A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents / R. MEISER-STEDMAN in Journal of Child Psychology and Psychiatry, 60-8 (August 2019)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 60-8 (August 2019) . - p.875-884 Titre : A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents Type de document : Texte imprimé et/ou numérique Auteurs : R. MEISER-STEDMAN, Auteur ; A. MCKINNON, Auteur ; C. DIXON, Auteur ; A. BOYLE, Auteur ; P. SMITH, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.875-884 Langues : Anglais (eng) Mots-clés : Post-traumatic stress disorder  cognitive development  early intervention  longitudinal studies Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma-exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post-traumatic stress symptoms (PTSS). METHODS: A prospective longitudinal study of youth aged 8-17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2-4 weeks (N = 226) and 2 months (N = 208) post-trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post-traumatic cognitive processes were assessed using self-report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. RESULTS: PTSS decreased between the two assessments. Cognitive processes at the 2- to 4-week assessment accounted for the most variance in PTSS at both the initial and follow-up assessment. The onset of post-traumatic stress was associated particularly with peritraumatic subjective threat, data-driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post-traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. CONCLUSIONS: Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma-related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS. En ligne : http://dx.doi.org/10.1111/jcpp.13054 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=404 [article] A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents [Texte imprimé et/ou numérique] / R. MEISER-STEDMAN, Auteur ; A. MCKINNON, Auteur ; C. DIXON, Auteur ; A. BOYLE, Auteur ; P. SMITH, Auteur ; Tim DALGLEISH, Auteur . - p.875-884. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 60-8 (August 2019) . - p.875-884 Mots-clés : Post-traumatic stress disorder  cognitive development  early intervention  longitudinal studies Index. décimale : PER Périodiques Résumé : BACKGROUND: Post-traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma-exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post-traumatic stress symptoms (PTSS). METHODS: A prospective longitudinal study of youth aged 8-17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2-4 weeks (N = 226) and 2 months (N = 208) post-trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post-traumatic cognitive processes were assessed using self-report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. RESULTS: PTSS decreased between the two assessments. Cognitive processes at the 2- to 4-week assessment accounted for the most variance in PTSS at both the initial and follow-up assessment. The onset of post-traumatic stress was associated particularly with peritraumatic subjective threat, data-driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post-traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. CONCLUSIONS: Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma-related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS. En ligne : http://dx.doi.org/10.1111/jcpp.13054 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=404

The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds / C. HITCHCOCK in Journal of Child Psychology and Psychiatry, 63-1 (January 2022)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.58-67 Titre : The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds Type de document : Texte imprimé et/ou numérique Auteurs : C. HITCHCOCK, Auteur ; B. GOODALL, Auteur ; I. M. WRIGHT, Auteur ; A. BOYLE, Auteur ; D. JOHNSTON, Auteur ; D. DUNNING, Auteur ; J. GILLARD, Auteur ; K. GRIFFITHS, Auteur ; A. HUMPHREY, Auteur ; A. MCKINNON, Auteur ; I. K. PANESAR, Auteur ; A. WERNER-SEIDLER, Auteur ; P. WATSON, Auteur ; P. SMITH, Auteur ; R. MEISER-STEDMAN, Auteur ; Tim DALGLEISH, Auteur Article en page(s) : p.58-67 Langues : Anglais (eng) Mots-clés : Adult  Child  Child, Preschool  Cognitive Behavioral Therapy  Hospitals  Humans  Prevalence  Psychotherapy  Stress Disorders, Post-Traumatic/diagnosis/epidemiology/therapy  Posttraumatic stress disorder  randomized control trial  young children Index. décimale : PER Périodiques Résumé : BACKGROUND: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ?6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. METHOD: Study 1 (N?=?105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N?=?37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. RESULTS: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3?months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. CONCLUSIONS: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted. En ligne : http://dx.doi.org/10.1111/jcpp.13460 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456 [article] The early course and treatment of posttraumatic stress disorder in very young children: diagnostic prevalence and predictors in hospital-attending children and a randomized controlled proof-of-concept trial of trauma-focused cognitive therapy, for 3- to 8-year-olds [Texte imprimé et/ou numérique] / C. HITCHCOCK, Auteur ; B. GOODALL, Auteur ; I. M. WRIGHT, Auteur ; A. BOYLE, Auteur ; D. JOHNSTON, Auteur ; D. DUNNING, Auteur ; J. GILLARD, Auteur ; K. GRIFFITHS, Auteur ; A. HUMPHREY, Auteur ; A. MCKINNON, Auteur ; I. K. PANESAR, Auteur ; A. WERNER-SEIDLER, Auteur ; P. WATSON, Auteur ; P. SMITH, Auteur ; R. MEISER-STEDMAN, Auteur ; Tim DALGLEISH, Auteur . - p.58-67. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.58-67 Mots-clés : Adult  Child  Child, Preschool  Cognitive Behavioral Therapy  Hospitals  Humans  Prevalence  Psychotherapy  Stress Disorders, Post-Traumatic/diagnosis/epidemiology/therapy  Posttraumatic stress disorder  randomized control trial  young children Index. décimale : PER Périodiques Résumé : BACKGROUND: The introduction of developmentally adapted criteria for posttraumatic stress disorder (PTSD) has improved the identification of ?6-year-old children with clinical needs. Across two studies, we assess predictors of the development of PTSD in young children (PTSD-YC), including the adult-led acute stress disorder (ASD) diagnosis, and provide proof of principle for cognitive-focused therapy for this age range, with the aim of increasing treatment options for children diagnosed with PTSD-YC. METHOD: Study 1 (N?=?105) assessed ASD and PTSD-YC diagnosis in 3- to 8-year-old children within one month and at around three months following attendance at an emergency room. Study 2 (N?=?37) was a preregistered (www.isrctn.com/ISRCTN35018680) randomized controlled early-phase trial comparing CBT-3M, a cognitive-focused intervention, to treatment-as-usual (TAU) delivered within the UK NHS to 3- to 8-year-olds diagnosed with PTSD-YC. RESULTS: In Study 1, the ASD diagnosis failed to identify any young children. In contrast, prevalence of acute PTSD-YC (minus the duration requirement) was 8.6% in the first month post-trauma and 10.1% at 3?months. Length of hospital stay, but no other demographic or trauma-related characteristics, predicted development of later PTSD-YC. Early (within one month) diagnosis of acute PTSD-YC had a positive predictive value of 50% for later PTSD-YC. In Study 2, most children lost their PTSD-YC diagnosis following completion of CBT-3M (84.6%) relative to TAU (6.7%) and CBT-3M was acceptable to recipient families. Effect sizes were also in favor of CBT-3M for secondary outcome measures. CONCLUSIONS: The ASD diagnosis is not fit for purpose in this age-group. There was a strong and encouraging signal of putative efficacy for young children treated using a cognitive-focused treatment for PTSD, and a larger trial of CBT-3M is now warranted. En ligne : http://dx.doi.org/10.1111/jcpp.13460 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456

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