clinical is discussed.

The relationship between processing style, trauma memory processes, and the development of posttraumatic stress symptoms in children and adolescents

Background and objectivesData-driven processing, peri-event fear, and trauma memory characteristics are hypothesised to play a core role in the development of Posttraumatic Stress Disorder. We assessed the relationships between these characteristics and Posttraumatic Stress (PTS) symptoms in a sample of youth. MethodsStudy 1 (N = 36, 7–16 years), involved a sample of children who had undergone a stressful orthopaedic procedure. One week later they answered a series of probed recall questions about the trauma (assessed for accuracy by comparison to a video) and reported on their PTS symptoms. They also rated confidence in their probed recall answers to assess meta-cognitive monitoring of their memory for the trauma. In Study 2, a sample of injured children (N = 57, 7–16 years) were assessed within 1-month of a visit to an Emergency Department, and then at 3-month follow-up. They answered probed recall questions, made confidence ratings, and completed measures of data-driven processing, peri-event fear, PTS and associated psychopathology. Memories were verified using witness accounts. ResultsStudies 1 and 2 did not find an association between PTS symptoms and trauma memory accuracy or confidence. In Studies 1 and 2 data-driven processing predicted PTS symptoms. LimitationsThe studies had modest samples sizes and there were ceiling effects for some accuracy and confidence items. ConclusionsData-driven processing at the time of a trauma was associated with PTS symptoms after accounting for fear at the time of the trauma. Accuracy of recall for trauma memories was not significantly related to PTS symptoms. No decisive conclusion could be drawn regarding the relation between confidence in trauma memories and PTS symptoms.

Relationship of medical treatment on acute posttraumatic stress symptoms in children following PICU admission

Relationship of medical treatment on acute posttraumatic stress symptoms in children following PICU admission

Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects.

Children and adolescents with a congenital heart defect (ConHD) frequently undergo painful or frightening medical procedures and hospitalizations. They often need multiple invasive procedures at a very young age and require regular checkups during their entire life. From other pediatric populations, it is known that these kinds of experiences can result in acute stress reactions and even in post-traumatic stress disorder (PTSD) in the long-term. PTSD and also subthreshold PTSD can lead to serious (psychosocial) impairment. However, limited information is available about PTSD in children with ConHD. Therefore, the aim of this review is to provide a summary of the current literature on post-traumatic stress (PTS) in children and adolescents with ConHD describing the prevalence of PTSD and its predictors/correlates. This review indicates that a range of 12–31% of children undergoing cardiac surgery develop PTSD. A range of 12–14% shows elevated post-traumatic stress symptoms (PTSS). These findings are comparable to those of hospitalized children without ConHD. Noteworthy, most studies used varying self-report questionnaires to measure PTSD and only one study used a semistructured interview. Although all studies point in the same direction of elevated PTSD and PTSS, systematic research is necessary to be able to draw firm conclusions. At present, as far as we know, in most clinics treating patients with ConHD, there is no regular screening for PTS in children with ConHD. In the reviewed literature, there is strong consensus that screening for PTSS and (preventive) psychological care for children and adolescents with ConHD is urgently needed.

Effect of a group intervention for children and their parents who have cancer.

Although support programs for children whose parents have cancer have been described and evaluated, formal research has not been conducted to document outcomes. We adapted a group intervention called CLIMB®, originally developed in the United States, and implemented it in Tokyo, Japan, for school-aged children and their parents with cancer. The purpose of this exploratory pilot study was to examine the feasibility, acceptability, and impact of the Japanese version of the CLIMB® Program on children's stress and parents' quality of life and psychosocial distress. We enrolled children and parents in six waves of replicate sets for the six-week group intervention. A total of 24 parents (23 mothers and 1 father) diagnosed with cancer and 38 school-aged children (27 girls and 11 boys) participated in our study. Intervention fidelity, including parent and child satisfaction with the program, was examined. The impact of the program was analyzed using a quasiexperimental within-subject design comparing pre- and posttest assessments of children and parents in separate analyses. Both children and parents experienced high levels of satisfaction with the program. Children's posttraumatic stress symptoms related to a parent's illness decreased after the intervention as measured by the Posttraumatic Stress Disorder-Reaction Index. No difference was found in children's psychosocial stress. The Functional Assessment of Chronic Illness Therapy scores indicated that parents' quality of life improved after the intervention in all domains except for physical well-being. However, no differences were found in parents' psychological distress and posttraumatic stress symptoms. Our results suggest that the group intervention using the CLIMB® Program relieved children's posttraumatic stress symptoms and improved parents' quality of life. The intervention proved the feasibility of delivering the program using manuals and training. Further research is needed to provide more substantiation for the benefits of the program.

Social support, negative maltreatment-related cognitions and posttraumatic stress symptoms in children and adolescents

Social support by family, friends and significant others is known to buffer the impact of adverse life events on children's well-being and functioning, however little is known about pathways explaining this association. We investigated whether maltreatment-related cognitions mediate the association between social support and posttraumatic stress symptoms (PTSS). Furthermore, age was introduced as moderator.We assessed the history of maltreatment in 200 maltreated children and adolescents (age 8–17 years) using a semi-structured interview. Participants’ perceived current social support, maltreatment-related negative cognitions related to the subjectively “worst” experience of maltreatment and PTSS during the past month were assessed using self-report questionnaires.A set of mediation analyses demonstrated, that negative maltreatment-related appraisals mediated the relation between perceived social support and PTSS. The hypothesized negative associations of social support with PTSS and dysfunctional cognitions did not differ between children (8–11;11 years) and adolescents (12–17;11 years). Thus, the protective function of social support after maltreatment can be explained by fewer negative beliefs maltreated youth have about themselves and the world. These results provide support to models of social-cognitive processing and emphasize the importance of cognitive coping in regard to episodes of maltreatment which can be shaped within social interactions with non-abusive caregivers, friends, and significant others.

Coping and posttraumatic stress symptoms in children with food allergies

Coping and posttraumatic stress symptoms in children with food allergies

Self-Blame and Avoidance Coping as Predictors of Post-Traumatic Stress Symptoms Among Sexually Abused Children

Abstract BACKGROUND: Child sexual abuse is clearly associated with posttrau-matic stress symptoms (PTSS). Prior studies have identified self-blame and coping as important predictors of PTSS among adult survivors of sexual assault. However, few studies have explored the potential impact of self-blame and avoidance coping in influencing PTSS in children who have disclosed sexual abuse. OBJECTIVES: This study attempted to test the contribution of self-blame and avoidance coping to the prediction of PTSS among sexually abused children. The severity of the abuse and child’s gender were also examined. DESIGN/METHODS: The sample consisted of 477 sexually abused children (319 girls and 128 boys), aged 6 to 12. Self-blame and PTSS were evaluated by the Children’s Impact of Traumatic Events Scale II. A brief version of the Self-Report Coping Scale was used to assess children’s coping avoidance. These questionnaires were child self-report measures. The severity of the abuse was categorized as (1) less severe (physical contact over clothing), (2) severe (physical contact under clothing without penetration or force) and (3) more severe (physical contact with penetration or attempted penetration). Linear regression analysis was used to test the contribution of self-blame and avoidance coping to the prediction of PTSS. First, the child’s gender and the severity of the abuse were entered, and secondly, self-blame and avoidance coping. RESULTS: A total of 10.7% of the sample reported less severe sexual abuse, 27.7% reported severe sexual abuse and 61.6% reported more severe abuse. The model which only included child’s gender and severity of the abuse explained 3.8% of the variance (F=9.04, p&amp;lt;0.001) in PTSS. Adding self-blame and avoidance coping, the proportion of explained variance increased to 35.1% (F=56.62%, p&amp;lt;0.001). Being a girl (beta=0.15, p&amp;lt;0.001), reporting high levels of self-blame (beta=0.26, p&amp;lt;0.001) and using avoidance coping (beta=0.43, p&amp;lt;0.001) were predictors of PTSS. The severity of the abuse was significant into the first model (beta=0.14, p=0.004), but not into the final one (beta=0.08, p=0.057). CONCLUSION: Results suggest that sense of self-blame and using avoidance coping are important targets for clinical intervention with sexually abused children, because these factors contribute to the prediction of PTSS among this vulnerable population.

Long-Term Fluctuations in Traumatic Symptoms of High School Girls Who Survived from the 2011 Japan Tsunami: Series of Questionnaire-Based Cross-Sectional Surveys.

On March 11, 2011, Japan was struck by a massive earthquake and tsunami. The tsunami caused tremendous damage and traumatized children. We aimed to evaluate and compare the changes in the traumatic symptoms of high school girls 8, 20, 30, and 42months after the 2011 tsunami. The Post-Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-rating questionnaire on traumatic symptoms, was administered to 811 high school girls at the above-mentioned intervals. We calculated the total score, post-traumatic stress disorder (PTSD) subscale, and depression subscale of PTSSC-15. The total score was correlated with house damage, evacuation experience, and bereavement experience. The PTSSC-15 total scores of high school girls with traumatic experience were significantly higher than the scores of children without these experiences (all p<0.0001). The PTSSC-15 total score did not decrease significantly over time. Furthermore, the PTSD subscale of the PTSSC-15 did not significantly improved over the study duration. However, the depression subscale of the PTSSC-15 significantly improved at 30months, but significantly worsened at 42months (both p<0.0001). This study demonstrates that the traumatic symptoms of high school girls who survived the massive tsunami fluctuated unpredictably with time. Nonetheless, high school girls continued to suffer depressive symptoms (insomnia, withdrawal, appetite loss, inattention, and physical symptoms) after 42months.

Behavior Problems and Post-traumatic Stress Symptoms in Children Beginning School: A Comparison of Pre- and Post-Earthquake Groups.

Introduction:Literature reviews caution that estimating the effects of disasters on the behavior of children following a disaster is difficult without baseline information and few studies report the effects of earthquakes on young children. In addition the relationship between age at the time of disaster and consequential behavior problems have not been reported for young children who experience disaster-related stress during a developmentally sensitive period.Methods:Behavior problems and symptoms of post-traumatic stress (PTS) were reported for two groups of children from nearby neighborhoods during their first term at school, using the Behavior Problem Index by teacher report, following approved informed consent procedures. Data on one group, “Pre-EQ” (N=297), was collected four years before the beginning of the earthquakes on children born 2001-2002. Data on the second group, “Post-EQ” (N=212), was collected approximately three to four years after the beginning of the earthquakes on children born 2007-2009 and living in heavily damaged neighborhoods. The Post-EQ group had significantly more children from high socioeconomic neighborhoods but no other significant differences on main demographic characteristics.Results:The mean behavior problem score was significantly higher in the Post-EQ group (Mean =6.11) as compared to the Pre-EQ group (Mean = 3.78). PTS symptoms were also significantly higher in the Post-EQ group (Mean =2.91) as compared to the Pre-EQ group (Mean=1.98) and more children had high PTS scores (20.9% v. 8.8%, OR= 2.73, 95%CI =1.57, 4.76). Model testing identified that a younger age at the time of exposure was the only significant predictor of high numbers of PTS symptoms in the Post-EQ group.Discussion: Rates of teacher-reported behavior problems in young children more than doubled following the Christchurch earthquakes. Younger children may be more vulnerable to the effects of earthquakes that occur during a developmentally sensitive period. Additional research is needed to consider the effects of age and duration of disaster effects to better understand the effects of disasters on children, their families and communities.

Traumatic Stress Symptoms in Children Exposed to Intimate Partner Violence: The Role of Parent Emotion Socialization and Children's Emotion Regulation Abilities

AbstractExposure to intimate partner violence (IPV) is a traumatic life event. Almost 50 percent of IPV‐exposed children show subsequent post‐traumatic stress symptoms (PTSS), and they are at increased risk for depression. We examined maternal emotion socialization and children's emotion regulation as a pathway that may protect IPV‐exposed children from developing PTSS and depression. Fifty‐eight female survivors of IPV and their 6‐ to 12‐year‐old children participated. Results showed no direct relations between maternal emotion socialization and child adjustment. However, several indirect effects were observed. Higher mother awareness and acceptance of sadness and awareness of fear predicted better child sadness and fear regulation, respectively, which in turn was related to fewer child PTSS. Similar indirect pathways were found with child depression. In addition, mothers’ acceptance and coaching of anger was associated with better child anger regulation, which related to fewer depression symptoms. Implications for prevention and intervention with high‐risk families are discussed.

Family Functioning and Children's Post-Traumatic Stress Symptoms in a Referred Sample Exposed to Interparental Violence.

This study examined the association between interparental violence (IPV), child abuse and neglect, other traumatic experiences, and children’s post-traumatic stress (PTS) symptoms and explored the moderating role of family functioning in the aftermath of IPV. One hundred and twenty IPV-exposed children (53.3 % male, M age = 9.85) and parents who were referred to community mental health centers participated in the study. Combined, IPV, child abuse and neglect, and other traumatic experiences were associated with PTS symptoms. For family functioning, higher levels of parenting stress were associated with higher levels of PTS symptoms. No moderating effects were found. To understand the variability in PTS symptoms among children exposed to IPV, other traumatic and stressful experiences need to be taken into account.

Preventing the detrimental effect of posttraumatic stress in young children: The role of theory of mind in the aftermath of a natural disaster

We conducted a field study to test whether parents' negative reactions to a natural disaster affected children's reactions, together with the factors buffering this negative influence. Specifically, we examined whether parents' posttraumatic stress symptoms following an earthquake were associated with children's posttraumatic symptoms and their use of negative coping strategies. Theory of mind (ToM) was tested as the factor allowing children to reduce the detrimental effects of posttraumatic stress symptoms on negative coping. Hypotheses were tested in a sample of elementary school children and their parents in the aftermath of the earthquakes that struck Northern Italy in 2012. Results revealed that mothers' (but not fathers') posttraumatic stress symptoms were positively associated with children's posttraumatic stress symptoms, which acted as mediator on the use of negative coping strategies by children, but only among children with low ToM abilities. We discuss the theoretical and practical implications of findings.