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Early screening may identify PTSD in young children
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Assessment of acute stress symptoms can be a predictor for full or partial posttraumatic stress disorder in preschool-aged children 6 months after a single accidental injury, according to recent study findings published in Pediatrics.
“In 2011, >10% of all US children up to 6 years old experienced at least one accidental trauma that needed to be treated in a hospital emergency department,” according to study background information. “Besides the potential for physical impairment, accidental injuries lead to a significant number of children suffering from long-lasting posttraumatic stress disorder (PTSD).”
Markus Landolt
The study included 87 children aged 2 to 6 years examined with the Pediatric Emotional Distress Scale-Early Screener (PEDS-ES) within 6 to 13 days after an accident. Questions on five additional risk factors were also examined and included pre-existing child behavioral problems, parental pre-existing chronic mental or physical illness, pre-traumatic life events in the family, parental feelings of guilt, and parental posttraumatic stress.
Researchers found that PEDS-ES performed best without additional risk factors with good sensitivity (85%) and moderate specificity (63%) for full or partial PTSD.
“This is the first study to show that injured preschool age children at risk for longer term psychological and behavioral problems can be identified at a very early stage after the accident,” Markus A. Landolt, PhD, of University Children’s Hospital in Switzerland told Infectious Diseases in Children. “Early identification of children at risk is an important prerequisite to provide appropriate early treatment and thus reduce the number of preschool age children suffering from psychological and behavioral problems after an accident.”
Disclosure: The study was funded in part by the Anna Mueller Grocholski Foundation and the Foundation Falk von Reichenbach. One researcher reports receiving royalties for two German books on psychotraumatology.
Perspective
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Suzanne D. Dixon-Hennessey, MD, MPH
The authors have done a service to patients, their families and clinicians by calling attention to the long-term effects of childhood traumatic events. Because youngsters often don’t discuss these things, either because they can’t due to age or suppression of memories or don’t want to, a routine evaluation in the week after as well as one after are worth doing. In this paper, a screening tool for PTSD is presented, an adaptation of one used for older children. The authors report good metrics in terms of things we look for in screeners such as specificity and sensitivity. However, I am concerned that this instrument isn’t ready for widespread usage.
The actual number of identified youngsters is less than 30 and they have a wide age range. Additionally, two year olds are substantially different in terms of cognition, memory, and behavior than six year olds. We need more subjects and testing of the test in larger, specific age cohorts. Unfortunately, when such studies are published at all, they are regarded as established when they are not. I would like to see drawing tasks added to such an assessment for those over three as this has been shown to be very effective in allowing young children to convey stressful events and there is a large literature on this approach.
Lastly, one never screens for any condition unless there is effective treatment available. Counseling in this circumstance may or may not be helpful in young children. Such services might be better directed at effected family members from whom children absorb emotional responses. Some data show the “grief counseling” can stir up and consolidate grief and lose feelings, not ameliorate them; it may be the same in these circumstances. Also, maybe it is different in Switzerland, but in this country we have poor access to any mental care for children and few therapists who are skilled in working with the very young. This paper is an important area to explore but I suggest caution. I hope the authors continue their work and we see it at a later developmental stage.
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