Psychological consequences of road traffic accidents in children

Questionnaire information about possible psychological changes in the months following their accident was obtained for 45 school age children who had attended an Accident and Emergency Department because of their involvement in road traffic accidents. Central nervous system involvement was rare in this group. Short-term psychological consequences were common, but even after 4-7 months 33% were considered by their parents to still have a moderate reaction and a further 11% were considered to be severely affected. The children had high levels of post-traumatic stress symptoms, particularly avoidance in over 50%. Travel anxiety was described in 39%, 23% were depressed and 14% highly anxious--features which were considered by parents to have appeared following the accident, often with increasing disturbance over time. Other apparent repercussions were nightmares and other sleep difficulties in 17%, accident related fears, irritability, anger and emotionally regressed behaviour. As head injury was very uncommon in this series, such psychological consequences were attributable to non-neurological factors. Parents had become more protective of their children and placed greater restrictions on their travel, causing conflict. Younger children, those who had not fully recovered from their accident injuries, and children who also had a parent involved in the same accident, were most at risk. Greater awareness of these psychological consequences of road traffic accidents is required on the part of parents and professionals. Prospective studies are also needed to delineate more precisely those at greatest risk and to assess the effectiveness of treatment approaches.