Children Injured in Accidents Show Post-Traumatic Stress

June 19, 2000
News Office: Corinna Kaarlela (415) 476-3804

Children injured in accidents suffer from post-traumatic stress disorder more than previously thought, according to new research by UCSF Medical Center doctors.

Study results show the psychological disorder, commonly called PTSD, is associated not only with major, life-threatening trauma, but also with more moderate injuries suffered by youngsters such as those from bicycle or car accidents.

In addition, research shows that parents and health care providers underestimate the severity of PTSD in the early period following injury. Study findings were reported on June 19 at the Fifth International Conference on Pediatric Trauma by a team of specialists from UCSF and Children's Hospital Oakland.

"One of the key findings from our study is the importance of developing better education programs for family members and the patient care team about the signs and symptoms of PTSD in a child, which can be very subtle," said researcher Chris Ladakakos, a psychologist with Children's and a post-doctoral fellow at UCSF.

"We believe that with the right intervention program and the support of family, a child stands the best chance for recovery, " he added.

Lead investigator of the study was Dr. Herb Schreier, chief of psychiatry at Children's. Senior investigator was Dr. M. Margaret Knudson, a surgeon at UCSF Medical Center. Knudson also is a UCSF associate professor of surgery, chief of pediatric trauma at San Francisco General Hospital Medical Center and director of the UCSF Injury Center.

The research team followed 80 children ages 7 to 17 who were injured in accidents. Each child self-assessed his or her own level of stress regarding the injury in an individual session with a researcher, who used the UCLA PTSD Reaction Index as a standardized guide for their discussion. A similar guide was used in sessions with parents and caregivers, who also were asked to rate the child's stress level.

Study results showed 60 percent of children exhibited symptoms of PTSD one month after the injury and 40 percent continued to have symptoms six months after the accident. Overall, children's ratings of their stress levels were much higher than the ratings by their parents and caregivers, and younger children reported more symptoms of PTSD than adolescents.

The difference in the child and adult ratings underscores the importance of increased awareness of the symptoms of childhood PTSD, because children may not be able to convey their level of emotional distress to adults, Schreier said.

Symptoms of PTSD in children fall into three general categories that even the child may not clearly recognize, according to the research team: re-experiencing the event through intrusive thoughts, wanting to avoid any subject or stimuli related to the event and an increase in startle response and jumpiness.

These symptoms often manifest themselves through behavior that may not be recognized by parents as related to their child's trauma, the researchers said. Signs for parents to watch for in the child include changes in grades, inability to concentrate, increased tearfulness, taking risks, getting into trouble at school and an attitude of "no hope" about the future.

Knudson emphasized that accurate diagnosis of PTSD in children is extremely important because if left untreated the disorder can interfere with future aspects of a child's development, educational experience, social interactions with peers and the quality of the child's relationship with parents.

In future studies, the researchers hope to focus on determining the most effective intervention programs for reducing PTSD in young patients. The study was funded by a grant from the Centers for Disease Control and Prevention.