Academic journal article European Journal of Psychotraumatology

A Novel Adaptation of a Parent-Child Observational Assessment Tool for Appraisals and Coping in Children Exposed to Acute Trauma

Academic journal article European Journal of Psychotraumatology

A Novel Adaptation of a Parent-Child Observational Assessment Tool for Appraisals and Coping in Children Exposed to Acute Trauma

Article excerpt

Every year, millions of children are exposed to potentially traumatic events (PTEs). In a recent systematic review, Price, Kassam-Adams, Alderfer, Christofferson, and Kazak (2016) identified that approximately 30% of youth and their parents develop significant posttraumatic stress symptoms (PTSS) following exposure of a PTE related to medical events. Following exposure to trauma (i.e., across types such as medical, disaster, child maltreatment, war exposure, and domestic violence), about 16% of children develop full posttraumatic stress disorder (PTSD; Alisic et al., 2014). Theoretical models and empirical investigations have identified early cognitive appraisals and coping behaviors as potential mechanisms of action in the development of PTSS in children (Dalgleish, Meiser-Stedman, & Smith, 2005; Ehlers & Clark, 2000; Marsac, Kassam-Adams, Delahanty, Widaman, & Barakat, 2014; Marsac et al., 2016; MeiserStedman, 2002). While some studies have suggested that parent reactions (such as PTSS and depressive symptoms) following PTEs may affect child reactions, the process through which this may occur remains unclear (Alisic, Jongmans, Van Wesel, & Kleber, 2011; Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). To date, research on appraisals and coping in children exposed to PTEs has primarily utilized self-report methodology. Further, few studies have systematically observed the process of interaction between children and parents immediately following a PTE (Gewirtz, Forgatch, & Weiling, 2008).

Information-processing models of anxiety and traumatic stress highlight the roles of appraisals and coping in the development and persistence of symptoms. Appraising a PTE as threatening can lead to behavioral strategies (i.e., coping solutions such as avoidance) that directly contribute to PTSS and/or prevent the development of longer-term realistic and adaptive appraisals (Ehlers & Clark, 2000; Meiser-Stedman, 2002). Marsac et al. (2014) proposed a biopsychosocial theoretical model focusing on the role of peri-trauma processes during acute medical events. This model specifies a role for biological, psychological, and social factors as having both independent and interactional relationships that influence the development and maintenance of PTSS. In addition to highlighting a role for child appraisals and coping, Marsac et al. (2014) suggest that parent-child interactions during the peri-trauma period may influence children's development of appraisals and coping related to the PTE, in turn influencing long-term PTSS.

A growing evidence base offers support for these models. In examining specific types of appraisals in youth with injuries, perception of threat, negative appraisals about vulnerability to future harm, and negative interpretation of intrusive memories and rumination have been found to be related to worse PTSS (Bryant, Salmon, Sinclair, & Davidson, 2007; Stallard & Smith, 2007). Hitchcock Ellis, Williamson, and Nixon (2015) expanded on the role of appraisals in predicting PTSS, finding that appraisals mediated the relationship between social support and PTSS in youth who had experienced a single-incident PTE. Though the exact nature of the relationship remains unclear, coping has likewise emerged as a potential contributor to PTSS in children. For example, following a motor-vehicle crash, children with PTSD used more coping strategies overall (particularly avoidant/escape strategies) than children without PTSD (Stallard, Velleman, Langsford, & Baldwin, 2001). Another investigation of children with injury showed that social withdrawal was related to concurrent PTSS, while resignation and social withdrawal were related to subsequent PTSS 6 months after injury (Marsac, Cirilli, KassamAdams, & Winston, 2011).

Two studies have examined appraisals and coping together with child PTSS in injured children. Stallard and Smith (2007) found that appraisals and coping (rumination, suppression, and distraction) together accounted for 64% of the variance in concurrent PTSS 8 months after injury (Stallard & Smith, 2007). …

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