Posttraumatic Stress Disorder Symptoms In Children Research Articles

Validation of Patient-Reported Outcome Measurement Information System (PROMIS) for Detection of Posttraumatic Stress in Children and Adolescents Following Procedures for Acute Orthopaedic Trauma

OBJECTIVES: The efficiency and validity of PROMIS surveys were determined for pediatric orthopaedic trauma patients with posttraumatic stress disorder (PTSD) symptoms in a clinic setting. METHODS: Design: Prospective cohort study. Setting: Single-institution, Level I Trauma Center. Patient Selection Criteria: All consecutive children aged 8-18 years undergoing procedures or surgery for orthopaedic trauma. Outcome Measures and Comparisons: The convergent, divergent, and discriminant validity of the PROMIS Anger and Anxiety computerized adaptive tests (CATs) were evaluated and compared to the previously validated Child PTSD Symptom Scale (CPSS). The efficiency in time to completion of the outcome measures was compared between the CPSS and PROMIS surveys. Cutoffs for increased likelihood of PTSD were established for the PROMIS questionnaires. RESULTS: A total of 233 subjects were included in this study (mean age 13.1 years with SD 2.8 years, 71% male). The majority (51%) of injuries were sports-related and most (60%) involved the upper extremity. Of those included, 41 patients had high levels of PTSD symptoms on the CPSS (18%; 95% CI=13.1-23.2%). The CPSS took 182 (IQR 141-228) seconds versus 52 (IQR 36-84) and 52 (IQR 36-70) seconds for PROMIS Anger and Anxiety CATs, respectively. Convergent validity showed patient scores on both PROMIS instruments significantly correlated with CPSS scores (Anger: p<0.001, r=0.51; Anxiety: p<0.001, r=0.41). Neither PROMIS score correlated with UCLA Activity Score (Anger: r=-0.26; Anxiety: r=-0.22), a functional outcome measure, demonstrating divergent validity. Both PROMIS instruments sufficiently discriminated across PTSD risk groups (Anger p<0.001; Anxiety p<0.001). A score of at least 53 on PROMIS Anger or at least 48 on PROMIS Anxiety indicated an increased likelihood of PTSD risk. CONCLUSIONS: PROMIS Anger and Anxiety CATs are efficient and valid for evaluating posttraumatic stress in children following orthopaedic trauma procedures. LEVEL OF EVIDENCE: Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis.

Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.

501 Maternal PTSD and Child Brain Function During Implicit Emotion Regulation

OBJECTIVES/GOALS: Maternal mental health, such as post-traumatic stress disorder (PTSD), is closely linked to child mental health. PTSD in mothers is associated with their children’s emotional responses. We examined associations between maternal PTSD and child brain function during emotion regulation. METHODS/STUDY POPULATION: Eight children ages 10-12 years, whose mothers had trauma histories, performed the Emotional N-Back task during functional MRI scanning. Mothers and children each reported on their trauma exposure and PTSD symptom severity. BOLD response to fearful faces during the Emotional N-Back was extracted from two specific brain regions of interest, amygdala and anterior cingulate cortex. These regions are involved in emotional response and attentional control, which are processes intrinsic to emotion regulation. An independent samples t-test was conducted on children’s BOLD response to fearful faces, with maternal PTSD symptom severity (high, low) as the independent variable. A parallel analysis was conducted with child PTSD symptom severity (high, low) as the independent variable. RESULTS/ANTICIPATED RESULTS: We found a main effect of maternal PTSD within brain regions of relevance to implicit emotion regulation. Compared to children whose mothers reported low PTSD symptom severity (n=4), children whose mothers reported high PTSD symptom severity (n=4) showed greater responsiveness to fearful faces in anterior cingulate cortex (t=2.04, p=.09,d=1.44) and amygdala (t=2.44, p=.05, d=1.72) at trending significance. A parallel analysis with child PTSD symptom severity showed no differences in brain function by this factor (ps=.55-.61). DISCUSSION/SIGNIFICANCE: Our pilot study is the first, to our knowledge, to examine associations between maternal PTSD and brain function during emotion regulation in their children. This study lays a foundation for future work; our goal is to explore dysfunction in emotion regulation neurocircuitry as one mechanism linking maternal PTSD to their children’s mental health.

Longitudinal Associations between Pain, Risk for Posttraumatic Stress Disorder, Posttraumatic Stress Symptoms, and Pain Characteristics in Children After Unintentional Injury.

Around 20% of children demonstrate persistent posttraumatic stress symptoms (PTSS) after unintentional injury, with more severe pain intensity predicting concurrent and later PTSS. Examining additional pain characteristics like pain behaviors, impairment related to pain, and subjective experiences of pain might provide additional insight into the mechanisms that reinforce relationships between risk for Posttraumatic Stress Disorder (PTSD), PTSS, and pain. During hospitalization for unintentional injury, the Screening Tool for Predictors of PTSD (STEPP) was administered and highest pain score was collected. One month later, the Child PTSD Symptom Scale and PROMIS questionnaires assessed PTSS and pain characteristics respectively, including intensity, interference, behaviors, and quality. Correlations between PTSS and PROMIS questionnaires were significant. STEPP predicted future PTSS and all PROMIS questionnaires. Highest pain score predicted future PTSS, as well as pain interference and pain behavior, and did not predict pain intensity and pain quality. When STEPP and highest pain score were combined into a single regression, STEPP and highest pain score predicted future PTSS but only STEPP continued to predict all PROMIS questionnaires. PTSD risk significantly predicted PTSS and pain characteristics one month later. Highest pain score predicted future PTSS and several pain characteristics but no longer had predictive value for pain-related outcomes when combined with PTSD risk. These results indicate that risk factors for PTSD are stronger predictors than pain-related risk factors in predicting pain outcomes. Addressing PTSD risk, as well as pain intensity during hospitalization, may result in improved outcomes for children with unintentional injury.

Psychological implications of man-made trauma and efficacy of “Teaching Recovery Techniques” on children and adolescents exposed to trauma

Trauma is a mental state of distress and pain resulting from memories of an unexpected, terrifying experience that threatens the survivor's sense of security, especially in children. The present research aimed to examine the Psychological Implications of man-made trauma and the efficacy of Teaching Recovery Techniques (TRT) to children and adolescents exposed to trauma.The Study comprises two parts. First, it aimed to find out the relationship between Child trauma (ChT) and Post-Traumatic Stress and Depressive Symptoms (PSTD) in children and adolescents who were exposed to fire incidents and terrorist attacks. Non-probability Purposive sampling was used in which 80 participants (45 boys and 35 girls) aged 8—17 years were selected from Joseph Colony and Yohanabad Christian Community of Lahore, and the second aimed to assess the TRT on the children and adolescents exposed to terrorist attacks. The results revealed a significant positive relationship between ChT and PTSD in children and adolescents exposed to fire incidents and terrorist attacks. Significant differences were found between the two groups in PTSD symptoms experienced by the participants. Furthermore, participants exposed to terror attacks experienced more PTSD symptoms than fire attacks. Age and proximity to the traumatic incident were significant predictors of PTSD symptoms. The intervention was given in five sessions at the Sunday school of Christ Church Yohanabad Lahore, and the results were promising. It concludes that significant improvement in post-intervention reduces PTSD symptoms in children and adolescents. The study findings can be applied to other such man-made and natural traumas in the future.

PTSD in Children and Adolescents in the Educational Context. A Conceptual Approach

This paper explores the multifaceted aspects of Post-Traumatic Stress Disorder (PTSD) in children and adolescents within educational contexts. It investigates the complexity of diagnosing PTSD in this demographic, recognizing the role of cognitive function, expression barriers, and parental influence. Considering the diverse and unique presentations of PTSD symptoms in children, the study highlights the challenges in identifying and treating PTSD among school-age children and adolescents, especially among highly vulnerable populations such as refugees. Through an extensive review of existing literature, the paper compares and contrasts the criteria from DSM-5 and ICD-11 for PTSD diagnosis and evaluates the efficacy of treatment options such as EMDR, CBT, and school-based interventions. The impact of PTSD on academic performance and social integration is emphasized, underlining the implications for educators, mental health professionals, and policy makers. Furthermore, the study calls attention to the co-occurrence of PTSD with other mental health conditions and the significant effects beyond educational achievement, including developmental, social, and cognitive domains. Drawing on current research, it advocates for integrated intervention strategies that promote socio-emotional learning, and underscores the importance of a secure, supportive educational environment.

Joint developmental trajectories of depression and post-traumatic stress disorder symptoms among Chinese children during COVID-19

BackgroundIn early 2020, Chinese children started to demonstrate severe depression and post-traumatic stress disorder symptoms (PTSS) caused by lockdown and self-isolation (measures taken at the beginning of the COVID-19 pandemic). ObjectivesConcerning the significant impact of the pandemic on children's physical and mental development, the study aimed to explore children's depression and PTSS during the COVID-19 pandemic and the protective effects of family resilience on the trajectories. Methods883 children participated and completed three waves of online follow-up questionnaires. The latent growth mixture modeling (LGMM) analysis was used to explore the trajectories of children's depression and PTSS based on the individual approach. ResultsTwo types of depression trajectories were identified and defined as the resilient group (83.01 %) and the recovery group (16.99 %); Two types of PTSS trajectories were identified and defined as the resilient group (71.12 %) and the recovery group (28.88 %); Two types of the joint trajectories of depression and PTSS were identified and defined as the resilient group (83.47 %) and the chronic group (16.53 %). The results indicated that maintaining a positive outlook (a dimension of family resilience) was the potential predictor of PTSS trajectories. ConclusionThe trajectories of depression and PTSS among Chinese children during the COVID-19 pandemic were heterogeneous, and there were similar evolving subtypes. Family resilience could be a critical protective factor for children and families.

Effect of Acceptance and Commitment Therapy on Emotional Regulation, Psychological Flexibility, and Stress in Children of Veterans With PTSD: A Randomized Controlled Clinical Trial

Objectives The present study aims to investigate the effect of acceptance and commitment therapy (ACT) on emotional regulation, psychological flexibility, and symptoms of post-traumatic stress disorder (PTSD) in children of veterans with PSTD. Methods This is a randomized controlled clinical trial with a pre-test/post-test/follow-up design. Participants were 70 children of veterans with PTSD (boys and girls) aged 15-19 years, who were selected using simple random sampling method and randomly divided into two groups of 35 including ACT and control. Before, immediately after, and 12 months after the intervention, people were measured using the acceptance and action questionnaire-II, difficulty in emotional regulation scale, and the PTSD checklist for DSM-5. The intervention group received group ACT at 8 sessions of 60-90 minutes. For the control group, life skills education was presented at 7 sessions of 60-90 minutes. Finally, the data was analyzed using SPSS software, version 22. Results The results of analysis of covariance showed a significant difference in difficulty in emotional regulation, psychological flexibility and PTSD symptoms in the post-test and follow-up phases in two groups (P<0.01). Moreover, the two ACT and control groups were significantly different in the hyperarousal symptom of PTSD at follow-up phase, but there was no significant difference in two symptoms of re-experiencing trauma and negative alterations in mood/avoidance (P>0.05). Conclusion The ACT can improve emotional regulation skills and psychological flexibility and reduce PTSD symptoms in children of veterans with PTSD. Therefore, this method can be used in counseling and mental health centers to improve these children’s symptoms.

Post-traumatic stress disorder in adolescents during the COVID-19 pandemic: a cross-sectional Tunisian study

ObjectivesEvaluate the prevalence of post-traumatic stress disorder (PTSD) on Tunisian adolescents enrolled in secondary schools during the COVID-19 pandemic and to identify associated factors.MethodsWe conducted a cross-sectional, descriptive, and analytic study on a sample of Tunisian adolescents. Participants were randomly selected from two schools in the region of Hamma (southern of Tunisia). This survey took place during the period extending from 5 March to 26 May 2021. Students were asked to complete a pre-established information sheet which contains questions about socio-demographic features, medical history, knowledge about the pandemic of COVID-19, and personal or family history of being infected with this virus. The Child PTSD Symptom Scale (CPSS) was used to screen for PTSD among students.ResultsThe sample was composed of 326 students (92 boys and 234 girls; mean age 16.65 years). The prevalence of PTSD was 37.4% according to the CPSS. Adolescents had more PTSD symptoms when they lived in a conflictual family atmosphere (AOR = 3.1 [1.4–6.9]). Moreover, adolescents who were infected by the virus, or whose relatives were contaminated or dead because of the COVID-19 infection, were more likely to develop PTSD symptoms. We stated that students who estimated that their knowledge about the COVID-19 pandemic were insufficient had a significant higher risk for PTSD (AOR = 2.5 [1.4–4.6]).ConclusionStudents seemed to have high frequency of PTSD symptoms during the COVID-19 pandemic. The identification of risk and protective factors are interesting to guide screening and prevention actions.Key points• Adolescents were vulnerable to psychological distress during COVID-19 pandemic, they were more exposed to develop post-traumatic stress disorder.• A total of 37.4% was the prevalence of PTSD among Tunisian adolescents. Sufficient information about the pandemic was protective. Conflictual family atmosphere constitutes a risk factor.• Family and social efforts should be directed toward supporting teenagers to cope with the pandemics’ mental health burden.

Comorbidity Patterns of Posttraumatic Stress Disorder and Depression Symptoms: Cross-Validation in Two Postearthquake Child and Adolescent Samples

Background. Children and adolescents who have been exposed to a major natural disaster are more likely to suffer from posttraumatic stress disorder (PTSD) and depression. However, only a few studies have examined comorbidity patterns at the symptom level. Furthermore, researchers should validate their findings using multiple samples to address the psychological reproducibility challenge. Methods. The Child PTSD Symptom Scale (CPSS) and Center for Epidemiological Studies Depression Scale for Children (CES-DC) were administered to two postearthquake child and adolescent samples (Wenchuan earthquake, N = 1506 ; Ya’an earthquake, N = 720 ). Each sample was followed up twice. Comorbidity patterns were characterized by cross-lagged panel network analysis (CLPN), and communities were determined by bootstrap exploratory graphical analysis (bootEGA). Results. Except for having difficulty remembering important aspects of the trauma, the remaining dysphoria symptoms could be considered bridge symptoms between PTSD and depression. Most often, intrusive and avoidant symptoms clustered together, whereas dysphoria symptoms tended to cluster with depressive symptoms. The relationship between PTSD and depression was reciprocal; within PTSD, intrusive symptoms often triggered avoidance symptoms. The correlation coefficient between the two networks was 0.70, and the correlation coefficient of node centrality was 0.55. Findings. The association between dysphoria symptoms and depression was strong, and intrusive symptoms constituted the core symptoms of PTSD. Depression and PTSD were causally related, explaining the high comorbidity rates. Two sample networks had similar global characteristics but different local characteristics. The conclusions can be generalized to some extent.

Treatment of multiple traumatized adolescents by enhancing regulation skills and reducing trauma related symptoms: rationale, study design, and methods of randomized controlled trial (the Mars-study)

BackgroundThere is ongoing debate regarding the treatment of severe and multiple traumatized children and adolescents with post-traumatic stress disorder (PTSD). Many clinicians favor a phase-based treatment approach (i.e., a stabilization phase prior to trauma-focused therapy) over immediate trauma-focused psychological treatment, despite the lack of scientific evidence. Research on the effects of different treatment approaches is needed for children and adolescents with (symptoms of complex) PTSD resulting from repeated sexual and/or physical abuse during childhood.ObjectiveThis paper describes the rationale, study design, and methods of the MARS-study, a two-arm randomized controlled trial (RCT) that aims to compare the results of phase-based treatment with those of immediate trauma-focused treatment and determine whether immediate trauma-focused treatment is not worse than phase-based treatment in reducing PTSD symptoms.MethodsParticipants are individuals between 12 and 18 years who meet the diagnostic criteria for PTSD due to repeated sexual abuse, physical abuse, or domestic violence during childhood. Participants will be blindly allocated to either the phase-based or immediate trauma-focused treatment condition. In the phase-based treatment condition, participants receive 12 sessions of the Dutch version of Skill Training in Affective and Interpersonal Regulation (STAIR-A), followed by 12 sessions of EMDR therapy. In the immediate trauma-focused condition, the participants receive 12 sessions of EMDR therapy. The two groups are compared for several outcome variables before treatment, mid-treatment (only in the phase-based treatment condition), after 12 trauma-focused treatment sessions (post-treatment), and six months post-treatment (follow-up). The main parameter is the presence and severity of PTSD symptoms (Clinician-Administered PTSD Scale for Children and Adolescents, CAPS-CA). The secondary outcome variables are the severity of complex PTSD symptoms (Interpersonal Problems as measured by the Experiences in Close Relationship-Revised, ECR-RC; Emotion Regulation as measured by the Difficulties in Emotion Regulation Scale, DERS; Self Esteem as measured by the Rosenberg Self Esteem Scale, RSES), changes in anxiety and mood symptoms (Revised Anxiety and Depression Scale; RCADS), changes in posttraumatic cognitions (Child Posttraumatic Cognitions Inventory, CPTCI), changes in general psychopathology symptoms (Child Behavior Checklist, CBCL), and Quality of Life (Youth Outcome Questionnaire, Y-OQ-30). Furthermore, parental stress (Opvoedingsvragenlijst, OBVL) and patient-therapist relationship (Feedback Informed Treatment, FIT) will be measured, whereas PTSD symptoms will be monitored in each session during both treatment conditions (Children’s Revised Impact of Event Scale, CRIES-13).DiscussionTreating (symptoms of complex) PTSD in children and adolescents with a history of repeated sexual and/or physical abuse during childhood is of great importance. However, there is a lack of consensus among trauma experts regarding the optimal treatment approach. The results of the current study may have important implications for selecting effective treatment options for clinicians working with children and adolescents who experience the effects of exposure to multiple interpersonal traumatic events during childhood.Trial registrationsThe study was registered on the “National Trial Register (NTR)” with the number NTR7024. This registry was obtained from the International Clinical Trial Registry Platform (ICTRP) and can be accessed through the ICTRP Search Portal (https://trialsearch.who.int/).

The Incidence of Posttraumatic Stress Symptoms in Children.

To determine the incidence of posttraumatic stress disorder (PTSD) symptoms and risk factors for their development in children and adolescents undergoing orthopaedic surgery for trauma. Prospective cohort study. Level-1 trauma center. Children (8 to 18), undergoing surgery for orthopaedic trauma. Upper and lower extremity surgery for orthopaedic trauma. PTSD symptoms at postoperative follow-up as determined by the Child PTSD Symptom Scale (CPSS). A total of 176 children with an average age at surgery of 13 years (8 to 18.8 years) participated in the study. Twenty-six subjects had high levels of PTSD symptoms (15%; 95% CI = 10.0 to 21.1%). Univariable and multivariable analyses determined that female sex (OR 2.63, 95% CI = 1.06 to 6.67, P = 0.04), older age at surgery (OR 1.25, 95% CI = 1.04 to 1.51, P = 0.02), and undergoing a previous surgery (OR 2.86, 95% CI = 1.06 to 7.73, P = 0.04) were all associated with increased PTSD risk. Children and adolescents experience a high level of PTSD symptoms (15%) after surgery for orthopaedic trauma. Clinicians should be aware of PTSD symptoms in children and adolescents after surgery for orthopaedic injuries and use comprehensive screening to facilitate timely intervention and treatment. II.

Implications of intergenerational trauma: Associations between caregiver ACEs and child internalizing symptoms in an urban African American sample.

The link between adverse childhood experiences (ACEs) and negative mental health outcomes is well established. However, the intergenerational link between caregiver ACE history and their child's psychosocial outcomes is understudied, particularly within minoritized groups. This study aimed to delineate relations between caregiver ACE exposure and their child's depression and posttraumatic stress disorder (PTSD) symptoms by proposing a serial mediation of caregiver PTSD, family management problems, and child ACEs. Two hundred seventy-three caregiver (Mage = 39.27; 88% female) and adolescent (Mage = 14.26; 57% female) dyads from low-income urban communities completed electronic questionnaires measuring PTSD symptoms and ACEs. Child participants also completed a measure of depression and family management problems. Regression and serial mediation analyses were conducted to examine associations among these variables. Caregiver ACEs were significantly associated with their child's PTSD symptoms but were not related to their child's depression scores. Serial mediation analyses indicated that child ACEs mediated the relation between caregiver ACEs and their child's PTSD symptoms. Evidence for an overall indirect effect via caregiver PTSD, family management problems, and child ACEs was not found. No indirect effects between caregiver ACEs and child depression were found. Findings demonstrate that higher levels of caregiver ACE exposure are associated with their child's PTSD symptoms in a sample of African American dyads living in urban, high-burden communities. These results suggest a need for ACE screening during medical visits and provides guidance for future clinical interventions. The distinct intergenerational consequences for caregivers with ACEs and their children's psychosocial wellbeing warrant further study. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trajectories of Traumatic Stress Symptoms Among Siblings of Children With Cancer: The First Two Years Post-Diagnosis.

Identify and describe trajectories of cancer-related posttraumatic stress symptoms (PTSS) among siblings of children with cancer within two years of diagnosis. Siblings (aged 8-18; M = 11.2 years) across the United States, and for each, one caregiver, were recruited for a cohort sequential longitudinal study with three data collection points six months apart beginning at 6- or 12-months after cancer diagnosis. Siblings (N = 229; 42% of eligible/approached; 53% identifying as female; 68% identifying as non-Hispanic White) completed the Child Posttraumatic Stress Disorder Symptom Scale. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Latent class growth analysis (LCGA) and growth mixture modeling (GMM) identified PTSS patterns across time. Fit statistics supported models with three to five PTSS trajectories. The three-class LCGA model included a large mild PTSS group (61%), a moderate PTSS group (35%), and a small (4%) stable severe PTSS group. The four-class LCGA and three- and four-class GMM included groups improving from moderate to mild PTSS (7-21%) and worsening to moderate PTSS across time (12-17%). Across models, siblings with mild PTSS had fewer caregiver-reported emotional and behavioral difficulties on the SDQ. A large group of siblings of children with cancer demonstrate resiliency, however, substantial subsets experience patterns of PTSS that include levels in the moderate-to-severe range during the first two years post-diagnosis. Future research should examine these patterns in more diverse/representative samples and identify factors associated with increasing and sustained severe PTSS to inform intervention targets and reduce cancer-related burden on families.

Eye movement desensitisation and reprocessing as a treatment for PTSD, trauma, and trauma related symptoms in children with intellectual disabilities: a general review

PurposeThis paper aims to discuss the utility of eye movement desensitization and reprocessing (EMDR) therapy as a treatment for children with intellectual disabilities (ID) who have experienced trauma.Design/methodology/approachRelevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide support for the use of EMDR as a treatment for trauma in children with ID.FindingsThere is a growing body of evidence which demonstrates that EMDR therapy is successful for the treatment of trauma in adults and children. However, for children with ID, the research is limited despite those with ID being more likely than non-disabled peers to experience trauma such as abuse or neglect.Practical implicationsEMDR can only be facilitated by trained mental health nurses, psychiatrists, psychologists (clinical, forensic, counselling or educational) or occupational therapists or social workers with additional training. Finally, general practitioners who are experienced in psychotherapy or psychological trauma and have accreditation. Therefore, this highlights that there may be a lack of trained staff to facilitate this intervention and that those who are generally working with the client closely and long term such as learning disability nurses are not able to conduct this intervention.Originality/valueThis paper presents an account of NICE guidance and evidence of the efficacy of EMDR as a treatment for adults, children and those with ID.

Bidirectional effects of parental and adolescent symptom change in trauma-focused cognitive behavioral therapy.

The current study examines dynamic, bidirectional associations between parent and adolescent symptom improvement in response to children's therapy for posttraumatic stress disorder (PTSD). Data were collected from a racially and ethnically heterogeneous sample of 1,807 adolescents (age 13-18 years old; 69% female) and a parent participating in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) at a community outpatient behavioral health clinic. Parents self-reported their depressive symptoms and youth self-reported their PTSD and depressive symptoms at the onset of treatment and every three months for up to nine months. Using a bivariate dual change score model (BDCSM) we examine: (a) individual dyad members' change in symptoms and (b) the bidirectional associations between changes in the parent's and youth's symptoms across treatment. Parents' and adolescents' symptoms at the start of treatment were correlated and both parents' and adolescents' symptoms decreased over the course of treatment. Parents' elevated depressive symptoms at each time point contributed to smaller decreases in their children's PTSD and depressive symptoms at the subsequent time point. Adolescents' elevated symptoms at each time point contributed to greater decreases in their parents' symptoms at the subsequent time point. These findings highlight the impact that parents and children have on each other's response to children's trauma-focused psychotherapy. Notably, parents' depressive symptoms appeared to slow their children's progress in treatment, suggesting that attending to parents' symptoms and providing them with supportive services may be an important adjunct to children's interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of abbreviated trauma-focused cognitive behavioural therapy for South African adolescents: a randomized controlled trial

ABSTRACT Background: In low- and middle- income countries (LMICs) trauma exposure among youth is high, but mental health services are critically under-resourced. In such contexts, abbreviated trauma treatments are needed. Objective: To evaluate the efficacy of an abbreviated eight-session version of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for improving posttraumatic stress disorder (PTSD) and depression symptoms in a sample of South African adolescents. Method: 75 trauma-exposed adolescents (21 males, 54 females; mean age = 14.92, range = 11–19) with posttraumatic stress disorder (PTSD) symptoms were randomly assigned to eight sessions of TF-CBT or to usual services. At baseline, post-treatment and three-month follow-up, participants completed the Child PTSD Symptom Scale for DSM 5 (CPSS-5) and the Beck Depression Inventory II (BDI-II). The trial is registered on the Pan African Trial Registry (PACTR202011506380839).6. Results: 95% of TF-CBT participants completed treatment while only 47% of TAU participants accessed treatment. Intention-to-treat analyses found that the TF-CBT group had a significantly greater reduction in CPSS-5 PTSD symptom severity at post-treatment (Cohen’s d = 0. 60, p < .01) and three-month follow-up (Cohen’s d = 0.62, p < . 01), and a greater reduction in the proportion of participants meeting the CPSS-5 clinical cut-off for PTSD at both time points (p = .02 and p = .03, respectively). There was also a significantly greater reduction in depression symptom severity in the TF-CBT group at post-treatment (Cohen’s d = 0.51, p = .03) and three-month follow-up (Cohen’s d = 0.41, p = .05), and a greater reduction in the proportion of TF-CBT participants meeting the BDI clinical cut-off for depression at both time points (p = .02 and p = .03, respectively). Conclusion: The findings provide preliminary evidence of the efficacy of an abbreviated eight-session version of TF-CBT for reducing PTSD and depression symptoms in a LMIC sample of adolescents with multiple trauma exposure.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BackgroundChildren of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.MethodsThe intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.DiscussionThis study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.Trial registrationThis protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Paediatric Medical Traumatic Stress in Children with Cancer and their Parents: Difference in Stress Levels Due to Illness and Treatment Factors.

Pediatric medical traumatic stress (PMTS) is a set of children's and their parents' psychological and physiological responses to pain, injuries, serious illnesses, and other experiences with the medical environment.Pediatric cancer patients have the highest prevalence of PMTS as the illness its treatment involve a set of stressors that trigger many negative psychological reactions. The current study examined the difference in levels of traumatic stress in children with cancer and their parents due to medical factors (type of cancer, outcome, duration, and intensity of treatment, time since diagnosis, relapse, and hospitalization in ICU). The study involved 183 parents of 133 children and 62 children and adolescents who were treated between 2009 and 2019 at the Clinical Department of Pediatric Hematology and Oncology of University Children's Hospital in Ljubljana. We collected the data using The Intensity of Treatment Rating Scale 2.0 [IRT-2], PTSD Checklist for Children/Parent [PCL-C/PR], The PTSD Checklist for DSM-5 [PCL-5] and The Child PTSD Symptoms Scale for DSM-5 [CPSS-5]. Traumatic stress symptoms are frequently present in both children and their parents, regardless of the cancer type, treatment duration, and treatment outcome. Children with relapse, children with more intensive treatment, and parents of the latter are at higher risk for PMTS occurrence. Additionally, we found a decreasing trend of traumatic responses after five or more years post-cancer diagnosis. [Table: see text].

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children

Altered secretion of cortisol, the primary effector of the hypothalamus–pituitary–adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6–18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.