Posttraumatic Stress Disorder In Children Research Articles

Childhood family violence and officer responses to officer-involved domestic violence: Effects of cumulative and resolved trauma

Law enforcement officers who witness or experience abuse in their family of origin are at higher risk of post-traumatic stress disorder (PTSD) and alcohol abuse. These trauma effects may, in turn, affect officers’ responses to domestic violence victims who call on them for help. The purpose of this study was to examine how these childhood traumas, PTSD, and alcohol abuse affect officers’ supportive responses to victims and perpetrators of officer-involved domestic violence (OIDV). We hypothesized that officers who witnessed or experienced family of origin violence would have higher levels of PTSD and abusive drinking than those without trauma. Furthermore, we hypothesized that officers with resolved trauma (i.e., no current PTSD or abusive drinking) would be more likely to support victims of OIDV than officers with unresolved trauma. Survey respondents were law enforcement officers ( n = 1661) in police and sheriff’s departments throughout the United States. Results partially supported the hypotheses regarding the separate and cumulative effects of witnessing family violence and experiencing child abuse. In addition, officers who endured these childhood traumas, but resolved these concerns reported a significantly greater average likelihood of helping an OIDV victim than those with unresolved trauma. Implications include the promotion of employee assistance programs and professional counselors to support officers with unresolved trauma, which may lead to improved responses to OIDV.

Machine Learning in the Recognition and Prognosis Prediction of Children's Post-traumatic Stress Disorder

Machine Learning in the Recognition and Prognosis Prediction of Children's Post-traumatic Stress Disorder

Childhood Adversity, Proximal Stressors and PTSD Among People with Severe Mental Illness: An Exploratory Study.

The purpose of this exploratory study is to: (1) assess prevalence of childhood adversities and posttraumatic stress disorder (PTSD); (2) assess their association, and; (3) explore whether proximal sources of stress affect this relationship and/or have an association with PTSD among people with severe and persistent psychological disorders. Using data from 141 respondents, we assess the extent to which individuals in this population experienced 17 PTSD symptoms, various correlates to probable PTSD, and the most relevant of these factors in a multivariate logistic regression. Overall, 27% of the participants met study criteria for probable PTSD and each symptom was reported by at least 18% of the sample. Multivariate logistic regression models indicated that interpersonal conflict and being a victim of a crime were significantly related to probable PTSD. We discuss these findings in relation to treatment and course of disease for people suffering from severe and persistent mental illness experiencing a traumatic event.

Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: a longitudinal examination.

Epidemiological and cross-sectional studies have shown that post-traumatic stress disorder symptoms (PTSS) are common and impairing in youth with chronic pain. Yet, the co-occurrence of PTSS and pediatric chronic pain has not been examined longitudinally, which has limited understanding of theoretically proposed mechanisms (eg, sleep disturbance) underlying the PTSS-pain relationship over time. This longitudinal study aimed to fill this gap. Participants included 138 youth (Mage = 14.29, 75% girls) referred to a tertiary-level outpatient chronic pain program and one of their parents. At baseline, youth reported their pain intensity and interference, PTSS, and subjective sleep disturbances (ie, sleep quality and insomnia). Youth and parents completed semistructured diagnostic interviews to determine the child's post-traumatic stress disorder diagnostic status, and youth completed an objective assessment of sleep patterns for 7 days using actigraphy. At 3-month follow-up, youth once again completed the diagnostic interview and reported their pain intensity, pain interference, and PTSS. Partially latent cross-lagged structural equation panel models revealed that, controlling for pain intensity, pain interference and PTSS co-occurred at baseline, but not at follow-up (while controlling for baseline levels). Higher levels of baseline PTSS were predictive of increases in pain interference at follow-up. Furthermore, subjective sleep disturbances mediated the relationship between baseline PTSS and follow-up pain interference. These findings lend support to conceptual models of PTSS-pain co-occurrence and highlight a critical need to assess and address trauma and sleep disturbances in youth with chronic pain.

An Innovative Mobile Game for Screening of Pediatric PTSD: a Study in Primary Care Settings.

Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants (n = 49) were children attending primary care appointments between 8 to 12years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency (α = 0.79), was significantly positively correlated to the total CPSS-5-SR (r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR (r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions.

Trajectories of maternal symptoms of posttraumatic stress disorder predict long-term mental health of children following the Wenchuan earthquake in China: A 10-year follow-up study

Background: Maternal psychopathology can be an important factor associated with psychological adjustment of children. However, there is limited research on long-term impacts of maternal posttraumatic stress disorder (PTSD) on children's mental health. This study examined how PTSD trajectories of women exposed to the 2008 Wenchuan earthquake in China predicted their children's mental health symptoms 10 years after the earthquake. Methods: 410 dyads of mothers and their adolescent children who exposed to the Wenchuan earthquake were investigated at 12 and 18 months post-earthquake. While the mothers completed measures of earthquake exposure and PTSD symptoms, the children completed measures of earthquake exposure, PTSD, depression and anxiety symptoms. In the 10-year follow up, 257 out of the 410 children completed measures of PTSD, depression and anxiety symptoms. Data were analyzed using linear regression. Results: Four trajectories of maternal PTSD symptoms were identified: (a) chronic (9.5%); (b) resilient (66.3%); (c) delayed (7.6%); and (d) recovery (16.6%); More importantly, the findings demonstrated that children whose mothers experienced chronic PTSD reported higher level of PTSD and anxiety symptoms 10 years after the earthquake. Limitations: Only two waves of maternal PTSD were collected, self-reported tools other than clinical reviews were used to collect data, and a significant proportion of participants did not respond at the 10-year follow-up. Conclusions: This study identified maternal PTSD trajectories following the Wenchuan earthquake. Chronic PTSD symptoms in mothers were associated with increased risk of children's PTSD and anxiety 10 years after the earthquake.

Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial.

Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children. Injured children (1-6years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete. One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n=62) or TAU (n=71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b=60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M=11.02, SD=10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M=17.30, SD=13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj.=.055, d=0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties. This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.

Some questions about the child`s experience of loss crisis (death of the parents – the mother) of primary school age

The article is related to the theoretical analysis of a child of primary school age who is experiencing a crisis of loss, namely the death of a loved one (one of the parents - the mother). The concepts of «grief», «loss crisis», «psychotrauma» and «post-traumatic stress disorder» were also analyzed. We also touched upon the issue of the type of loss crisis during the analysis. Primary school children have a specific emotional sphere for their development - we have considered this issue in more detail in a scientific article. The main reactions of the child to the loss of a loved one are also described. The death of a loved one has a certain individual imprint on the life of any person or child. Therefore, the impact of the death of a loved one on the present and future of the child was considered. Too often, relatives or guardians living with a child misbehave with a younger student, which also affects the child’s emotional state and has a significant impact on his or her personal development. In our work, this problem was also considered as the main cause of the development of a child of primary school age not only depression but also post-traumatic stress disorder, which is a serious intervention for the already vulnerable psyche of the child. Post-traumatic stress disorder (PTSD) in children of primary school age who survived the death of one of the parents – the mother – is considered. The article emphasizes that the emotional sphere in children and adolescents is particularly reactive, so mental trauma (loss crisis) affects them more than adults. However, it is necessary to take into account the smaller depth of feelings, the rapid change of mood in children, due to which psychogenic reactions in them are shorter. We also considered in the article the reasons for the development of post-traumatic stress disorder in children of primary school age. The scientific article considered post-traumatic stress disorder at the emotional, cognitive and behavioral levels in a child of primary school age who has lost a loved one. The article examines children of primary school age with post-traumatic stress disorder who have lost a loved one – the mother, the presence of a negative emotional state (malaise, low activity and poor depressed mood) and the results were confirmed by statistical processing.

PTSD treatment response and quality of life in women with childhood trauma histories.

Childhood trauma is associated with greater psychological problems and poorer quality of life (QOL). This study evaluates the effect of multiple types of childhood trauma on posttraumatic stress disorder (PTSD) and QOL following cognitive processing therapy (CPT). Understanding how the breadth of traumatic experiences in childhood can influence psychosocial treatment outcomes may help to identify the unique needs of this population. This secondary data analysis of a randomized controlled trial delivering CPT to civilian (n = 105) and veteran women (n = 21) with PTSD used linear regressions to examine relationships between the number of unique types of childhood trauma, PTSD, and QOL before and after treatment. Models controlled for demographic information, adult trauma, and pretreatment PTSD, depression, and QOL scores. More types of childhood trauma predicted pretreatment PTSD symptoms (B = 1.98, p = .02) but not QOL (B = -.018, p = .18). Significant reductions in Clinician-Administered PTSD Scale for DSM-IV-TR score, t(302) = 10.32, p < .001, and QOL, t(309) = -4.06, p < .001, were reported after treatment; number of traumatic event types was not predictive of QOL change (B = .01, p = .957). Women with more types of trauma reported significantly less PTSD symptom reduction when compared with those with one type (B = 3.12, p = .042). Women who experienced a broader range of childhood trauma may experience diminished PTSD symptom reduction following CPT in comparison with women with less exposure. On average, all women, regardless of trauma history, reported small improvements in QOL. Clinical considerations are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The relationship between stress response after trauma with anxiety and depression levels of syrian children

Witnessing many painful events such as war and systematic violence adversely affects children’s mental health and development. Refugee children are the most at-risk group with the incidence of Post Traumatic Stress Disorder. The aim of this study upon working group of refugee children victims of war was to investigate the relationship between post-traumatic stress responses and anxiety and depression levels of children living in Turkey. This descriptive study was designed according to relational survey model. The sample of the study consists of 224 Syrian children who were randomly selected among the children living in Turkey. In the research, “Revised Child Anxiety and Depression Scales Child Version (RCADS-CV)” and Child The Child Posttraumatic Stress Disorder Reaction Index (CPTS-RI) ”data collection tools were used. To analyze the study data, Pearson Product Moment Correlation coefficients and frequency and percentage were used as descriptive statistical methods. As a result of the study, a positive, high and significant relationship was found between the total post-traumatic stress response levels and anxiety and depression levels of children (p

TEPT y Ansiedad en niños y adolescentes 2 años posterior al terremoto de 2016 en Unidades Educativas de la ciudad de Portoviejo, Ecuador

El trastorno de estrés postraumático (TEPT) es una de las consecuencias de la exposición a desastres naturales más frecuente e incapacitante en niños, quienes representan la población más vulnerable para desarrollarlo, por lo que el médico pediatra debe estar preparado para identificar los rasgos y características de estos trastornos y poder realizar un diagnóstico oportuno. Objetivo: determinar la presencia de TEPT y ansiedad en los niños y adolescentes que presenciaron el terremoto de abril del 2016 en la Provincia de Manabí, en las unidades educativas Antonio Meléndez, María de la Merced y Francisco Pacheco. Metodología: estudio observacional, transversal, retrospectivo, descriptivo, analítico, con 271 niños de 9 -14 años. Encuestas: factores sociodemográficos y económicos, Escala Infantil de Síntomas de Trastorno de Estrés Postraumático (CPSS), la Escala de Ansiedad de Spence; datos fueron procesados con SPSS V22. Los estadísticos OR y Chi cuadrado, IC 95% y p menor a 0.05. Resultados: TEPT se presentó en 18,1% y el Trastorno de Ansiedad en 23,1%, mayor en el sexo femenino para ambos trastornos, el trastorno de ansiedad presentó una diferencia significativa en los escolares respecto a los adolescentes, la probabilidad de presentar comorbilidad entre ambos trastornos fue elevada. Conclusiones: el TEPT está presente en niños de la zona a dos años del terremoto del 2016, el sexo femenino y los niños de menor edad presentan mayor riesgo.

Adverse Childhood Experience, Genes, and PTSD Risk in Soldiers: A Methylation Study.

Epigenetics can serve as a marker of susceptibility to many known psychiatric diseases. DNA methylation patterns of multiple genes have been studied in both civilian populations and military personnel with post-traumatic stress disorder (PTSD). Many of these genes serve various functions that span the hypothalamic-pituitary-adrenal axis, immune system, and central nervous system (CNS) growth factors and neurotransmission. It is thought that the methylation levels of such genes may be able to identify individuals who are at higher risk of developing PTSD. Our study seeks to establish whether previously reported PTSD genes possess a particular methylation pattern that is predictive of PTSD in active duty military members with combat exposure. This is an institutional review board (IRB)-approved, cross-sectional, case control, gene-environment interaction study. About 170 active military members with and without PTSD were recruited. Patients with a history of structural brain damage, traumatic brain injury (TBI) resulting in loss of consciousness, predeployment diagnosis of PTSD or anxiety disorder, and predeployment prescription of an antidepressant or psychoactive medication were excluded. Validated measures of childhood trauma and adversity (adverse childhood experience [ACE] score), PTSD symptoms (PTSD check-list military version [PCL-M]), and combat exposure scales (CES) were measured via validated questionnaires for all subjects. After extracting DNA from peripheral blood provided by the 170 subjects, we determined methylation percentages, via pyrosequencing assays, for nine target areas within the following seven genes: BDNF, NR3C1, MAN2C1, TLR8, SLC6A4, IL-18, and SKA2. These genes are commonly reported in the literature as being highly correlated with PTSD and early-life traumatic experiences.Methylation levels were measured as a percentage at specific sites within the previously mentioned genes. Data were examined with SPSS v 22.0 Statistics and JMP v13.1 software using a general linear model for methylation × trauma (CES scores) split by diagnosis of PTSD or not, methylation versus childhood trauma (ACE scores), and methylation versus PTSD severity (PCL-M score). Two-way ANOVA was performed to control for antidepressant use. A two-tailed Student t-test was performed for PTSD analyses and was correlated with PTSD diagnosis, demographic information as well as ACE score, PCL-M score, and CES scores. Differentially methylated sites that were highly associated with PTSD diagnosis were found in three of seven candidate genes: BDNF, NR3C1, and MAN2C1. When compared to controls, patients with PTSD diagnosis had significantly lower levels of methylation, even after controlling for antidepressant use. PCL-M, ACE, and CES scores were significantly associated with PTSD diagnosis. Our study suggests that methylation of key genes involved in synaptic plasticity and the hypothalamic-pituitary-adrenal axis is associated with lower levels of methylation in military PTSD subjects exposed to combat when compared to their non-PTSD counterparts. Strengths of this study include controlling for antidepressant use and excluding TBI patients. Similar studies in an active duty population of this size are scarce. What is not clear is whether methylation changes are driving PTSD symptomology or whether they are merely a marker of disease. Future areas of research include prospective studies that measure methylation pre- and postcombat exposure in the same individual.

A preliminary investigation of rare variants associated with genetic risk for PTSD in a natural disaster-exposed adolescent sample

ABSTRACT Background: Posttraumatic stress disorder (PTSD) involves a complex interaction of biological, psychological, and social factors. Numerous studies have demonstrated genetic variation associated with the development of PTSD, primarily in adults. However, the contribution of low frequency and rare genetic variants to PTSD is unknown to date. Moreover, there is limited work on genetic risk for PTSD in child and adolescent populations. Objective: This preliminary study aimed to identify the low frequency and rare genetic variation that contributes to PTSD using an exome array. Method: This post-disaster, adolescent sample (n = 707, 51% females, M age = 14.54) was assessed for PTSD diagnosis and symptom count following tornado exposure. Results: Gene-based models, covarying for ancestry principal components, age, sex, tornado severity, and previous trauma identified variants in four genes associated with diagnosis and 276 genes associated with symptom count (at p adj < .001). Functional class analyses suggested an association with variants in the nonsense class (nonsynonymous variant that results in truncation of, and usually non-functional, protein) with both outcomes. An exploratory gene network pathway analysis showed a great number of significant genes involved in brain and immune function, illustrating the usefulness of downstream examination of gene-based findings that may point to relevant biological processes. Conclusions: While further investigation in larger samples is warranted, findings align with extant PTSD literature that has identified variants associated with biological conditions such as immune function.

Pharmacological prevention and early treatment of post-traumatic stress disorder and acute stress disorder: a systematic review and meta-analysis

Post-traumatic stress disorder (PTSD) is a common mental disorder associated with significant distress and reduced functioning. Its occurrence after a severe traumatic event and association with characteristic neurobiological changes make PTSD a good candidate for pharmacological prevention and early treatment. The primary aim for this systematic review and meta-analysis was to assess whether pharmacological interventions when compared to placebo, or other pharmacological/psychosocial interventions resulted in a clinically significant reduction or prevention of symptoms, improved functioning or quality of life, presence of disorder, or adverse effects. A systematic search was undertaken to identify RCTs, which used early pharmacotherapy (within three months of a traumatic event) to prevent and treat PTSD and acute stress disorder (ASD) in children and adults. Using Cochrane Collaboration methodology, RCTs were identified and rated for risk of bias. Available data was pooled to calculate risk ratios (RR) for PTSD prevalence and standardised mean differences (SMD) for PTSD severity. 19 RCTs met the inclusion criteria; 16 studies with adult participants and three with children. The methodological quality of most trials was low. Only hydrocortisone in adults was found to be superior to placebo (3 studies, n = 88, RR: 0.21 (CI 0.05 to 0.89)) although this was in populations with severe physical illness, raising concerns about generalisability. No significant effects were found for the other pharmacotherapies investigated (propranolol, oxytocin, gabapentin, fish oil (1470 mg DHA/147 mg EPA), fish oil (224 mg DHA/22.4 mg EPA), dexamethasone, escitalopram, imipramine and chloral hydrate). Hydrocortisone shows the most promise, of pharmacotherapies subjected to RCTs, as an emerging intervention in the prevention of PTSD within three months after trauma and should be a target for further investigation. The limited evidence for hydrocortisone and its adverse effects mean it cannot be recommended for routine use, but, it could be considered as a preventative intervention for people with severe physical illness or injury, shortly after a traumatic event, as long as there are no contraindications. More research is needed using larger, high quality RCTs to establish the most efficacious use of hydrocortisone in different populations and optimal dosing, dosing window and route. There is currently a lack of evidence to suggest that other pharmacological agents are likely to be effective.

Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity.

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Identifying predictors of probable posttraumatic stress disorder in children and adolescents with earthquake exposure: A longitudinal study using a machine learning approach

BackgroundEvidence has identified risk factors associated with individuals with trauma exposure who develop posttraumatic stress disorder (PTSD). How to combine risk factors to predict probable PTSD in young survivors using machine learning is limited. The study aimed to integrated multiple measures at 2 weeks after the earthquake using machine learning for the prediction of probable PTSD at 3 months after earthquake. MethodsA total of 2099 young survivors with earthquake exposure were included. We integrated multiple domains of variables to ‘train’ a machine learning algorithm (XGBoost). Thirty-one combination types were implemented and evaluated. The resulting XGBoost was utilized in identifying individual participants as either probable PTSD or no PTSD. ResultsAny combination type predicted young survivor probable PTSD, with prediction accuracies ranging between 66%-80% (p < 0.05). In particular, the combination of earthquake experience, everyday functioning, somatic symptoms and sleeping correctly predicted 683 out of 802 cases of probable PTSD, translating to a classical accuracy of 74.476% (85.156% sensitivity and 60.366% specificity) and an area under the curve of 0.80. The most relevant variables (e.g. age, sex, property loss and a sedentary lifestyle) revealed in the present study. LimitationsParticipants from a specific district might limit the generalizability of our results. Self-report questionnaires and non-standardized measures were used to assess symptoms. ConclusionDetection of probable PTSD according to self-reported measurement data is feasible, may improve operational efficiencies via enabling targeted intervention, before manifestation of symptoms.

Bidirectional associations of insomnia symptoms with somatic complaints and posttraumatic stress disorder in child and adolescent earthquake survivors: a longitudinal study.

We aimed to explore insomnia symptoms among 2299 children and adolescents after an earthquake and their bidirectional relationship to somatic complaints and posttraumatic stress disorder (PTSD). The Patient Health Questionnaire-15 scale, the Children's Revised Impact of Event Scale, and three questions evaluating insomnia symptoms (including difficulty falling asleep, difficulty staying asleep, and early morning awakening) were administered to child and adolescent survivors 3 and 6months after the Lushan earthquake. The prevalence rates of insomnia symptoms among children and adolescents were 52 and 40% 3 and 6months after the Lushan Earthquake, respectively. Insomnia symptoms evaluated after 3months could significantly predict subsequent PTSD (odds ratio (OR), 1.476; 95% confidence interval (CI), 1.133-1.924) and all somatic symptoms, except for dizziness, evaluated after 6months. PTSD (OR, 1.633; 95%CI, 1.315-2.027) and headache (OR, 1.545; 95%CI, 1.223-1.953) evaluated after 3months significantly predicted insomnia symptoms evaluated after 6months. Insomnia symptoms, which were commonly seen after the earthquake, could longitudinally predict the development of PTSD and various somatic symptoms, and PTSD and headache could longitudinally predict the developments of insomnia symptoms among children and adolescent earthquake survivors. These findings highlight the importance of assessing and addressing insomnia symptoms in children and adolescents following a traumatic event.

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis.

The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. We compiled a large international data set of 2,313 children and adolescents aged 6 to 18years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

Eye Movement Desensitization Reprocessing for Children and Adolescents With Posttraumatic Stress Disorder: A Systematic Narrative Review

There is currently a limited number of studies into the efficacy of eye movement desensitization reprocessing (EMDR) therapy with children and adolescents with posttraumatic stress disorder (PTSD). The current study utilizes a systematic narrative review of methodologies and findings of previous literature reviews and meta-analyses as well as analyzing randomized control trials (RCTs) conducted from 2002 to 2018. Following initial scoping of the extent of studies, two systematic literature searches were conducted, firstly for literature reviews and secondly for recent RCTs. Nine databases were utilized. Eight reviews and seven RCTs were identified and analyzed for quality of methodology and outcome as measured by impact on PTSD symptoms. EMDR was found to be efficacious in reducing children's PTSD symptoms compared to waitlist conditions, with similar outcomes to cognitive behavior therapy (CBT). EMDR was effective with both single-event trauma as well as cumulative trauma such as sexual abuse. EMDR was equally effective with girls and boys as well as children from different cultures. EMDR achieved medium to large effect sizes. Reductions in PTSD were maintained at 2-, 3-, 6-, and 12-month follow-up. In conclusion, EMDR was consistently found to be an efficacious treatment for children with PTSD. Recommendations are made for future practice and research.

Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury.

The aim of this study is to describe the risk factors of injured children's posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children. Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, "PTSD," "child"/"children," "injury"/"injuries," and "China"/"Chinese." Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models. The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%-23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%). PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.