Carolyn A. Greene

An Update on Posttraumatic Stress Disorder in Children and Adolescents

Recent violent tragedies in schools, universities, and in public spaces have focused increased attention on the symptoms and consequences of maladaptive traumatic stress and posttraumatic stress disorder (PTSD) in children and adolescents. Child maltreatment and its consequences continue to be prevalent in the United States. Recent changes to diagnosis in the Diagnostic and Statistical Manual, 5th edition (DSM-5) identify new criteria for PTSD in young children as well as in schoolage children and adolescents. There is a growing body of knowledge about what psychological treatments are effective in children. Pediatricians are often the first to identify and treat traumatized children. An update on this topic is relevant because data show that only 18% of primary care pediatricians’ self-report adequate knowledge of childhood PTSDs, and only 10% report frequent experience in the assessment and treatment of posttraumatic stress symptoms.

Multidimensional control beliefs, socioeconomic status, and health.

OBJECTIVES To investigate the role of control beliefs in the relationship between SES and health. METHODS Two different aspects of perceived control - contingency beliefs (locus of control) and competence beliefs (self-efficacy) - were examined in relation to subjective SES and physical health outcomes (subjective health, functional impairment, chronic health problems, and acute health symptoms) in a diverse sample of undergraduates (N=231). RESULTS Low self-efficacy was directly associated with poorer health outcomes and mediated the relationship between low SES and health, whereas locus of control did not. CONCLUSIONS Health behavior interventions targeting generalized competence beliefs may benefit individuals from low SES backgrounds.

Posttraumatic stress mediates the relationship between childhood victimization and current mental health burden in newly incarcerated adults

The purpose of this study was to evaluate the interrelationship among childhood abuse and traumatic loss, posttraumatic stress symptoms (PTSS), and Axis I psychiatric disorders other than PTSD among newly incarcerated adults, and to test a proposed model in which the severity of PTSS mediates the relationship between childhood abuse/loss and adult psychiatric disorders. Four hundred sixty-five male and female inmates participated in a structured clinical research interview. Four types of interpersonal potentially traumatic experiences (physical abuse, sexual abuse, emotional abuse, and traumatic loss) were assessed for occurrence prior to the age of 18 years old. Current psychiatric disorders and PTSS were also assessed by structured interview. Negative binomial regression was used to evaluate the association between the cumulative number of types of childhood abuse/loss experienced and number of current Axis I disorders, and to test the mediation model. Approximately half of the sample (51%) experienced 1 or more types of childhood abuse/loss, and 30% of the sample had at least one psychiatric disorder other than PTSD. For both men and women, childhood physical abuse and childhood sexual abuse were independently associated with psychiatric morbidity, and an increasing number of types of childhood trauma experienced was associated with an increase in the number of current Axis I diagnoses. However, these associations were no longer statistically significant when severity of PTSS was added to the model, providing support for the proposed mediation model. Implications for secondary prevention services for at-risk inmates are discussed.

The Puzzle of Problem-Solving Efficacy: Understanding Anxiety Among Urban Children Coping with Asthma-Related and Life Stress

Abstract Children with asthma living in urban environments are at risk for experiencing anxiety by virtue of both social context and health-related stressors. Although the use of active coping strategies is generally associated with more optimal psychosocial functioning, there is evidence that active coping is less helpful in response to uncontrollable or severe stress. Expectations that one can fix a problem that is uncontrollable or insurmountable may create distress. Problem-solving efficacy was examined as a moderator of the association between stress and anxiety among children residing in inner-city neighborhoods. It was hypothesized that childrens perceptions of high problem-solving efficacy would exacerbate their vulnerability to stress. Forty-five parent–child dyads were recruited from urban community health centers. Most participants were members of ethnic minority groups. Hierarchical multiple regression analyses revealed main effects of asthma-related stress and life stress on childrens anxiety. However, these effects were moderated by problem-solving efficacy. Asthma-related stress and life stress were positively associated with anxiety only for children who had the highest levels of problem-solving efficacy. In other words, positive expectations about the ability to solve problems functioned as a liability for highly stressed children. Implications for psychosocial interventions with at-risk children are discussed.

Coping With Illness-Related Stress Among Urban Children With Asthma

The effect of problem-focused and avoidant coping on social withdrawal was investigated among a sample of 31 urban children with asthma experiencing varied levels of illness-related stress. Two main and two moderating effects were examined. Neither problem-focused nor avoidant coping was significantly associated with withdrawal when the childs asthma symptoms and stressors were controlled. However, a pattern emerged in analyses of the interaction between coping and stress level. Higher levels of both problem-focused and avoidant coping were associated with lower levels of social withdrawal, but only for children with low levels of asthma-related stress.

Psychological and Biological Theories of Child and Adolescent Traumatic Stress Disorders

In order to assess and treat child and adolescent traumatic stress disorders, clinicians need a guiding theoretical framework for conceptualizing the origins, course, and contributing (risk and protective) factors for these disorders. The current chapter therefore provides an overview of the leading psychobiological theories of childhood traumatic stress disorders. The chapter begins with a brief historical chronology of the dominant theories, followed by a summary of the scientific research that has informed theory development in the traumatic stress field. Then the major current theories of child and adolescent traumatic stress disorders are described, including learning/conditioning, cognitive/information processing, interpersonal/resources, developmental, and intergenerational theories. The chapter concludes with a discussion of the implications of these theories for clinical assessment and treatment of childhood traumatic stress disorders.

Posttraumatic Stress Disorder and Acute Stress Disorder in Childhood and Adolescence

Posttraumatic stress disorder (PTSD) is a prevalent disorder among children that can cause clinically significant functional impairment, especially when it occurs with common comorbidities such as anxiety, mood, disruptive behavior, or substance use disorders. Traumatized children also may develop an acute stress disorder (ASD) when traumatic stress symptoms are severe and persistent in the first several days and weeks in the aftermath of exposure to traumatic stressors. In this chapter, we will describe the history of childhood PTSD’s origin and changing definitions as it evolved as a theoretical and empirical construct and clinical diagnosis, with a detailed discussion of how PTSD and ASD are defined in the DSM-5 (including adaptations for children and separate criteria for diagnosing PTSD in preschool-age children). The chapter then provides a review of empirical evidence regarding epidemiology (prevalence and comorbidities), etiology (risk factors and causal mechanisms, including ethnocultural, gender, and developmental factors), and DSM-5 informed assessment, treatment, and prevention of pediatric PTSD.