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Early psychological intervention in accidentally injured children ages 2-16: a randomized controlled trial
Didier N Kramer1, Markus A Landolt2
1Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
An early psychological intervention helped school-age children with road traffic accidents (RTAs) and burns, reducing internalizing problems. However, it was ineffective for pre-school children, indicating a need for tailored approaches to prevent psychological sequelae.
Area of Science:
- Child Psychology
- Trauma Interventions
- Pediatric Mental Health
Background:
- Road traffic accidents (RTAs) and burns are common in children, often leading to long-term psychological issues.
- Early psychological interventions are crucial but evidence is limited, especially for pre-school children.
- Posttraumatic stress disorder (PTSD) and behavioral problems can develop after such events.
Purpose of the Study:
- To assess the effectiveness of a brief, early cognitive-behavioral intervention for children aged 2-16 following RTAs and burns.
- To evaluate the intervention's impact on PTSD, behavioral problems, and depression symptoms.
- To provide evidence for early psychological support in pediatric trauma recovery.
Main Methods:
- 108 children at risk for PTSD were randomized into an intervention or control group.
- A two-session cognitive-behavioral intervention was administered to the intervention group.
- Outcomes were assessed at baseline, 3 months, and 6 months using blinded evaluations.
Main Results:
- The intervention showed no significant effects in pre-school children.
- School-age children in the intervention group had fewer internalizing problems at 3-month follow-up.
- A trend towards reduced PTSD intrusion symptoms was observed in the intervention group (p=0.06).
Conclusions:
- The early intervention was not effective for pre-school children, limiting evidence-based practice recommendations for this age group.
- Brief parental counseling on coping skills may still be beneficial for pre-schoolers.
- A step-wise approach, targeting high-risk school-age children, may be effective for preventing trauma-related disorders.
Background:
Road traffic accidents (RTA) and burns are frequent events in children. Although many children recover spontaneously, a considerable number develop long-term psychological sequelae. Evidence on early psychological interventions to prevent such long-term problems is still scarce for school-age children and completely lacking for pre-school children.
Objectives:
To evaluate the efficacy of an early two-session cognitive-behavioral intervention in 108 children ages 2-16 after RTAs and burns.
Methods:
Children assessed at risk for the development of posttraumatic stress disorder (PTSD) were randomly assigned to either a control group offered treatment as usual or an intervention group. Primary outcomes were PTSD, behavioral problems, and depression symptoms. Baseline and blinded 3- and 6-month follow-up assessments were conducted.
Results:
In pre-school children, no intervention effects were found. School-age children in the intervention group exhibited significantly fewer internalizing problems at 3-month follow-up relative to controls and a borderline significant time-by-group effect for PTSD intrusion symptoms was found (p=0.06).
Conclusions:
This is the first study examining the efficacy of an indicated, early psychological intervention among both school-age and pre-school-age children. Because the intervention was ineffective for young children, no evidence-based practice can currently be suggested. Given that parents of pre-school children perceived the intervention as helpful, brief counseling of parents in terms of psychoeducation and training in coping skills still should be provided by clinicians, despite the current lack of evidence. To prevent trauma-related disorders in school-age children, the intervention might be used in a step-wise manner, where only children at risk for long-term psychological maladjustment are provided with psychological support.
