Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

British Medical Journal, Dec 12, 1998 by Paul Stallard, Richard Velleman, Sarah Baldwin

Conclusions

Post-traumatic stress disorder is a controversial diagnosis, and some researchers have argued that the reactions of children to traumatic events are temporary and comparatively minor.[23] The basis for this argument has been contested, and there is now increasing evidence that children are considerably affected in a similar way to adults.[24] Post-traumatic stress disorder refers only to a defined set of symptoms, however, and does not encompass other important although less severe trauma reactions or other disorders associated with traumatic events, particularly anxiety and depressive disorders. The results reported here are therefore limited but nevertheless show that significant psychological distress about 6 weeks after everyday road traffic accidents is comparatively common.

We believe that the results of this study are applicable to all child survivors of road traffic accidents, which would imply that of the 60 000 children under the age of 19 who suffered mild to moderate injuries in 1997, over 20 000 (around 35%) would experience post-traumatic stress disorder. Adoption of a more conservative criteria would still suggest that almost 9000 (about 15%) children each year would suffer post-traumatic stress disorder 6 weeks after their accident and that these symptoms are sufficiently severe to interfere with the child's everyday functioning. Unfortunately the children in this study were not followed up over time, although other research would indicate that by 3-4 months about half would improve without any specialist intervention.[15] Further research is required to determine the long term psychological effects of road traffic accidents and to identify ways in which those children with chronic symptoms can be correctly identified at an early stage and provided with effective psychological interventions.

Despite the frequency and potential severity of the psychological consequences of road traffic accidents these incidents are not generally considered to be major traumas. One off disasters affecting groups of children attract far greater professional attention and support even though the number of children involved is comparatively low. Psychological services for children involved in road traffic accidents are not at present provided in a comprehensive or routine way and often arise as a result of personal injury and compensation claims. Indeed, none of the children experiencing post-traumatic stress disorder in our study had received any professional help at the time of assessment. At the end of each interview the family were given an information leaflet outlining the possible effects of post-traumatic stress disorder and a telephone number to contact if they wanted help, yet only two families contacted the psychologist. Whether this was because professional help was perceived as unnecessary or whether parents and young people failed to acknowledge the severity of their distress remains unknown. Whatever the reason, the psychological needs of most children involved in road traffic accidents remain largely unrecognised.