Impact, Psychological Sequelae and Management of Trauma
Impact, Psychological Sequelae and Management of Trauma
Purpose of Review: In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments.
Recent Findings: Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms.
Summary: Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.
In the wake of recent natural and man-made disasters, and acts of violence there is growing interest in the impact of traumatic events on children and youths. Some victims do organize, adapt and recover in a surprising manner, despite the traumatic experience they have lived through or witnessed; individual protective factors, as well as parental/social support, may help children to recover, thereby preventing severe psychosocial impairment. Nevertheless, a significant proportion of youths exhibits developmental disorders and substantial levels of impairment in their daily lives.
Over the past 20 years, empirical and theoretical understanding of the effects of childhood trauma on various developmental domains (e.g. biology, cognition, self-development and attachment) has grown considerably. What is less clear from the existing research is the extent to which psychopathology interferes with children's daily lives and functions, or whether the symptoms may be considered 'normal' reactions to abnormal events. Another open question concerns the psychobiological mechanism of vulnerability. Given the potential long-term effects of trauma on children and adolescents, mental health professionals must be careful to assess children's pre-existing levels of psychopathology as well as their functioning after trauma.
We searched two computerized scientific literature databases most relevant to psychiatry and psychology (Medline, PsycInfo) from 2004 up to February 2005. The search includes the following terms and combinations of terms: 'post-traumatic stress disorder', 'psychological trauma' and 'children and adolescents'. We downloaded all bibliographic records generated from the search and duplicate records were identified and removed. After the search was completed (345 articles), we selected relevant abstracts. The criteria for inclusion of abstracts were as follows: it was published in a scientific journal; it included original data or review; and it evaluated impact, sequelae and/or intervention programs. An abstract could be excluded if the inclusion criteria or the same criteria used in the first assessment of relevance were not met. A total of 171 abstracts, including some in languages other than English, were suitable for review. The most relevant articles were analyzed and are described here.
Purpose of Review: In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments.
Recent Findings: Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms.
Summary: Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.
In the wake of recent natural and man-made disasters, and acts of violence there is growing interest in the impact of traumatic events on children and youths. Some victims do organize, adapt and recover in a surprising manner, despite the traumatic experience they have lived through or witnessed; individual protective factors, as well as parental/social support, may help children to recover, thereby preventing severe psychosocial impairment. Nevertheless, a significant proportion of youths exhibits developmental disorders and substantial levels of impairment in their daily lives.
Over the past 20 years, empirical and theoretical understanding of the effects of childhood trauma on various developmental domains (e.g. biology, cognition, self-development and attachment) has grown considerably. What is less clear from the existing research is the extent to which psychopathology interferes with children's daily lives and functions, or whether the symptoms may be considered 'normal' reactions to abnormal events. Another open question concerns the psychobiological mechanism of vulnerability. Given the potential long-term effects of trauma on children and adolescents, mental health professionals must be careful to assess children's pre-existing levels of psychopathology as well as their functioning after trauma.
We searched two computerized scientific literature databases most relevant to psychiatry and psychology (Medline, PsycInfo) from 2004 up to February 2005. The search includes the following terms and combinations of terms: 'post-traumatic stress disorder', 'psychological trauma' and 'children and adolescents'. We downloaded all bibliographic records generated from the search and duplicate records were identified and removed. After the search was completed (345 articles), we selected relevant abstracts. The criteria for inclusion of abstracts were as follows: it was published in a scientific journal; it included original data or review; and it evaluated impact, sequelae and/or intervention programs. An abstract could be excluded if the inclusion criteria or the same criteria used in the first assessment of relevance were not met. A total of 171 abstracts, including some in languages other than English, were suitable for review. The most relevant articles were analyzed and are described here.
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