Jennifer E. Drake

Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns.

This study tested the hypothesis that very young children who received more morphine for acute burns would have larger decreases in posttraumatic symptoms 3 to 6 months later. This has never before been studied in very young children, despite the high frequency of burns and trauma in this age group. Seventy 12- to 48-month-old nonvented children with acute burns admitted to a major pediatric burn center and their parents participated. Parents were interviewed at three time points: during their child’s hospitalization, 1 month, and 3 to 6 months after discharge. Measures included the Child Stress Disorders Checklist – Burn Version (CSDC-B). Chart reviews were conducted to obtain children’s morphine dosages during hospitalization. Mean equivalency dosages of morphine (mg/kg/d) were calculated to combine oral and intravenous administrations. Eleven participants had complete 3 to 6-month data on the CSDC. The correlation between average morphine dose and amount of decrease in posttraumatic stress disorder symptoms on the CSDC (r = −0.32) was similar to that found in studies with older children. The correlation between morphine dose and amount of decrease in symptoms on the arousal cluster of the CSDC was significant (r = −0.63, P < .05). Findings from the current study suggest that, for young children, management of pain with higher doses of morphine may be associated with a decreasing number of posttraumatic stress disorder symptoms, especially those of arousal, in the months after major trauma. This extends, with very young children, the previous findings with 6- to 16-year olds.

A randomized controlled trial of sertraline to prevent posttraumatic stress disorder in burned children.

BACKGROUND This study evaluated the potential benefits of a centrally acting selective serotonin reuptake inhibitor, sertraline, versus placebo for prevention of symptoms of posttraumatic stress disorder (PTSD) and depression in burned children. This is the first controlled investigation based on our review of the early use of a medication to prevent PTSD in children. METHODS Twenty-six children aged 6-20 were assessed in a 24-week double-blind placebo-controlled design. Each child received either flexibly dosed sertraline between 25-150 mg/day or placebo. At each reassessment, information was collected in compliance with the study medication, parental assessment of the childs symptomatology and functioning, and the childs self-report of symptomatology. The protocol was approved by the Human Studies Committees of Massachusetts General Hospital and Shriners Hospitals for Children. RESULTS The final sample was 17 subjects who received sertraline versus 9 placebo control subjects matched for age, severity of injury, and type of hospitalization. There was no significant difference in change from baseline with child-reported symptoms; however, the sertraline group demonstrated a greater decrease in parent-reported symptoms over 8 weeks (-4.1 vs. -0.5, p=0.005), over 12 weeks (-4.4 vs. -1.2, p=.008), and over 24 weeks (-4.0 vs. -0.2, p=0.017). CONCLUSIONS Sertraline was a safe drug, and it was somewhat more effective in preventing PTSD symptoms than placebo according to parent report but not child report. Based on this study, sertraline may prevent the emergence of PTSD symptoms in children.

Short-Term Mood Repair Through Art: Effects of Medium and Strategy

Abstract This study examined the effects of expressive media (drawing versus writing) and emotion regulation strategy (coping by venting versus coping by distraction) on short-term mood repair. After inducing a sad mood in 40 participants, the researchers randomly assigned them to one of two conditions: drawing or writing. Mood valence was assessed before and after the activity, and participants reported whether they used the activity to vent or to distract themselves. Findings indicated that mood valence was significantly more positive after drawing than writing, and more positive when individuals reported using distraction rather than venting to regulate their emotions. Drawing in this study was a more effective means of immediate mood repair than writing; both activities repaired mood more effectively through distraction than through venting.

Trauma severity influences acute stress in young burned children.

The purpose of this study was to assess the role of trauma severity on subsequent symptoms of posttraumatic stress disorder (PTSD) and physiological reactivity in a total of 70 children, ranging from 12 to 48 months of age, who were acutely burned. Parents were interviewed shortly after the child was admitted to the hospital. PTSD symptoms were measured using the Posttraumatic Stress Disorder Semi-Structured Interview and Observational Record for Infants and Young Children and the Diagnostic Interview for Children and Adolescents. Nurses completed a questionnaire about the childs symptoms and recorded the childs physiological data throughout the hospital stay. Significant relationships were found between severity of childhood trauma and the total number of PTSD symptoms and physiological reactivity. This study supports the hypothesis that severity of trauma experienced by young children influences psychological and physiological stress indicators after burn injuries. These findings provide new directions for the assessment and prevention of PTSD in this age group.

How children use drawing to regulate their emotions

We examined two ways in which drawing may function to elevate mood in children—venting (expressing negative feelings) and distraction (expressing something unrelated to the negative feelings). We examined the effectiveness of drawing as an emotion regulator when drawing is used to vent versus distract (Study 1) and tested whether the effects found are specific to the activity of creating ones own drawing or generalisable to a drawing activity in which children had to copy anothers drawing (Study 2). To induce a negative mood, we asked children to think of a disappointing event. Mood was assessed before and after the assigned activity. In both studies, mood improved significantly more in the distract than in the vent or copy condition. Study 1 demonstrates that drawing improves mood in children via distraction and not via venting. Study 2 demonstrates that this effect is specific to a drawing task in which an image is freely constructed. When a copying task is used, the effect disappears.

Realistic Drawing Talent in Typical Adults is Associated with the Same Kind of Local Processing Bias Found in Individuals with ASD

A local processing bias has been found in individuals with autism as well as in typical children with a gift for drawing realistically. This study investigated whether a local processing bias in typical adults is more strongly associated with drawing realism or autistic-like traits. Forty-two adults made an observational drawing (scored for realism), completed four measures that assessed a local processing bias, and completed the Autism-spectrum Quotient (AQ) which assesses autistic-like traits. Drawing Realism score and not AQ score was associated with a local processing bias as shown by performance on two of the tasks. Typical adults who score high in the ability to draw realistically show the same kind of local processing bias found in individuals with ASD.

Precocious realists: perceptual and cognitive characteristics associated with drawing talent in non-autistic children

A local processing bias in the block design task and in drawing strategy has been used to account for realistic drawing skill in individuals with autism. We investigated whether the same kind of local processing bias is seen in typically developing children with unusual skill in realistic graphic representation. Forty-three 5–11-year-olds who drew a still life completed a version of the block design task in both standard and segmented form, were tested for their memory for the block design items, and were given the Kaufmann Brief Intelligence Test-II. Children were classified as gifted, moderately gifted or typical on the basis of the level of realism in their drawings. Similar to autistic individuals, the gifted group showed a local processing bias in the block design task. But unlike autistic individuals, the gifted group showed a global advantage in the visual memory task and did not use a local drawing strategy; in addition, their graphic realism skill was related to verbal IQ. Differences in the extent of local processing bias in autistic and typically developing children with drawing talent are discussed.

Drawing versus Writing: The Role of Preference in Regulating Short-Term Affect.

Abstract In a pilot study we investigated whether the most effective medium for regulating short-term affect depends on ones preference for drawing or writing, and also investigated the emotion regulation strategy (distraction versus expression) spontaneously chosen when drawing and writing. Eighty undergraduates indicated their preference for drawing or writing. After a sad mood induction, half were assigned to their preferred activity and half to their non-preferred activity. Positive and negative affect was assessed before and after the activity, and participants reported whether they used the activity to express or to distract themselves. Negative affect was significantly lower after drawing than after writing, even when the preferred activity indicated was writing. Participants were more likely to use drawing to distract and writing to express.

Superior Visual Analysis and Imagery in an Autistic Child with Drawing Talent

Two opposing theories have been proposed to account for the strong visuospatial performance often seen in high-functioning individuals with autism. According to the weak central coherence account, individuals with autism show a local processing bias. They have a superior grasp of the local details of a visual display but fail to grasp global aspects of the display (Happé & Frith, 2006). According to the enhanced perceptual functioning account, individuals with autism have superior local processing as well as intact global processing (Mottron & Burack, 2001). We report a case study of J.G., a 10-year-old child of normal intelligence diagnosed with autism. He experienced expressive language delay, but showed special talents in both drawing and visual imagery. Our tests revealed that J.G. had superior local but poor global processing. This pattern of performance provides stronger support for weak central coherence than for enhanced perceptual functioning.

Children Gifted in Drawing: The Incidence of Precocious Realism.

Although one study has reported that 6% of children with autism spectrum disorder (ASD) have drawing talent, no study has examined the incidence of drawing talent in typical children. We asked 153 children aged 6–12 years to draw a picture of their hand. We scored the drawings for the use of detail, correct proportion, and overall contour; assessed the drawings as above average at each age based on a global assessment; and compared the drawings with those of three identified drawing prodigies. Most children were able to capture the overall contour of their hand; the ability to draw relevant details was not common until age 8; and correct proportion was not seen even in the oldest children. We identified 13% of drawings as above average for the child’s age group. However, even those drawings identified as above average were significantly less realistic than the drawings of the prodigies.