Psychological Impact of Burn Injury on Young Children & their Parents: Implications for Diagnosis, Assessment and Treatment

Alexandra De Young (2010). Psychological Impact of Burn Injury on Young Children & their Parents: Implications for Diagnosis, Assessment and Treatment PhD Thesis, School of Psychology, The University of Queensland.

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Author Alexandra De Young
Thesis Title Psychological Impact of Burn Injury on Young Children & their Parents: Implications for Diagnosis, Assessment and Treatment
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2010-12
Thesis type PhD Thesis
Supervisor Professor Justin Kenardy
Dr Vanessa Cobham
Professor Roy Kimble
Dr Samantha Keogh
Total pages 230
Total colour pages 5
Total black and white pages 225
Subjects 17 Psychology and Cognitive Sciences
Abstract/Summary Background: Infants, toddlers and preschoolers are a high risk group for exposure to trauma. However, despite the fact that millions of young children experience trauma each year and that they are particularly vulnerable to adverse outcomes, this population has been largely neglected. Research is needed to provide empirical support for existing posttraumatic stress disorder (PTSD) algorithms for preschool children. Additionally, as the majority of existing studies have been with preschoolers exposed to interpersonal or mass trauma, research is needed to examine the psychological impact of single-event traumas. In particular, given that burn injury is one type of potentially traumatic event that is especially common in children under the age of 5 years, research is needed to document the prevalence and course of psychological disorders in young children and their parents following burns. Additionally, research is needed to identify what factors increase the risk of children and parents following a chronic and debilitating symptom trajectory. Objectives: To conduct a prospective longitudinal research project to (1) determine the most developmentally sensitive and valid approach for diagnosis of PTSD in preschool children; (2) document the prevalence, onset, comorbidity and course of psychological reactions in unintentionally burned children aged 1-6 years; (3) investigate the psychological impact on parents over the course of 6 months and identify risk factors that predict the development of PTSD symptoms at 1 and 6 months; and (4) identify risk factors that predict preschool children who go on to develop persistent PTSD and examine the relationship between child and parent distress. Methods: Parents of 130 children (aged 1-6 years) with unintentional burns were recruited consecutively from the Royal Children’s Hospital, Brisbane, Australia. Diagnostic interviews were conducted with parents about their child’s emotional and behavioural adjustment at 1 and 6 months post injury. A battery of parent report questionnaires was also completed (0-2 weeks, 1 month and 6 months post burn) to assess child and parent psychological distress and family functioning. Results: The proposed PTSD in preschool children criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) was identified as the most valid algorithm for diagnosing PTSD in young children. Additionally, findings from this study showed that the majority of children and parents were resilient or made a good psychological recovery. However, approximately one quarter of children and parents experienced elevated distress within the first month of the child’s injury and a clinically significant subset (8% children; 5% parents) did not experience any improvement in traumatic stress symptomatology over the course of 6 months. There was a high rate of comorbidity with child PTSD, especially for oppositional behaviour and separation anxiety, and the majority of disorders were new onset following the injury. A number of pretrauma, trauma-related, peritrauma, acute-posttrauma and posttrauma-related variables were identified that predicted children and parents who developed PTSS 1 and 6 months after the injury. A key finding from the risk factor analyses was the bidirectional relationship found between child and parent distress. Conclusions: The negative outcomes identified in this study are likely to have implications for a young child’s medical and psychosocial recovery as well as their developmental trajectories. It is recommended that screening, prevention and early intervention resources are incorporated into paediatric health care settings to optimise child and parent psychological adjustment following burn injury. Finally, the findings from this research provide support for the inclusion of the proposed PTSD in preschool children algorithm in the DSM-V.
Keyword Burn
Posttraumatic stress disorder (PTSD)
Parent distress
Additional Notes p108, p176, p 177, p179, p181

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Created: Thu, 07 Apr 2011, 19:51:33 EST by Mrs Alexandra De Young on behalf of Library - Information Access Service