Child accident victims show high level of post-traumatic stress that often is not recognized by parents and care-givers

June 18, 2000

Children injured in accidents suffer from post-traumatic stress disorder more often than previously thought, according to new research.

Study results show the psychological disorder, commonly called PTSD, is associated not only with major trauma in which injuries may be life-threatening, but it also is prevalent among youngsters who experience injuries considered mild or moderate that often result from bicycle crashes, falls, or being hit by a car.

In addition, research shows that both parents and health care providers significantly underestimate the severity of PTSD in the early period following injury.

Study findings were reported today (Monday, June 19) at the Fifth International Conference on Pediatric Trauma by a team of specialists from the University of California, San Francisco and Children's Hospital Oakland (Calif.). The conference is taking place near Vail, Colo.

"One of the key findings from our study is the importance of developing better education programs for family members and the patient care team about the signs and symptoms of PTSD in a child, which can be very subtle," said researcher Chris Ladakakos, PhD, a psychologist with Children's and post-doctoral fellow at UCSF.

"We believe that with the right intervention program and the support of family, a child stands the best chance for recovery, " he added.

Study lead investigator was Herb Schreier, MD, chief of psychiatry at Children's, and senior investigator was M. Margaret Knudson, MD, UCSF associate professor of surgery, chief of pediatric trauma at San Francisco General Hospital Medical Center, and director of the UCSF Injury Center.

The research team followed 80 children ages 7 to 17 who were injured in accidents. Each child self-assessed his or her own level of stress regarding the injury in an individual session with a researcher, who used the UCLA PTSD Reaction Index as a standardized guide for their discussion. A similar guide was used in sessions with parents and care-givers, who also were asked to rate the child's stress level.

Study results showed 60 percent of children exhibited symptoms of PTSD one month after the injury and 40 percent continued to have symptoms six months after the accident. Overall, children's ratings of their stress levels were much higher than the ratings by their parents and care-givers, and younger children reported more symptoms of PTSD than adolescents.

The difference in the child and adult ratings underscores the importance of increased awareness of the symptoms of childhood PTSD, because children may not be able to convey their level of emotional distress to adults, Schreier said.

Symptoms of PTSD in children fall into three general categories that even the child may not clearly recognize, according to the research team: re-experiencing the event through intrusive thoughts, wanting to avoid any subject or stimuli related to the event, and an increase in startle response and jumpiness

These symptoms often manifest themselves through behavior that may not be recognized by parents as related to their child's trauma, the researchers said. Signs for parents to watch for in the child include changes in grades, inability to concentrate, increased tearfulness, taking risks, getting into trouble at school, and an attitude of "no hope" about the future.

Knudson, who treats many injury victims first-hand in the Trauma Service at SFGHMC, emphasized that accurate diagnosis of PTSD in children is extremely important because if left untreated the disorder can interfere with future aspects of a child's development, educational experience, social interactions with peers, and the quality of the child's relationship with parents.

In future studies, the researchers hope to focus on determining the most effective intervention programs for reducing PTSD in young patients. The study was funded by a grant from the Centers for Disease Control and Prevention.
NOTE TO THE MEDIA: The Fifth International Conference on Pediatric Trauma is scheduled for June 17 to 20 at the Vilar Center for Performing Arts in Vail/Beaver Creek, Colo. For information about the conference, contact Trish Kenyon c/o the Charter Hotel at 800-525-6660.

To arrange an interview with UCSF/Children's Hospital researchers about the PTSD study, contact Corinna Kaarlela in the UCSF News Office at 415-476-3804.

University of California - San Francisco

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