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Researching post emergency recovery for very young

Introduction When the diagnosis of PTSD was first formulated in 1980 American Psychiatric Association, 1980 it was initially believed that it would not be relevant to children and young people. This was soon demonstrated to be false and it is now accepted that children and young people can develop PTSD following traumatic events.

From the age of 8—10 years, following traumatic events, children display reactions closely similar to those manifested by adults. Below 8 years of age, and in particular below the age of 5 years, there is less agreement as to the range and severity of the reactions.

Scheeringa et al 1995 have suggested an alternative set of criteria for the diagnosis of PTSD in children, placing more emphasis on regressive behaviours and new fears, but these have yet to be fully validated.


Traumatic reactions in children have been less extensively studied than in adults and there are few naturalistic, longitudinal studies mapping the natural history of these reactions. It has long been recognised Eth, 2001 that it is much more difficult to elicit evidence of emotional numbing in young children.

Other items indicating avoidance reactions in children simply are not relevant, thereby making it difficult for children to meet DSM criteria for that part of the diagnostic algorithm although this does not apply to the ICD diagnosis.

In general, it is agreed that children display a wide range of stress reactions. To some extent these vary with age, with younger children displaying more overt aggression and destructiveness. They may also show more repetitive play about the traumatic event, and this may even be reflected in repetitive drawing. This has not been adequately studied in relation to PTSD in children. This is, in part, one of the reasons for the finding that even more than with other anxiety disorders, parents grossly underestimate the degree of researching post emergency recovery for very young reactions experienced by their children.

Thus, one cannot rely solely on parental report when making diagnoses or estimating prevalence. However, as mothers had rated both their own adjustment and that of their children, this finding was suspect. Subsequent studies for example Smith et al, 2001 have found that direct exposure is usually a stronger determinant of child reaction, with maternal reactions being important modifying influences. Multiple versus single trauma Many children presenting with symptoms of PTSD may have been subjected to multiple traumas such as childhood sexual abuse or domestic violence.

The most common form of multiple trauma for children that has been studied and investigated is childhood sexual abuse, which often occurs in secret and is repeated over a long period.

Planning for Post-Disaster Recovery: Next Generation

The traumatic reactions associated with such multiple trauma can be usefully construed as similar to those that follow from single traumas, although issues of abuse of power, loss of trust and so on do make them different. Incidence, prevalence and natural history 9. Prevalence Most epidemiological studies have been of older young people and adults. In contrast, the British National Survey of Mental Health of over 10 000 children and young people Meltzer et al, 2000 reported that 0. Below the age of 10 years, PTSD was scarcely registered.

This lower rate is, of course, a point prevalence estimate and is bound to be lower than a lifetime prevalence estimate.

  1. The intended audience is both local officials and leaders as it bridges the gap between government's emergency response and long-term community recovery necessary after a disaster.
  2. Traumatic reactions in children have been less extensively studied than in adults and there are few naturalistic, longitudinal studies mapping the natural history of these reactions.
  3. A compilation of eight papers and one commentary about disaster resilience and sustainability.
  4. The author looks at how poverty exacerbates the impact of extreme weather events. In a book focused on historical facts, the authors begin with the 1871 Great Fire of Chicago, then travel throughout international history.
  5. Following social science sociology research from the 1970s, the book states that not enough is being done in the field of disasters.

Moreover, the screening instrument employed was not specifically developed to screen for PTSD. Incidence Estimates of the incidence of PTSD are more frequently reported after various natural and other disasters.

Rates vary enormously, partly as a result of different methodologies and partly as a result of different types of traumatic event. Most cases manifested within the first few weeks, with delayed onset being rare. Other disorders such as anxiety and depression were common as well. Yule, personal communication, 2004. Therefore, significantly increased demands may be made at all levels of primary and secondary child and adolescent mental health services following traumatic events.

In other words, in the absence of effective therapy, the long-term effects of life-threatening, traumatic events in childhood can be severe. Diagnostic and assessment measures 9.

Children, Youth, and Disaster

Children over 7 years old More is known about screening, assessment and diagnosis in children over the age of 7 years because above that age many children can read independently and can complete self-rating scales. It is much more time-consuming and expensive to conduct standardised clinical interviews with both parent and child to establish a diagnosis in large groups of children.

For a detailed recent review of self-completed scales, see Ohan et al 2002. The adult version has been used with children and young people in its original 15-item version.

Rape Treatment Outcome Research: Empirical Findings and State of the Literature

Following two large principal component analyses, a briefer eight-item version was developed for children Yule, 1997 and subsequently expanded to a 13-item version to include five items attempting to measure arousal see http: More recently it has been modified to be a self-report instrument Pynoos et al, 1987 ; Pynoos, 2002.

It contains a brief functional impairment rating. Structured interviews for PTSD in children and young people Structured interviews for children are not well developed; three of the more commonly used scales are described below.

Both the parent and the child are interviewed. Children aged 7 years or younger No consensus has emerged as to how to measure PTSD symptoms in children aged 7 years or younger.

  • PE aims to decrease anxiety associated with rape memories, thus allowing victims to reevaluate meanings associated with the memories and construct a more organized trauma story;
  • This study offers important preliminary evidence for using brief psychoeducational intervention in the immediate aftermath of a sexual assault in a format that could be easily disseminated;
  • A number of non-controlled trials suggest that treatments specifically CBT and EMDR are efficacious, but these have not been formally tested Cohen et al, 2000.

Measures of outcome for children within this review Given the lack of consensus about the measurement of PTSD for younger children, a range of child-specific measures were included in this review Table 9. In addition to PTSD scales, a range of child measures of depression, anxiety and quality of life were included within the review.

Measures of exposure to traumatic events The structured interviews indicate the most likely adverse life events that may result in PTSD in children and young people, but they do not constitute formal measures.

General practitioners, paediatricians and child mental health workers who see a child presenting with a sudden change in sleep pattern, nightmares and researching post emergency recovery for very young should enquire about intrusive images and then ask whether the child has experienced any threatening life event such as a bad accident, natural disaster, or physical or sexual abuse.

Measures of process and related aspects Increasing attention is being paid to cognitive factors such as the way in which children attribute blame for an event or the extent to which they erroneously believe that they might have died in the accident. The effective social support that is available to the child is also likely to be a key determinant of whether the child continues to respond adversely Joseph et al, 1993.

Standard measures of these aspects are still being developed. Psychological interventions Early intervention would be attractive if it could be shown that it prevented later development of PTSD or other disorders, but, as with adult studies, there have been few properly controlled trials of any early intervention. The only one known is that of Stallard et al 2005which is discussed below. They identified 12 RCTs: However, the dependent outcome measures were very varied, and only five studies looked at recognised, specific measures of PTSD.

Otherwise the inclusion criteria were identical to those for adults see Chapter 4.

  • As the research on children and youth in disaster has progressed, there has been increasing attention paid to how children are not just helpless victims, but also active agents who could be a valuable part of risk reduction and recovery;
  • However, the Echeburua et al.

From the main search for RCTs see Appendix 611 studies of psychological interventions were identified by the Guideline Development Group as meeting the inclusion criteria: References given in shortened format and summary characteristics of individual included trials are given in Appendix 14. Interventions considered Broadly, four different psychological interventions were covered within the included studies: Within these broad categories of treatments there was considerable variation in how treatments were delivered, with many studies allowing for some part of treatment being delivered to the caretaker as well as the child, either individually or in sessions for both the child and the caretaker.

Given the many different formats in which the four treatments were delivered, it was not possible to combine many of the studies for the purpose of this review. Interventions for which eligible studies were available. Populations — childhood sexual abuse and other traumas Nine of the studies related to childhood sexual abuse and were analysed separately from the remaining studies, which covered a range of traumatic events including witnessing violence, natural disaster, war and burns.

Each treatment arm consisted of 12 weekly sessions of 45 min for the child individually and 45 min for the parent, although three of the weekly sessions involved 30 min of joint parent—child therapy. Supportive therapy was child- and parent-centred, allowing the child or parent to guide the structure and content of the treatment, supplemented by the provision of written psychoeducational information.

Trauma-focused therapy worked on expression of feelings, coping skills and gradual exposure, whereby the children were assisted in developing their own trauma narrative as well as some psychoeducation.

Each treatment arm consisted of 12 individual treatment sessions of 90 min 45 min for the child individually and 45 min for the parent individually. Another study CELANO 1996 compared developmentally appropriate cognitive—behavioural techniques and metaphoric techniques with supportive therapy for girls aged 8—13 years and their carers.

Each treatment arm consisted of eight 1-hour weekly sessions. Sessions were split with 30 min of treatment each for the child and the carer individually, although two or three sessions included some joint work. There was limited evidence that CBT for children over 7 years old and their carers was better than supportive therapy in reducing the severity of PTSD symptoms post-treatment.

For the other outcome measures post-treatment, the evidence was either inconclusive child-rated depression, parent-rated researching post emergency recovery for very young and externalising behaviours, sexualised behaviours and likelihood of leaving the study early or indicated that there was unlikely to be a clinically important difference child-rated anxiety.

Unfortunately we do not know how sustained these improvements are because no follow-up data are currently available. Each treatment arm consisted of 12 weekly sessions of 50 min for the parent individually and 30—40 min for the child. There is limited evidence favouring CBT over supportive therapy for reducing parent-rated externalising symptoms and sexualised behaviour both post-treatment and at 1-year follow-up. Community care consisted of support from child protection workers and victim witness advocates and encouragement to seek therapists within the local community, and was researching post emergency recovery for very young as an active intervention for this review.

Individual treatment consisted of 12 treatment sessions of 45 min. The joint treatment condition comprised 12 sessions of 90 min with individual sessions for the child and mother and some joint sessions. Children ranged in age from 7 years to 13 years. However, by the 2-year follow-up the difference between the groups had diminished. There are similar results for the CDI self-report measure of depression, and the advantage of CBT for child only is present at the end of treatment and at the 6-month and 2-year post-treatment evaluations.

Given the nature of the community care, evidence on tolerability leaving the study early is difficult to interpret. The results for depression child-rated showed clinically significant improvement at the post-treatment and 2-year follow-up assessments but did not reach the threshold for clinical significance at researching post emergency recovery for very young intervening assessments. The interventions consisted of 20 weekly sessions of 50 min; however, the child and mother joint intervention arm consisted of a further 20 weekly 50 min sessions of training for the parents in child behaviour management skills.

Children ranged in age from 5 years to 17 years. Effect sizes for depression and anxiety did not reach the threshold for clinical importance. Individual versus group psychotherapy for children One study TROWELL 2002 compared group psychotherapy with individual psychotherapy for sexually abused girls aged 6—14 years. Individual psychotherapy entailed up to 30 weekly sessions, compared with up to 18 sessions for those completing group psychotherapy.

Unfortunately data were not available for total PTSD symptoms arousal symptoms data were not reported. There was limited evidence that individual therapy was better than the group delivery in terms of reducing re-experiencing and avoidance symptoms at 12 months and 24 months post-therapy, although effect sizes were borderline for clinical importance.

The evidence suggests that neither treatment was substantially better tolerated than the other. Each treatment arm entailed up to 12 sessions duration not specified and CBT incorporated a degree of exposure work. Debriefing One unpublished study STALLARD compared single-session debriefing with a generally supportive talk to children aged 7—18 years who had been involved in road traffic accidents, within approximately 2 weeks of the accident occurring.

The interventions were of approximately equal duration 68 min. The evidence was inconclusive for PTSD diagnosis and tolerability. The intervention consisted of ten group sessions and was delivered in a school mental health clinic. The children were approximately 10—12 years old.

In This Article

Clinical summary of psychological interventions The above evidence suggests that psychological interventions, specifically trauma-focused cognitive—behavioural psychotherapy, can be effective for the treatment of post-traumatic stress symptoms in children and young people who have been sexually abused. In contrast, there is very little evidence from RCTs for the efficacy of any psychological interventions for children or young people who suffer from PTSD arising from other forms of trauma.

This reflects not the inconclusive nature of the evidence but rather the lack of RCTs.