Posttraumatic growth among children and adolescents: A systematic review

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Abstract

Stress and trauma research has traditionally focused on negative sequelae of adversity. Recently, research has begun to focus on positive outcomes, specifically posttraumatic growth (PTG) – “positive change experienced as a result of the struggle with trauma” – which emphasizes the transformative potential of one's experiences with highly stressful events and circumstances. The positive changes of PTG are generally thought to occur in five domains: new possibilities, relating to others, personal strength, appreciation of life, and spiritual change. The study of PTG has, for the most part, been centered on adults, and not until very recently has there been sufficient research on PTG among children and adolescents to justify a review. The current systematic review of the literature on PTG among children and adolescents included 25 studies that tested associations between PTG and conceptually-relevant variables found to be associated with PTG in adults and hypothesized to play similar roles in young people, including environmental characteristics, distress responses, social processes, psychological processes, positive outcomes, and demographic variables. Links were made between a theoretical model of PTG among youth and findings of the current review. Limitations and recommendations for future research are discussed.

Highlights

► Ties between PTG and stress/distress, social/religious support, coping, and health. ► Youth PTG may decay over time more quickly than does PTG in adults. ► PTG may be optimal during late adolescence and moderate trauma severity and PTSS. ► Gender differences (females report more PTG) may not emerge until early adulthood. ► Potential utility of PTG to catalyze long-term positive change beyond itself.

Section snippets

Definitions of posttraumatic growth

Posttraumatic growth (PTG) – “positive change experienced as a result of the struggle with trauma” (Kilmer, 2006, Tedeschi and Calhoun, 1995) – emphasizes the transformative quality of responding to highly stressful and/or traumatic events (Calhoun & Tedeschi, 2006). Those studying PTG underscore that it is not the event itself, but rather the struggle in the wake of trauma that is believed to lead to PTG (Tedeschi & Calhoun, 1995). In their work with adults, Tedeschi and Calhoun, 1995, Calhoun

Measurement of posttraumatic growth

Although the constructs and measures of PTG, benefit finding, and stress-related growth differ to some extent, significant overlap is seen in the questions that comprise these measures. For example, a sample item on the PTGI-C-R (Kilmer et al., 2009) is, “I know what is important to me,” and a similar item on the BFSC (Phipps et al., 2007) is, “Has taught me what is really important in life.” Nevertheless, the distinction between benefit finding and growth has been argued (Davis et al., 1998,

Correlates of PTG in adult samples

Recent meta-analyses of PTG among adults have established relations between PTG and various environmental, social, psychological, and demographic variables. For instance, Helgeson et al. (2006) conducted a meta-analysis of 87 studies and reported that growth and/or benefit finding was negatively related to depression and positively related to objective severity of the trauma, perceived stress, intrusive-avoidant cognitions, denial, optimism, positive reappraisal, religiosity, acceptance, and

Rationale for the present review

In comparison to the state of the field with adults, little is known about the construct of PTG in children and adolescents. No reviews to date have been conducted of research examining the factors that are related to and/or influence PTG among young people exclusively. In fact, until very recently there was not sufficient published (and/or unpublished) research on PTG among children and adolescents to justify a review. Kilmer (2006) published a book chapter in which he noted that only two

Procedures and inclusion/exclusion criteria

Pertinent studies were identified through four major database searches: PubMed, PsycINFO, ERIC, and Social Science Citation Index, as well as Google Scholar (http://scholar.google.com/) and through manual searches of prominent journals in the field (e.g., Journal of Traumatic Stress; Traumatology; and Anxiety, Stress, and Coping), for all published articles and dissertations on the topic. Keywords, as suggested in prior reviews with adults (e.g., Prati & Pietrantoni, 2009) were posttraumatic

Results

A total of 22 peer-reviewed journal articles and three dissertations met the inclusion criteria for this review. Of the 25 included studies, there were 22 samples, as some investigations used data from the same samples. It should be noted that Levine, Laufer, Hamama-Raz, Stein, and Solomon (2008) examined the same sample of 2999 participants that was examined by Laufer and Solomon (2006); however, Levine et al. collected an additional sample of 1745 adolescents. These studies are considered as

Discussion

This paper provides the first systematic review of PTG studies conducted exclusively with children and adolescents. Until very recently, there were insufficient studies to justify such a review. In fact, most of the studies included in this review were conducted within the past five years. Currently, 25 studies (including 22 samples) have examined PTG in young people.

Our review of these studies revealed methodological strengths and weaknesses in this body of research. Evidence of strengths

Acknowledgments

The authors would like to thank Joseph R. Cohen, Rutgers University, for sharing his ideas and creativity during the inception of this project, as well as the authors of the studies included in this review for their contributions to the field.

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