Researchers and medical professionals have long recognized that adults that experience trauma can develop a variety of symptoms including flashbacks, intrusive memories, nightmares, and emotional numbing. They may also experience impairment in occupational performance, social confidence, and competency. These symptoms and reactions to trauma are defined in the DSM-IV as posttraumatic stress disorder (PTSD). It is only recently that research has turned to the issue of PTSD and children.
This Australian study sought to examine the prevalence of PTSD in children that had been in motor vehicle accidents either as pedestrians, passengers, or cyclists. The study was comprised of twenty-six patients, aged 8-13 years that presented in an emergency room following a motor vehicle accident (MVA). A standard clinical psychiatric assessment, a structured research interview, and self- and parent report questionnaires were used to assess the patients three months post-trauma. The sample represented only 34% of those who met the inclusion criteria. Low participation level was due to low levels of parental consent (parents were less likely to give consent if injuries more serious than abrasions or minor soft tissue damage were sustained), psychological evaluation of the child, and failure to attend an interview even though consent was previously given. Because of the limited sample size the authors state that caution should be used in interpreting the results, but because the more seriously injured were underrepresented, it may be that PTSD prevalence was underestimated for the population of children that present in an emergency room after a motor vehicle accident.
Study results showed that 3 (11%) of the patients met the diagnostic criteria for severe PTSD, 3 (11%) for moderate PTSD, 9 (35%) for mild PTSD, and 11 (42%) were classed as "doubtful" PTSD cases. None of the subjects met the criteria for very severe PTSD. The researchers found that the variables that were most likely to predict higher PTSD-RI scores were avoidance and numbing, and hyperarousal symptoms. Clinicians should be aware of a potential case of PTSD when teachers and parents report hypervigilance, an exaggerated startle response, or a "personality" change. Variables related the MVAs were not generally useful as predictors, however, as other research has shown the perception of threat and fear of death at the time of, and immediately following the accident, were correlated with PTSD.
The authors state:
"Given the frequency of motor vehicle accidents and the prevalence of PTSD, in this study 22% of the sample were in the moderate to severe range on the PTSD-RI, it is the authors' view that emotional stress in children and adolescents following MVAs is an under-recognised public health problem in Australia and other countries with similar widespread access to motor vehicles. We note the limitations of this study: sample acquisition from a tertiary hospital, a reticence by many parents to allow psychological assessment of their child and a feeling by many parents that their child, in their opinion, was 'unaffected' or will 'get over it.' Further research with children and families is needed to better understand the aetiology of MVA related PTSD, to define the natural history of the condition, the breadth of impairment in social and academic functioning, possible neurobehavioral sequelae and altered family dynamics post-MVA. Future research should include children with more serious physical injuries including those hospitalized post-MVA, a control group of non-MVA and emergency attenders, and a larger sample size that will allow investigation of the differences between individual who experience a MVA as a car passenger or pedestrian."
McDermott B, Cvitanovich A. Posttraumatic stress disorder and emotional problems in children following motor vehicle accidents: an extended case series. Australian and New Zealand Journal of Psychiatry 2000;34:446-452
