SAN DIEGO – Children who are hospitalized for moderate to severe physical injuries face a high risk of posttraumatic stress disorder symptoms and psychological impairment if they display certain avoidance behaviors, Dr. Christopher Petersen said in an interview during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.
Examples of such behavior include the child saying it's difficult to feel happy or staying away from reminders of the event that led to his or her injury.
The finding “confirms some of the things we know about adults that we've been trying to apply to children,” Dr. Petersen said. “That is, out of avoidance, hyperarousal, and reexperiencing, avoidance seems to be the factor that most likely goes with [psychological] impairment.”
He and his associates also found no correlation between the level of a child's physical trauma and the severity of subsequent psychological impairment or PTSD symptoms.
“We thought that the kids who had major physical trauma would be more traumatized psychologically, but that's not necessarily the case,” said Dr. Petersen of the department of psychiatry at Pennsylvania State University in Hershey. “There are other factors playing into that.”
The researchers studied 28 children who were hospitalized for moderate to severe injuries: 22 were injured in motor vehicle accidents, 5 during sports, and 1 in a fall from a second-story window.
The mean age of the children was 13 years, and more than half (16) were boys. Ten days after hospital discharge, the children completed the Child and Adolescent PTSD Checklist, and their parents completed the Columbia Impairment Scale.
Of the 13 items on the PTSD Checklist, 82% of children reported that one or more of the symptoms caused problems for them most or all of the time. The most common symptoms reported were difficulty remembering what happened (32%), trying not to think about what happened (25%), and mentally going over what happened (25%).
Only six of the children (21%) had Columbia Impairment Scale scores in the abnormal range. The mean score for all patients was 10.6, which is considered normal.
Dr. Petersen noted that the PTSD subscales of avoidance and hyperarousal were significantly correlated with the Columbia Impairment Scale score, but the reexperiencing subscale was not.
“Watch for kids who have avoidance symptoms,” he advised. “If those symptoms persist beyond 30 days, those are the kids you really need to track or get into treatment early.”
In contrast, Dr. Petersen added, young people “who are dealing with [the physical trauma] over and over again, talking about it, struggling with it, maybe getting angry or tearful–those are kids who are more likely to work through it.” The researchers also found that high levels of physical trauma severity were not associated with high levels of psychological impairment or PTSD symptoms, a finding they did not expect.
“Is that because a lot of these children may have been as traumatized by the experience in the hospital with surgeries or interventions compared to the original physical trauma, or is that because of previous traumas that they had?” Dr. Petersen asked. “We don't know.”
He and his associates are in the process of conducting the study in a larger patient population to see whether the findings bear out.
The study was funded by grants from the Penn State Children, Youth, and Families Consortium and the Penn State Children's Miracle Network.
In addition, funding was provided by a grant from the American Academy of Child and Adolescent Psychiatry that was supported by McNeil Consumer and Specialty Pharmaceuticals.