Posttraumatic stress following pediatric injury update on diagnosis, risk factors, and intervention

Posttraumatic stress related to pediatric injury is common and can pose a threat to a child's full recovery. A substantial research base has established the occurrence and effect of PTS symptoms following injury, and the interrelationship of these psychological sequelae with physical and functional recovery. Within the past several years, meta-analytic studies6,42-44 have identified risk factors with large effect sizes, including preinjury psychopathology, peritrauma subjective experience (fear and life threat), early postinjury psychological reactions,andparents' earlyPTSsymptoms.Maladaptive trauma-related appraisals appear to influence the development and persistence of PTS symptoms.55 Posttrauma social support and adaptive posttraumacoping strategies serve as protective factors. Designedwithanunderstandingof these riskandprotectiveprocesses, the interventions aimed at preventing or treating persistent PTS symptoms often target coping strategies, appraisals, and parents' role inchild recovery. Universal preventive interventions including information and psychoeducation have shown modest effects,69,70andweb-based deliverypromises awide reach.68There is promising evidence for targeted preventive interventions.71However, additional well-designed studies of early posttraumainterventions for injured children areneededbeforewecan confidently draw conclusions about the relative role of universal and targeted intervention efforts. For treatment of PTSD in injured children, TF-CBT has the strongest evidence base60; more research is needed to establish its effectiveness as an indicated intervention to treat severe acute PTS symptoms.