Academic journal article International Journal of Child and Adolescent Health

Children, Youth, Motor Vehicle Crashes, and Post-Traumatic Stress Disorder: Future Research Development

Academic journal article International Journal of Child and Adolescent Health

Children, Youth, Motor Vehicle Crashes, and Post-Traumatic Stress Disorder: Future Research Development

Article excerpt

Introduction

The first steam-powered vehicle is attributed to Ferdinand Verbiest in China and it was made in 1672 for the Kangxi Emperor. The first recorded automobile death was Mary Ward in Ireland who was thrown from a steam-powered car and fell under its wheels in 1869 (1). The first person killed in the United States is recorded as Henry Bliss in New York City on Wednesday, September 13, 1899. The automobile became popular among humans in the 20th century and the motor vehicle crash became the major cause of death and disability among children and adolescents. Research initially focused on the physical trauma that motor vehicle crashes induced, but eventually the psychological toll of MVCs in the pediatric population became appreciated (2). This treatise reflects on how this occurred taking the entire 20th century to be acknowledged by researchers, clinicians, parents, and the general society.

This discussion has continued into the 21st century with more research being accomplished now and into the future of this second decade of this century. Some concepts now being studied will continue to be under researchers' eyes into the near and far future. One issue that continues to be studied is the precise prevalence of PTSD in children and adolescents after motor vehicle crashes. Current data suggest that though the majority of adolescents are exposed to potentially traumatic experiences, most do not develop PTSD (3). However, this "minority" of persons suffering from PTSD remains serious and alarming. Current data suggest that 12% to 46% of school-aged children develop PTSD in the first four months after an MVC and 13% to 25% can also be diagnosed with this condition 4 to 12 months after the MVC (4).

Real generosity towards the future lies in giving all to the present.

Albert Camus (1913-1960), Notebooks 1935-1942

What does the future hold?

Precise prevalence rates will continue to be debated by different researchers depending on definitions and methodology that is used. Complicating the prevalence picture is that some develop delayed PTSD beyond the classic development of this condition 1 to 6 months post-trauma (5). Thus, research will further delineate delayed-onset PTSD in contrast to that developing within 6 months. This also highlights the need for improved research with improved scientific study designs to better understand the many complex facets of PTSD and MVCs that complicate the lives of our children (6).

Current work is also focusing on 20th century studies seeking to better understand predictors of PTSD in those who do develop this condition 1 to 6 months post MVC and why others involved in MVCs apparently did not develop it. For example the role of parental psychopathology in the development of childhood PTSD is under review as noted in a recent report that maternal PTSD predicted the presence of the exposed child's PTSD within a month of the accident (7). This remains a complex issue with many variables including whether or not the parent was involved in the MVC, witnessed it, or was not involved in the crash. More understanding on PTSD in children will come from more research into the peri-trauma period of the injury to understand peritraumatic distress (including peri-traumatic guilt) and its influence on PTSD (8-10).

Another aspect of current and future research is the role of quality of life issues in PTSD development and chronicity. Children with a high degree of body pain and low quality of life (seen on physical and psychosocial scores) tend to have lower health status one year after the MVC (11). The presence of severe pain and/or comorbid psychiatric disorders even with relatively minor physical injury can lead to long-term disability in adults that include PTSD (12, 13). Thus, the need to control pain effectively is an important component in the overall approach to victims of MVCs. The concern for the present and the future is to effectively treat pain related to MVCs without the development of drug addiction in this person (14). …

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