This is indeed an important topic for nursing practice. It is difficult if not impossible to separate out physical injury from the psychological effects that can occur. One of the developing issues in pediatric nursing is that the constructs used in work with child psychopathology have been derived from examination of how the illness develops and affects adults. It is important, however to differentiate between the diagnostic formulation of any mental illness in adults form the situation in children.
This is particularly so for PTSD as questions arise about the validity of the diagnostic formulation of PTSD in children. PTSD is an anxiety disorder that can result from exposure to events that can be physically threatening. These events can include physical or sexual abuse, torture, severe motor vehicle accidents, war exposure, being kidnapped or taken hostage, terrorist attack, natural or man-made disasters, community violence, or being diagnosed with a life-threatening illnesses (e. g. , cancer). Many of these seem to be increasing threats for children today.
This study by Meiser-Stedman et al (2008) examined the diagnosis of pre-school and elementary school children exposed to motor vehicle accidents. Their emphasis was on accurate diagnosis of PTSD in children. Three main points presented were how to modify the diagnosis for young children, how psychopathology is best detected at an early stage and how to make use of multiple informants. The study was a longitudinal assessment of preschool and elementary school children who were exposed to a traumatic event.
The participants were 114 children, aged 2- 10, from three emergency departments in London, England. They were all from low socioeconomic boroughs that had experienced a motor vehicle accident. The measures used included structured interviews completed by the children and their parents or caregivers at initial stage and at 6-month follow-up. The parents completed the PTSD semi-structured interview and Observational Record for Infants and Young Children. They also completed the Anxiety Disorder Interview Schedule – Child and Parent Version.
The important results of the study were that the percentage of children meeting the criteria for a diagnosis of PTSD based on the alternative algorithm criteria was higher than with the DSM-IV diagnosis, and that the combined report of child (7- 10 years) and parent was more reliable in predicting post-traumatic psychopathology than the report of parent alone. The study demonstrated for the first time that a significant degree of psychopathology persists over the first six months of post trauma in young children.
Secondly the results implied that when only one informant is available clinically significant cases are overlooked. The study emphasizes the growing consensus that many adult psychiatric disorders have origins in childhood and adolescence. Therefore it is becoming more important to be able to accurately diagnose psychopathology in children, even at preschool level. There is a need therefore to develop valid and reliable diagnostic criteria for these age groups. Pediatric nurses can benefit from this information.
Perhaps the fundamental issue is the relationship between physical pain and psychological effects; and therefore how psychological effects follow from such physical trauma such as fractures and burns and how these psychological effects can contribute to the development of PTSD in children. Not enough is known about the normal range of acute psychological responses in children to traumatic physical injury so this research is significant. There are possibilities that aggressive pharmacological pain management during hospitalization and care of children can help to reduce the likelihood of the later development of PTSD.
Nurses can assess for a history of pain and trauma and for early predictors of PTSD, even in emergency room. Nurses can also follow up after the injury to ask about behavioral symptoms that may be developing that will help with intervention and prevention of PTSD later on. Reference Meiser-Stedman, R. , Smith, P. , Glucksman, E. Yule, W. & Dalgliesh, T. (2008). The Posttraumatic Stress Disorder Diagnosis in Preschool- and Elementary School –age children exposed to motor vehicle accidents. The American Journal of Psychiatry, 165 (10) pp: 1326- 1337