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Exposure to traumatic events is a common experience for children and adolescents. Accurate early assessment of acute stress responses can help predict risk for longer term sequelae and can guide secondary prevention to reduce the incidence and severity of post-traumatic stress disorder (PTSD) after trauma exposure.

The goal of this project was to develop a practical self-report measure of acute stress disorder (ASD) for children and adolescents, and to provide initial evidence as to its reliability and validity. The specific aims of the project were to:

• Aim 1: Establish the content validity of a pilot Child ASD measure for ages 8 to 17, based on expert review and youth feedback.
• Aim 2: In a sample of recently injured children (n=176), assess the psychometric properties of the measure: internal consistency, test-retest reliability, convergent and discriminant validity with other measures and other reporters.
• Aim 3: Provide initial data regarding the predictive validity of the Child ASD measure in relation to later PTSD development in the same sample of children.

Children and youth, aged 8 - 18 years, were invited to participate in this study after being treated in an emergency department (ED) for an injury resulting from interpersonal community violence. Each invited youth also had to have been living within specified postal codes (urban areas surrounding the hospital). Following the youth's baseline assessment (T1), participants completed between 0 and 4 follow-up assessments. The timing of each follow-up assessment was scheduled according to the relative time since the index (violent injury) event occurred. The average follow-up assessment was conducted at 27 days (T3), 75 days (T5), 199 days (T7), and 467 days (T10).

After pediatric injury, posttraumatic stress and other emotional outcomes in children and their parents often go unrecognized and untreated. This is due in part to the challenges in identifying at-risk children and their parents in the emergency care setting. The aims of this study were to assess the extent to which nurses were able to implement a brief screener for posttraumatic stress symptoms risk within the course of normal care of injured patients, and to assess posttraumatic stress and depression symptoms in injured children (aged 8-17 years) and their parents after emergency department care, and the relationship of these symptoms to parent-reported overall recovery.

The objectives of the current study were to describe child post-traumatic stress (PTS), coping behavior, and parent coping assistance following a child's injury. The study enrolled children age 8 to 17 treated at the emergency department or admitted to the hospital for unintentional injury, and one parent per child. Children and parents completed measures of child PTS, coping, and coping assistance at 2 weeks post-injury and 3 months post-injury. The research team addressed these questions:

1. What types of coping do children use following an injury?
2. Is parent coping assistance related to child coping behavior?
3. Are child coping strategies associated with PTS symptoms?
4. Is early parent coping assistance related to later development of child PTS symptoms?

This study was originally conceived as a prospective randomized trial to evaluate the efficacy of secondary prevention messages conveyed in printed informational materials (handouts and workbooks) for children and parents after pediatric injury. Children and their parents received 1 of 5 randomly assigned workbook sections (each addressing a different key theme). No differences were observed between groups for parent/child knowledge and beliefs about PTS and adaptive coping, nor in child PTS symptoms. Thus, data from all groups have been combined for analyses of prospective PTS outcomes and coping processes.

Because the emergency department (ED) is often the only point of contact with the health care system for violently injured adolescents, it provides a unique opportunity to assess children following a violent injury. In violently injured teens, depressive and acute posttraumatic stress symptoms may help predict future behavioral risk factors and reinjury. The objective of this study was to examine whether emergency department (ED) assessments of depressive and posttraumatic stress symptoms after an episode of interpersonal violence are associated with future risk behaviors, re-injury and posttraumatic stress symptoms in adolescents.

Injured adolescents (age 12-17 years) were assessed for posttraumatic stress and depression symptoms and self-reported risk behaviors either during or soon after (within 2 weeks) an ED visit and completed a telephone follow-up assessment between 6 and 18 months later, during which they were assessed again for self-reported risk behaviors, posttraumatic stress symptoms and re-injury.