Posttraumatic stress symptoms in children after mild to moderate pediatric trauma: a longitudinal examination of symptom prevalence, correlates, and parent-child symptom reporting

Abstract

Background: Full recovery from injury may be hindered by both physical ailments and psychologic distress. Little information is available on the psychologic response of children to physical trauma, although long-term dysfunction may result if psychologic needs are not identified and addressed. This study examined the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms in children and adolescents after an acute traumatic event resulting in mild to moderate physical injury. We were also interested in analyzing the discrepancies between parent/child reporting of the child's PTSD symptomatology. Because of the paucity of research evaluating interventions for pediatric PTSD, and as a secondary objective for this study, we collected preliminary data on the effectiveness of a single-session art therapy intervention designed to reduce PTSD symptoms.

Method: From July 1998 through October 2000, 83 children/adolescents between the ages of 7 and 17 and their caregivers were interviewed within 24 hours of hospital admission and assessed for PTSD symptomatology, trauma history, and other measures of child and family functioning. Interviews were repeated at 1 month, 6 months, and 18 months after the initial hospitalization. Patients with at least mild symptomatology at the initial interview were randomized to receive either an art therapy intervention or standard hospital services alone.

Results: A total of 69% of children were found to have at least mild PTSD symptoms at baseline, 57% at 1 month, 59% at 6 months, and 38% at 18 months postinjury. Younger age and the severity of parental PTSD symptoms were correlated with symptom presence in children. Parents initially underreported their child's symptom severity when compared with the child's report, but assessments converged over time. The art therapy intervention showed no sustained effects on the reduction of PTSD symptoms.

Conclusion: The presence of PTSD symptoms in children after traumatic injury is very high. Parental distress and characteristics of the family environment appear to be more relevant to the presence of child symptoms than the family make-up, course of hospitalization, or extent of the child's injuries. Parents may not initially recognize the degree to which their children experience such symptoms. The high presence of symptoms in this population underscores the need for treatment efficacy studies and parent/medical staff education in identification of PTSD.