Stress Disorder Symptoms In Children Research Articles

Prevalence of anxiety, depression and post-traumatic stress disorder symptoms in children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis

Prevalence of anxiety, depression and post-traumatic stress disorder symptoms in children and adolescents during the COVID-19 pandemic: A systematic review and meta-analysis

Emotional difficulties and post-traumatic stress disorder symptoms in children refugees & the role of ICTs: A case study in northern Greece borders

The aim of this study was to investigate the emotional difficulties and post-traumatic stress disorder symptoms within children refugees in northern Greece borders. The present research focuses on the traumatic and emotional difficulties experienced by children refugees, who have been separated from their families during their journey to Europe. This study adopted a research approach with a sample of five children from Syria, of both sexes, aged 11 to 16 years. Each participant was given an Android-based mobile phone with the online forms of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Achenbach Adolescent Self-Report Questionnaire (YSR 11-18). The completion results showed high levels of post-traumatic stress disorder and intensive emotional problems in the sample of refugees children. In particular, the findings showed a correlation between the level of emotional problems and post-traumatic stress disorder and the type of trauma related to the family traumatic experience.

Associations Between Traumatic Stress, Brain Volumes and Post-traumatic Stress Disorder Symptoms in Children: Data from the ABCD Study

Reduced volumes in brain regions of interest (ROIs), primarily from adult samples, are associated with posttraumatic stress disorder (PTSD). We extended this work to children using data from the Adolescent Brain Cognitive Development (ABCD) Study® (N = 11,848; Mage = 9.92). Structural equation modeling and an elastic-net (EN) machine-learning approach were used to identify potential effects of traumatic events (TEs) on PTSD symptoms (PTSDsx) directly, and indirectly via the volumes 300 subcortical and cortical ROIs. We then estimated the genetic and environmental variation in the phenotypes. TEs were directly associated with PTSDsx (r = 0.92) in children, but their indirect effects (r < 0.0004)—via the volumes of EN-identified subcortical and cortical ROIs—were negligible at this age. Additive genetic factors explained a modest proportion of the variance in TEs (23.4%) and PTSDsx (21.3%), and accounted for most of the variance of EN-identified volumes of four of the five subcortical (52.4–61.8%) three of the nine cortical ROIs (46.4–53.3%) and cerebral white matter in the left hemisphere (57.4%). Environmental factors explained most of the variance in TEs (C = 61.6%, E = 15.1%), PTSDsx (residual-C = 18.4%, residual-E = 21.8%), right lateral ventricle (C = 15.2%, E = 43.1%) and six of the nine EN-identified cortical ROIs (C = 4.0–13.6%, E = 56.7–74.8%). There is negligible evidence that the volumes of brain ROIs are associated with the indirect effects of TEs on PTSDsx at this age. Overall, environmental factors accounted for more of the variation in TEs and PTSDsx. Whereas additive genetic factors accounted for most of the variability in the volumes of a minority of cortical and in most of subcortical ROIs.

Common practice elements of school-based trauma interventions for children and adolescents exhibiting symptoms of post-traumatic stress disorder: a systematic review

AbstractThe prevalence of post-traumatic stress disorder symptoms in children and adolescents requires school psychologists and counsellors to be informed of evidence-based elements of interventions through which they can tailor their treatment to the individual in a school context. This meta-analysis identified common practice elements within evidence-based trauma interventions for schools. A small to medium effect size was identified in the 10 randomised controlled trials (RCTs) included in this meta-analysis. Within these RCTs, 31 common practice elements were identified, with social skills training, coping skills training, relaxation techniques, psychoeducation, mind-body techniques, group work and creative-expressive techniques correlating with the most effective outcomes. The findings suggest that common practice elements exist across multiple school-based trauma interventions of varying modalities.

Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive

ABSTRACT Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5–18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.

Validation of the Child Post-Traumatic Cognitions Inventory in Korean survivors of sexual violence

BackgroundDysfunctional cognitions related to trauma is an important factor in the development and maintenance of post-traumatic stress disorder symptoms in children and adolescents. The Child Post-traumatic Cognitions Inventory (CPTCI) assesses such cognitions about trauma. We investigated the psychometric properties of the Korean version of CPTCI and its short form by surveying child and adolescent survivors of sexual violence.MethodsChildren and adolescents aged 7–16 years (N = 237, Mage = 12.6, SD = 2.3, 222 [93.7%] were female) who were exposed to sexual violence were included in this survey. We assessed the factor structure, internal consistency, and validity of the CPTCI and its short form through data analysis.ResultsConfirmatory factor analysis results supported the two-factor model presented in the original study. The total scale, its subscales, and the short form had good internal consistency (Cronbach’s α = .96 for total scale and .91–.95 for the other scales). The CPTCI showed high correlations with scales measuring post-traumatic stress symptoms (r = .77–.80), anxiety (r = .69–.71), and depression (r = .74–.77); the correlation with post-traumatic stress symptoms was the highest. The differences in CPTCI scores per post-traumatic stress symptom levels were significant (all p < .001) Sex differences in CPTCI scores were not significant (p > .05 for all comparisons); however, the scores exhibited differences per age group (all p < .001).ConclusionsThe results indicate that the Korean version of the CPTCI is a valid and reliable scale; therefore, it may be a valuable tool for assessing maladaptive cognitions related to trauma in research and clinical settings.

Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children.

Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3-6years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother's recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.

Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia.

Kozanhan B, Kocaoğlu C, Gündüz M, Akça ÖF. Posttraumatic stress disorder symptoms in children exposed to circumcision under general or local anesthesia. Turk J Pediatr 2018; 60: 718-725. The aim of this study was to investigate the impact of general versus local anesthesia on the Posttraumatic Stress Disorder (PTSD) symptoms after circumcision. Of the 134 consecutive children (7-12 years of age) who underwent circumcision, 71 had general anesthesia (GA) and 63 had local anesthesia (LA). All participants completed the child depression inventory (CDI), State Anxiety (SA) and Trait Anxiety (TA) inventories, and Childhood Anxiety Sensitivity Index (CASI) before the operation as well as the Child Posttraumatic Stress Reaction Index (CPSRI) one month after the operation. The CDI, CASI and TA scores of the children were similar in both groups, while the SA scores of the LA group were higher than those in GA group (p < 0.001). The CPSRI scores of the GA group were higher than those of the LA group (p=0.04). When the other parameters were controlled via regression analysis, only the CDI scores and being in the GA group predicted the CPSRI scores. This study suggests that children witnessing the surgical procedure of the circumcision developed no serious symptoms of PTSD. In contrast, children exposed to GA during circumcision developed more serious PTSD symptoms than children who had LA. The severity of depressive symptoms may be important in the development of PTSD symptoms after circumcision.

Meta-analysis of the Long-Term Treatment Effects of Psychological Interventions in Youth with PTSD Symptoms.

To date, the long-term effectiveness of psychological treatments in reducing post-traumatic stress disorder symptoms in children and adolescents has not been investigated extensively. This meta-analysis quantifies the long-term effects of psychological interventions in children and adolescents with PTSD symptoms and examines the period-dependent follow-up (FU) effects based on 47 studies. The mean FU effect sizes (ESs) for PTSD symptoms ranged from medium (between treatment ESs for controlled studies) to large (within treatment ESs for uncontrolled studies; pooled analysis including all studies). These effects were comparable to the post-treatment ESs, which suggests that the treatment effects remained stable. ESs did not differ depending on the length of the FU period (</>6months). In randomized controlled trials (RCTs), as well as trials conducted with treatment as usual or active control groups, the long-term treatment effects for the reduction of PTSD symptoms were small. These results demonstrate the long-term effectiveness of psychological interventions in the treatment of PTSD in youth. However, more studies should include a FU assessment. Further research should focus on RCTs with long-term assessments, report comorbid symptoms and investigate the influence of potential moderators. Research is also warranted to determine how to improve the long-term effects of treatments for PTSD in youth.

Neurocognitive predictors of posttraumatic stress disorder symptoms in children 6 months after traumatic brain injury: A prospective study.

Various neurocognitive mechanisms have been proposed to explain the development of Posttraumatic Stress Disorder (PTSD) symptoms. However, the neurocognitive mechanisms underlying comorbid PTSD following Traumatic Brain Injury (TBI) have not been fully investigated, especially among children. This study prospectively examined the influence of theorized neurocognitive deficits at 3 months post pediatric TBI on the development of PTSD symptoms 6 months postinjury. One hundred sixty-six children aged between 6 and 14 years were recruited after sustaining a TBI. Their demographic information and injury severity were assessed at 2 months postinjury, their neurocognitive outcomes in selective attention, sustained attention, verbal learning, working memory, and processing speed were assessed at 3 months postinjury, and PTSD symptoms were measured at 6 months postinjury. Consistent with the Neurobiological Theory of PTSD, sustained attention deficits 3 months postinjury emerged as the key predictor for greater future PTSD severity at 6 months, especially following a mild TBI. However, contrary to the expectations of the Emotional Processing Theory and Dual Representation Theory, verbal learning and working memory deficits at 3 months postinjury protected children from the development of PTSD symptoms 6 months postinjury. PTSD involves a complex interplay between attention and memory functions post pediatric TBI. When trauma memory is relatively intact, difficulties disengaging from distractors contribute to the development of PTSD symptoms. (PsycINFO Database Record

Short-term psychiatric adjustment of children and their parents following meningococcal disease

To assess short-term changes in child and parent psychiatric status following meningococcal disease. Prospective cohort study; 3-month follow-up using parent, teacher, and child questionnaires. Hospital admissions to three pediatric intensive care units and 19 general pediatric wards. Sixty children aged 3-6 yrs, 60 mothers, and 45 fathers. We administered measures of illness severity (Glasgow Meningococcal Septicaemia Prognostic Score, days in hospital) and psychiatric morbidity (Strengths and Difficulties Questionnaires, parent and teacher versions; Impact of Event scales; General Health Questionnaire-28). In children admitted to pediatric intensive care units, parental reports at 3-month follow-up showed a significant increase in emotional and hyperactivity symptoms and in related impairment; symptoms of posttraumatic stress disorder were present in four of 26 (15%) children >8 yrs old. Regarding the parents, 26 of 60 (43%) mothers in the total sample had questionnaire scores indicative of high risk for psychiatric disorder and 22 of 58 (48%) for posttraumatic stress disorder. In fathers there was high risk for psychiatric disorder in 11 of 45 (24%) and for posttraumatic stress disorder in 8 of 43 (19%). Severity of the child's physical condition on admission was significantly associated with hyperactivity and conduct symptoms at follow-up. Length of hospital admission was associated with psychiatric symptoms in the child and posttraumatic stress disorder symptoms in parents. There were also significant associations between psychiatric symptoms in children and parents. Admission of children to pediatric intensive care units for meningococcal disease is associated with an increase in and high levels of psychiatric and posttraumatic stress disorder symptoms in children and parents. Length of admission is associated with psychiatric symptoms in children and posttraumatic stress disorder symptoms in parents. Pediatric follow-up should explore psychiatric as well as physical sequelae in children and parents.

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

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

The Impact of Terrorism on Children

Abstract Terrorism is an extreme form of violent trauma made worse by being of human design. Following the terrorist attacks of September 11, 2001, the United States and the entire world entered into a new era in history. As much as adults seek to protect children from harm, their lives are too often touched by trauma, including terrorism. It is essential to examine and synthesize the findings of previous research regarding terrorism and trauma in order to guide our mental health work with children and families, particularly in the aftermath of recent terrorist events. Post Traumatic Stress Disorder symptoms in children affected by terrorism are high, with other common long-term consequences such as depression, anxiety, behavior, and developmental problems. Terrorism also raises unique trauma consequences for children. How children responded after the bombing of the Murrah Federal Building in Oklahoma City is reviewed in this paper. Although children of all ages had and have reactions to the terrorist traumas, these may be mediated by different variables. Furthermore, the new threat of invisible agent attacks may further complicate trauma reactions in children. Research and interventions with children must be conducted on all levels (individual, family, school, community, and public policy) to effectively meet the needs of our next generation.

The Child PTSD Symptom Scale: A Preliminary Examination of its Psychometric Properties

Reports on the development and preliminary validation of the Child PTSD Symptom Scale (CPSS) for children and adolescents. The CPSS is a new instrument that was developed to assess the severity of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) posttraumatic stress disorder symptoms in children exposed to trauma. The CPSS was administered to 75 school-age children approximately 2 years after the 1994 Northridge, California, earthquake. The psychometric properties of the CPSS show high internal consistency and test-retest reliability for both the total score and the three subscales. Convergent validity with the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) was established. As expected, the correlations of the CPSS with depression and anxiety measures were lower than those with the CPTSD-RI, providing some support for discriminant validity of the CPSS. These results suggest that the CPSS is a useful tool for the assessment of posttraumatic stress disorder (PTSD) severity and for the screening of PTSD diagnosis among traumatized children.

Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: Results from confirmatory factor analyses.

Factor analytic studies of trauma victims' posttraumatic stress disorder (PTSD) have offered conflicting hypotheses about how to conceptualize PTSD into symptom categories. The present study used confirmatory factor analyses of self-reported PTSD symptomatology from 5,664 child and adolescent victims of Hurricane Hugo to compare 10 models of PTSD dimensionality. PTSD was best represented by a 2nd-order PTSD factor that manifests in 3 symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal). This model was cross-validated on 3 age groups (late childhood, early adolescence, and late adolescence), and results indicated factorial invariance across groups. PTSD symptoms varied in relative centrality to the underlying dimensions of PTSD, which differed in their relations with anxiety and degree of traumatic exposure. Implications for classification criteria and an empirically supported theory of PTSD are discussed.

Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: Results from confirmatory factor analyses.

Factor analytic studies of trauma victims' posttraumatic stress disorder (PTSD) have offered conflicting hypotheses about how to conceptualize PTSD into symptom categories. The present study used confirmatory factor analyses of self-reported PTSD symptomatology from 5,664 child and adolescent victims of Hurricane Hugo to compare 10 models of PTSD dimensionality. PTSD was best represented by a 2nd-order PTSD factor that manifests in 3 symptom clusters (Intrusion/Active Avoidance, Numbing/Passive Avoidance, and Arousal). This model was cross-validated on 3 age groups (late childhood, early adolescence, and late adolescence), and results indicated factorial invariance across groups. PTSD symptoms varied in relative centrality to the underlying dimensions of PTSD, which differed in their relations with anxiety and degree of traumatic exposure. Implications for classification criteria and an empirically supported theory of PTSD are discussed.

Post-Traumatic Stress Disorder Symptoms in Child Sexual Abuse Victims and Their Mothers

ABSTRACT Post-Traumatic Stress Disorder (PTSD) symptoms in children who reported sexual abuse, and their mothers, were compared for children in two groups: children whose mothers reported having been sexually abused as a child and children whose mothers did not report sexual victimization. Rates of PTSD symptoms are comparable to the rates found in previous studies, with over half of the sexually abused children displaying PTSD symptoms. The two group of children were equivalent on presence of PTSD symptoms. More mothers victimized as children suffer PTSD when their children report being sexually abused. Although both children and mothers displayed PTSD sexually abused. Although both children and mothers displayed PTSD symptoms, mother-child pairs when examined as a unit did not reliably exhibit PTSD symptoms.

Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.