Fabia Capello

Posttraumatic reactions among injured children and their caregivers 3 months after the terrorist attack in Beslan

This report describes symptoms of posttraumatic stress disorder (PTSD) among a group of Beslans children (N=22) and their primary caregivers (N=20) 3 months after the children had been taken hostage in their school by a group of terrorists. Attention and memory were also measured. Children and their caretakers showed high levels of ongoing PTSD symptoms. Children also showed difficulties in sustaining attention and in short-term memory (digit span). These scores strongly indicate the need for appropriate interventions and ongoing monitoring of course of recovery.

Recognition of facial expressions of mixed emotions in school-age children exposed to terrorism.

This exploratory study aims at investigating the effects of terrorism on childrens ability to recognize emotions. A sample of 101 exposed and 102 nonexposed children (mean age = 11 years), balanced for age and gender, were assessed 20 months after a terrorist attack in Beslan, Russia. Two trials controlled for childrens ability to match a facial emotional stimulus with an emotional label and their ability to match an emotional label with an emotional context. The experimental trial evaluated the relation between exposure to terrorism and childrens free labeling of mixed emotion facial stimuli created by morphing between 2 prototypical emotions. Repeated measures analyses of covariance revealed that exposed children correctly recognized pure emotions. Four log-linear models were performed to explore the association between exposure group and category of answer given in response to different mixed emotion facial stimuli. Model parameters indicated that, compared with nonexposed children, exposed children (a) labeled facial expressions containing anger and sadness significantly more often than expected as anger, and (b) produced fewer correct answers in response to stimuli containing sadness as a target emotion.

Attention and Memory in School-Age Children Surviving the Terrorist Attack in Beslan, Russia

Little is known about the impact of terrorism on childrens cognitive functioning and school learning. The primary purpose of this study was to report on cognitive functioning among school-age children 20 months after a terrorist attack against their school. Participants included 203 directly and indirectly exposed children from Beslan and 100 nonexposed children from another town of the Russian Federation. All children were tested using nonverbal neuropsychological measures of attention, memory, and visual-spatial performance. Predisaster traumatic events and terrorism-related exposure factors were evaluated. Findings revealed that overall, directly and indirectly exposed children performed significantly less well than controls in all domains. In addition, direct exposure and loss of a family member were associated with poor memory performance.

Conversational strategies with parents of newly diagnosed leukaemic children: An analysis of 4880 conversational turns

Goals of workCommunication with parents of children newly diagnosed with cancer poses a number of problems, mostly due to the psychological effects of parental trauma. This study was designed to answer the following questions: How can we sustain the flow of communication with parents of children newly diagnosed with leukaemia so that it may become easier and more effective? What should we say to gather more reliable information from parents? How can we help empower their coping strategies?Patients and methodsWe analysed 4880 conversational turns in individual conversations carried out between psychologists and 21 parents of children with leukaemia. The conversations were aimed at gathering information of the families’ daily routines. Dialogues were audiotaped and fully transcribed. The type and frequency of speech acts present in each turn were coded along 18 categories by two independent judges (inter-rater agreement, Cohen Kappa =0.73).Main resultsThe parental speech acts expressing emotion in various ways go up to 58% of the total number of their speech acts. The lag-sequential analysis showed that such expressions are not associated with any of the interviewer’s speech act. The same analysis showed that, by contrast, the interviewer’s style has an effect upon the cognitive aspects of parents’ conversation. Support of hope favoured parental ability to identify their coping strategies. Explicit requests, confirmations such as “sure” and key words summarizing parents’ viewpoints are followed by parental factual and objective narratives.ConclusionsBased on these results, a few practical recommendations for health care professionals are given in order to better communicate with parents of children newly diagnosed with cancer.

Trauma reminders and PTSD symptoms in children three years after a terrorist attack in Beslan

As a consequence of a terrorist attack, children may experience trauma-related internal and external reminders that are directly linked to their physical and psychological health. We assessed PTSD and trauma reminders in 58 school-age children three years after the terrorist attack in Beslan, Russia in 2004, as well as their association with degree of exposure, psychological distress and coping. Findings revealed a prevalence of situational trauma reminders associated with high levels of distress in more exposed children. The presence of PTSD was predicted by level of exposure to the attack, frequency of exposure to trauma reminders, and support seeking as a coping strategy. Findings are discussed in light of the socio-political climate in Beslan and distress experienced by the population three years after the attack.

Neurodevelopmental Functioning in Very Young Children Undergoing Treatment for Non-CNS Cancers

OBJECTIVE We initiated a prospective study of very young children with cancer, in comparison with matched healthy children, to investigate neurodevelopmental consequences of non-CNS cancers and treatment. METHODS A total of 61 children (≤42 months) with non-CNS cancers and 61 matched controls underwent an identical age-appropriate neuropsychological test battery. RESULTS Children with cancer manifested deficits compared to healthy controls in motor, mental, and language development, but were similar to controls in cognitive representational abilities and emotional relationships in interaction with their mothers. Better physician-rated health status at diagnosis and mother-rated behavioral status 1 month prior to assessment were associated with better motor and mental performance in the cancer group. CONCLUSIONS This study identifies deficits as well as spared functions in children with non-CNS cancers; the results suggest ways parents and healthcare professionals may plan specific remediations to enhance quality of life in young cancer survivors.

Psychopathological Aspects in Childhood Hematopoietic Stem Cell Transplantation (HSCT): The Perception of Parents and Adolescents

Background: Data about psychosocial sequelae of childhood Hematopoietic Stem Cell Transplantation (HSCT) are limited and the association with a specific donor type or other medical factors is largely unknown (Chang et al., 2012). The aim of the present study was to compare the psychological aspects of pediatric HSCT survivors with healthy peers. A secondary aim was to detect whether parents and children differed in the perception of mental health status. The influence of medical factors on psychological status was also examined. Method: Thirty seven HSCT survivors (23 males) with a mean age of 14.4 years (SD = 3.03; range 8.16–18.33) were recruited. Twenty-six patients underwent an allogenic HSCT (matched unrelated donor, n = 20; matched sibling donor, n = 6) and 11 patients received an autologous HSCT. The children psychological aspects were assessed using the Youth Self Report (YSR) (Achenbach and Rescorla, 2001) and compared to a group of matched healthy peers. At the same time, parents were requested to complete the Child Behavior Checklist 6–18 (Achenbach and Rescorla, 2001). Medical and socio-demographic data were also collected. Results: HSCT survivors reported significantly higher levels of somatic complains (t27 = 3.14; p = 0.004; mean = 3.1) when compared to healthy peers (mean = 1.5). The parent CBCL scores on “child total competence” exceeded the normative clinical cutoff in 48.6% cases. Inter-rater agreement between parent and patient reports was present only in three scales: total competence score (K = 0.06, p = 0.002), somatic complaints (K = 0.21, p = 0.003) and attention problems (k = 0.13; p = 0.02). According to Ancova models, internalizing problems were more frequent in HSCT from family donors (F2 = 3.13; p = 0.06) or in the presence of acute complications (F1 = 11.95; p = 0.003). Conclusion: In contrast to the perception of parents, pediatric HSCT survivors reported good psychological health. However, they complained about more somatic problems as compared with healthy peers. Medical aspects such as donor source and the presence of acute complications should be taken into consideration for the psychological approach in order to improve pediatric HSCT survivor care.

Reply to Long-Term Effects of the Terrorist Attack in Beslan on Adolescent Survivors

Sir: The important study by Moscardino et al. showed that adolescents who survived the Beslan terrorist attack (North Ossetia) did not report more overall levels of psychological distress (as measured with the Brief Symptom Inventory 18 and Strengths and Difficulties Questionnaire) 18 months after the event than a group of adolescents who were not in the school during the attack. The authors conclude that these findings are in line with previous research suggesting that both directly and indirectly exposed children are at risk of developing adverse psychological symptoms after terrorism-induced trauma. However, a nonexposed control group was not included. Since the “normal” level of psychological distress among comparable nonexposed adolescents is unknown, this limitation severely hinders firm conclusions about the possible mid-term effects of the terrorist attack and may overestimate adverse affects. The cross-sectional nature of the study and the measures used prohibit any conclusion about the course or development of general psychological problems. Perhaps Moscardino and colleagues are right, but the reported data do not support their conclusion about the risk of developing adverse psychological symptoms. Of course, controlling for nonretrospective data on pre-event functioning is a powerful alternative, but in the case of such disasters, these data are hardly available. The only thing we are sure of is that both groups reported comparable levels of general psychological distress 18 months postevent. In addition, the high ethical standard of the researchers prevented the assessment of posttraumatic stress disorder— although Galea et al. showed that adverse effects of administering such measures might be very limited—and therefore it is unclear whether both groups are equally at risk for developing symptoms related specifically to the adverse event. Although the nature of the trauma exposure was not comparable with that in the Beslan case, a 5-year longitudinal study (using the electronic medical records of general practitioners) of health effects among adolescents in a discotheque fire showed that in the first year youth both with and without burns presented many symptoms, psychological as well as physical. After 1 year, the problems of youth without burns decreased to the level of a matched control group. Apart from the societal situation in Beslan, it may be expected that problems will diverge in time between exposed and nonexposed adolescents. Nonexposed youth from the same community may be subjected to “the hierarchy of suffering,” meaning that there is less attention for their problems. Furthermore, a group of families surviving the attack were hosted or relocated for a 6-week period 3 months after the event in a private residential structure in Trento, Italy. The authors were contacted to provide psychological assistance. Disaster studies suggest that relocation, even during a relatively short period, might be a risk factor for postevent psychological disturbances. Being relocated with the expectation of returning after 6 weeks to a changed social system in which, according to one participant, “Now everyone follows his own path, not knowing which direction to take” might be an important new source of stress. On the other hand, the 6-week period in Italy may have provided comfort, rest, and social support and helped to foster resilience and diminish stress, as was probably the aim of the 6week hosting. Possible participation of adolescents in both groups in this 6-week relocation was not presented in the article, nor part of the analyses, although it may confound outcomes. According to the researchers, this study is part of an ongoing project on the mental health of Beslan’s children and families. As stated in the article, the number of studies examining the long-term psychological effects of such attacks is limited. We hope that the authors are able to conduct a follow-up study in which the aforementioned issues can be addressed.