Acute Stress Symptoms in Children: Results From an International Data Archive

doi:10.1016/j.jaac.2012.05.013

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 51, Issue 8, August 2012, Pages 812-820

https://doi.org/10.1016/j.jaac.2012.05.013 Get rights and content

Objective

To describe the prevalence of acute stress disorder (ASD) symptoms and to examine proposed DSM-5 symptom criteria in relation to concurrent functional impairment in children and adolescents.

Method

From an international archive, datasets were identified that included assessment of acute traumatic stress reactions and concurrent impairment in children and adolescents 5 to 17 years of age. Data came from 15 studies conducted in the United States, United Kingdom, Australia, and Switzerland and included 1,645 children and adolescents. Dichotomized items were created to indicate the presence or absence of each of the 14 proposed ASD symptoms and functional impairment. The performance of a proposed diagnostic criterion (number of ASD symptoms required) was examined as a predictor of concurrent impairment.

Results

Each ASD symptom was endorsed by 14% to 51% of children and adolescents; 41% reported clinically relevant impairment. Children and adolescents reported from 0 to 13 symptoms (mean = 3.6). Individual ASD symptoms were associated with greater likelihood of functional impairment. The DSM-5 proposed eight-symptom requirement was met by 202 individuals (12.3%) and had low sensitivity (0.25) in predicting concurrent clinically relevant impairment. Requiring fewer symptoms (three to four) greatly improved sensitivity while maintaining moderate specificity.

Conclusions

This group of symptoms appears to capture aspects of traumatic stress reactions that can create distress and interfere with children's and adolescents' ability to function in the acute post-trauma phase. Results provide a benchmark for comparison with adult samples; a smaller proportion of children and adolescents met the eight-symptom criterion than reported for adults. Symptom requirements for the ASD diagnosis may need to be lowered to optimally identify children and adolescents whose acute distress warrants clinical attention.

Section snippets

Datasets

This project made use of a new and unique data resource, the PTSD after Acute Child Trauma (PACT) Data Archive. This international archive contains investigator-provided, de-identified datasets from prospective studies of children exposed to an acute, potentially traumatic event. Currently, the archive contains datasets from 19 studies and from four countries. Each dataset in the archive includes basic data on demographics, trauma characteristics, one or more potential predictors of ongoing

Sample Characteristics

Table 2 shows demographic characteristics, trauma type, and country/region of residence for the total combined sample across all 15 datasets. Children and adolescents in this combined sample ranged in age from 5 to 17 years (mean = 11.6; SD = 3.0); about two-thirds were male, and nearly one-half were of minority ethnicity. The most common index trauma was injury, although categories were not mutually exclusive, i.e., an individual who was injured and was in a road traffic accident was counted

Discussion

Clear conceptualization and empirically validated diagnostic criteria can advance efforts to identify children and adolescents with significant distress who need increased psychosocial supports or formal clinical attention. Data from 15 studies including 1,645 children and adolescents assessed soon after an acute trauma were combined to examine the utility of proposed DSM-5 ASD symptom criteria. Each symptom was endorsed by 14% to 51% of children or adolescents. Of the 14 symptoms, 13 were

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Factors associated with new mental health diagnoses and resource utilization among pediatric patients following trauma admission
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Citation Excerpt :
Traumatic injury is well recognized as the most common cause of physical morbidity and mortality among children in the United States [1]. Beyond the physical sequelae and complications associated with injury, children may experience a variety of emotional sequelae that impair their ability to return to their baseline function prior to injury [2]. At present, it is estimated that 1 in 11 children, regardless of history of physical trauma, experience anxiety, and 1 in 20 are diagnosed with depression [3].
Injured children are at risk for a variety of physical and emotional sequelae that may impair their ability to return to prior function. The effect of traumatic injury on mental health in children is not well characterized or understood. We sought to determine factors associated with new mental health diagnoses and/or mental health resource utilization following admission to a Level 1 pediatric trauma center for traumatic injury.
A retrospective chart review of patients admitted for accidental trauma between 2016 and 2019 was performed. Demographic data, injury characteristics, new mental health diagnoses and/or mental health resource utilization following hospitalization were extracted. Patients with prior mental health diagnosis, psychotropic prescription(s), or resource utilization were excluded from this cohort. A multivariable logistic regression model was used to examine predictors of new mental health diagnoses and/or resource utilization.
The prevalence of new mental health diagnoses or resources utilization was 9.5% (363/3828). The most common diagnoses were anxiety disorders and nonbipolar depression. The most common psychotropic medication prescribed was antidepressants. Patients with new mental illness were older (odds ratio [OR] 1.1 [95% CI: 1.06, 1.12]), more likely to sustain burn injuries (OR 6.3 [4.2, 9.5]), have non-sports related injuries (OR 3.5 [2.1, 6.0]), and be pedestrian struck (OR 2.7 [1.5, 4.8]). They additionally were more likely to sustain head, neck, and spine injuries (OR 3.8 [2.9, 5.1], 2.4 [1.1, 5.5], and 2.1 [1.3, 3.3], respectively).
There are a variety of demographic and injury specific factors associated with new mental health diagnoses and/or resource utilization in children following admission for trauma. Knowledge of these risk factors may ensure patients are allocated adequate resources to promote timely access to appropriate mental health services after hospitalization.
Retrospective comparative study
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Acute stress disorder in children and adolescents: A systematic review and meta-analysis of prevalence following exposure to a traumatic event
2020, Journal of Affective Disorders Reports
Citation Excerpt :
However, the findings here suggest that many children and adolescents who might meet diagnostic criteria through a clinical interview may not be identified using a questionnaire oriented to DSM-IV ASD criteria. This has been attributed to the lack of coverage of dissociative symptoms on questionnaire measures of DSM-IV ASD when compared to interview, resulting in many youth not meeting diagnostic criteria (Kassam-Adams et al., 2013). Questionnaires for use with the updated DSM-5 criteria will no longer include the cluster-based algorithm, although will require the presence of at least nine of fourteen symptoms.
Acute stress disorder (ASD) was proposed to encapsulate traumatic stress reactions within the first few months of exposure to trauma. The present systematic review and meta-analysis aimed to estimate the prevalence of ASD in children and adolescents, and the extent to which assessment, demographic and trauma variables moderate this.
Searches of EMBASE, MEDLINE (PubMed), PsycINFO, PsycARTICLES and PILOTS were conducted to identify studies published between 1^st January 1994 and 1^st January 2018. Seventeen studies were identified as meeting inclusion criteria (N=2918 participants).
The pooled prevalence estimate for ASD was 16.5% (95% CI 10.6–23.4%), with considerable heterogeneity between studies (Q[16]=261.12, p < .001, I²=95.3%). Risk of bias was unrelated to prevalence estimates. Studies that used a clinical interview (k=8) yielded a higher estimate (24.0%, 95% CI 13.8–36.0%) than those that used a questionnaire which adhered to the diagnostic algorithm for DSM-IV ASD (k=6; 6.8%, 95% CI 3.6–10.9%). Studies comprising older participants yielded greater prevalence estimates. Prevalence was significantly greater in studies where the majority of participants had been exposed to interpersonal trauma (27.9%, 95% CI 15.1–42.8%; k=5) compared to non-interpersonal trauma (12.8%, 95% CI 7.2–19.7%; k=12).
This review suggests that a significant minority of trauma-exposed children and adolescents meet criteria for ASD (in particular youth exposed to interpersonal trauma), but the findings are limited by a large degree of heterogeneity. DSM-IV ASD-specific self-report questionnaire measures may be too insensitive for identifying youth with this disorder.
Relationship between posttraumatic stress symptoms, caregiving response, and parent mental health in youth exposed to single incident trauma
2019, Journal of Affective Disorders
Family factors may alter the risk of developing posttraumatic stress disorder (PTSD) or depression in young people after a traumatic event, but it is not clear which modifiable family variables can be addressed in psychological therapies. This study examined the relationships between family factors (Expressed Emotion [EE] and family accommodation) and psychopathology (posttraumatic stress symptoms; PTSS) in young people following a single incident trauma. Potential mediators of these relationships were also investigated.
Sixty-six parent-child dyads (aged 8–17 years) were assessed within one month of attending an Emergency Department. Self-reported PTSS and perceived EE were assessed in young people. Parents’ own PTSS, mood symptoms, EE, and accommodating behaviours were also assessed.
Cross-sectional analyses revealed that young person-perceived EE, parent-reported emotional over involvement (EOI) and accommodation behaviours significantly predicted higher PTSS in young people. The stress experienced as a consequence of EE mediated the relationship between young person-perceived EOI and PTSS in young people. Parental PTSS and anxiety were positively correlated with EOI and accommodation. Parental PTSS was not significantly associated with symptoms in young people.
The results support the hypothesis that EE and accommodation are positively associated with PTSS in young people in the month following a potentially traumatic event. Understanding the child in the context of their family environment and relationships offers an important framework for making sense of and facilitating adaptive adjustment following a traumatic event.
Surviving the Immediate Aftermath of a Disaster: A Preliminary Investigation of Adolescents’ Acute Stress Reactions and Mental Health Needs after the 2023 Turkey Earthquakes
2023, Children
The Incidence of Posttraumatic Stress Symptoms in Children
2023, Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
Preventive and Therapeutic Mental Health Care after the Earthquake-Expert Opinion from the Psychiatric Association of Turkey
2023, Turk Psikiyatri Dergisi

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: Clinical guidance is available at the end of this article.

: This work was supported by grant R21MH086304 from the National Institute of Mental Health.

: Disclosure: Drs. Kassam-Adams, Palmieri, Rork, Delahanty, Kenardy, Landolt, Le Broque, Marsac, Meiser-Stedman, Nixon, and Bui, and Ms. Kohser and McGrath report no biomedical financial interests or potential conflicts of interest.

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New researchAcute Stress Symptoms in Children: Results From an International Data Archive

Objective

Method

Results

Conclusions

Section snippets

Datasets

Sample Characteristics

Discussion

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

J Trauma Stress

A diagnostic interview for acute stress disorder for children and adolescents

J Trauma Stress

A review of acute stress disorder in DSM-5

Depress Anxiety

The posttraumatic stress disorder diagnosis in preschool- and elementary school-age children exposed to motor vehicle accidents

Am J Psychiatry

PTSD in children and adolesccents: toward an empirically based algorithm

Depress Anxiety

Considering PTSD for DSM-5

Depress Anxiety

Psychological consequences of road traffic accidents for children and their mothers

Psychol Med

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

J Trauma Stress

The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors

J Consult Clin Psychol

Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury

Am J Psychiatry

Final NIH Statement on Sharing Research Data (NOT-OD-03-032)

Demographic and psychological concomitants of ASD and PTSD: an analysis of children after traffic injury

Persistence of posttraumatic stress in violently injured youth seen in the emergency department

Arch Pediatr Adolesc Med

A pilot randomized controlled trial assessing secondary prevention of traumatic stress integrated into pediatric trauma care

J Trauma Stress

New research
Acute Stress Symptoms in Children: Results From an International Data Archive