Clinical Child and Family Psychology Review

, Volume 15, Issue 4, pp 345–363 | Cite as

Involving Parents in Indicated Early Intervention for Childhood PTSD Following Accidental Injury

  • Vanessa E. Cobham
  • Sonja March
  • Alexandra De Young
  • Fiona Leeson
  • Reginald Nixon
  • Brett McDermott
  • Justin Kenardy


Accidental injuries represent the most common type of traumatic event to which a youth is likely to be exposed. While the majority of youth who experience an accidental injury will recover spontaneously, a significant proportion will go on to develop Post-Traumatic Stress Disorder (PTSD). And yet, there is little published treatment outcome research in this area. This review focuses on two key issues within the child PTSD literature—namely the role of parents in treatment and the timing of intervention. The issue of parental involvement in the treatment of child PTSD is a question that is increasingly being recognized as important. In addition, the need to find a balance between providing early intervention to at risk youth while avoiding providing treatment to those youth who will recover spontaneously has yet to be addressed. This paper outlines the rationale for and the development of a trauma-focused CBT protocol with separate parent and child programs, for use with children and adolescents experiencing PTSD following an accidental injury. The protocol is embedded within an indicated intervention framework, allowing for the early identification of youth at risk within a medical setting. Two case studies are presented in order to illustrate key issues raised in the review, implementation of the interventions, and the challenges involved.


PTSD Accidental injury Children 


  1. Aaron, J., Zaglul, H., & Emery, R. E. (1999). Posttraumatic stress in children following acute physical injury. Journal of Pediatric Psychology, 24(4), 335–343.PubMedCrossRefGoogle Scholar
  2. Achenbach, T. M., & Rescorla, L. A. (2003). Manual for ASEBA adult forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  3. Adler-Nevo, G., & Manassis, K. (2005). Psychosocial treatment of pediatric posttraumatic stress disorder: The neglected field of single-incident trauma. Depression and Anxiety, 22, 177–189.PubMedCrossRefGoogle Scholar
  4. American Academy of Child and Adolescent Psychiatry. (2010). Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(4), 414–430.Google Scholar
  5. Berry, J. G., & Harrison, J. E. (2007). Serious injury due to land transport accidents, Australia, 2003–2004. Australian Institute of Health and Welfare. AIHW cat no. INJCAT 107. Canberra: AIHW & ATSB.Google Scholar
  6. Bisson, J. I., Jenkins, P. L., Alexander, J., & Bannister, C. (1997). Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78–81.PubMedCrossRefGoogle Scholar
  7. Bolton, D., O’Ryan, D., Udwin, O., Boyle, S., & Yule, W. (2000). The long-term psychological effects of a disaster experienced in adolescence: II: General psychopathology. Journal of Child Psychology and Psychiatry, 41, 513–523.PubMedCrossRefGoogle Scholar
  8. Bryant, B., Mayou, R., Wiggs, L., Ehlers, A., & Stores, G. (2004). Psychological consequences of road traffic accidents for children and their mothers. Psychological Medicine, 34(2), 335–346.PubMedCrossRefGoogle Scholar
  9. Carrion, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the American Academy for Child and Adolescent Psychiatry, 41(2), 166–173.CrossRefGoogle Scholar
  10. Chambless, D. L., & Hollon, S. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.PubMedCrossRefGoogle Scholar
  11. Chambless, D. L., Sanderson, W. C., Shoham, V., Johnson, S. B., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5–18.Google Scholar
  12. Chemtob, C. M., Nakashima, J., & Hamada, R. S. (2002). Psychosocial intervention for postdisaster trauma symptoms in elementary school children. Archives of Pediatric and Adolescent Medicine, 156, 211–216.Google Scholar
  13. Cobham, V. E. (2012). Do anxiety-disordered children need to come into the clinic for efficacious treatment? Journal of Consulting and Clinical Psychology, 80(3), 465–476.PubMedCrossRefGoogle Scholar
  14. Cobham, V. E., & McDermott, B. M. (2010). Family functioning and parenting in the post-disaster environment. Paper presented at the World Congress of Behavioural and Cognitive Therapies, Boston, USA.Google Scholar
  15. Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 66, 893–905.PubMedCrossRefGoogle Scholar
  16. Cobham, V. E., Lilley, P.-R., Kenardy, J. A., Spence, S. H., & McDermott, B. M. (2007a). My child and the accident: A story with a happy ending. Treatment manual available from V.E. Cobham: University of Queensland.Google Scholar
  17. Cobham, V. E., Lilley, P.-R., Kenardy, J. A., Spence, S. H., & McDermott, B. M. (2007b). Me and the accident: A story with a happy ending. Treatment manual available from V.E. Cobham: University of Queensland.Google Scholar
  18. Cobham, V. E., Dadds, M. R., Spence, S. H., & McDermott, B. (2010). Parental anxiety in the treatment of childhood anxiety: A different story three years later. Journal of Clinical Child and Adolescent Psychology, 39(3), 410–420.PubMedCrossRefGoogle Scholar
  19. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577–584.PubMedCrossRefGoogle Scholar
  20. Cresswell, C., & Cartwright-Hatton, S. (2007). Family treatment of child anxiety: Outcomes, limitations and future directions. Clinical Child and Family Psychology Review, 10, 232–252.CrossRefGoogle Scholar
  21. Davis, L., & Siegel, L. J. (2000). Posttraumatic stress disorder in children and adolescents: A review and analysis. Clinical Child and Family Psychology Review, 3, 135–154.PubMedCrossRefGoogle Scholar
  22. Deblinger, E., Lippmann, J., & Steer, R. (1996). Sexually abused children suffering posttraumatic stress symptoms: Initial treatment outcome findings. Child Maltreatment, 1, 310–321.CrossRefGoogle Scholar
  23. DeYoung, A. C., Kenardy, J. A., Cobham, V. E., & Kimble, R. (2012). Prevalence, comorbidity and course of trauma reactions in young burn-injured children. Journal of Child Psychology and Psychiatry, 53(1), 56–63.CrossRefGoogle Scholar
  24. Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.PubMedCrossRefGoogle Scholar
  25. Foa, E. B. (1992). Posttraumatic stress diagnostic scale manual. National Computer Systems Inc.Google Scholar
  26. Foa, E. B., Johnson, K., Feeny, N. C., & Treadwell, K. R. (2001). The Child PTSD Symptom Scale (CPSS): Preliminary psychometrics of a measure for children with PTSD. Journal of Clinical Child Psychology, 30, 376–384.PubMedCrossRefGoogle Scholar
  27. Graham-Bermann, S. A., & Seng, J. (2005). Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children. Journal of Pediatrics, 146(3), 349–354.PubMedCrossRefGoogle Scholar
  28. In-Albon, T., & Schneider, S. (2006). Psychotherapy of childhood anxiety disorders: A meta-analysis. Psychotherapy and Psychosomatics, 76(1), 15–24.CrossRefGoogle Scholar
  29. Jacobson, N. S., & Traux, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.PubMedCrossRefGoogle Scholar
  30. James, A., Soler, A., & Weatherall, R. (2006). Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane Library, 1, 1–25.Google Scholar
  31. Kassam-Adams, N., & Winston, F. K. (2004). Predicting child PTSD: The relationship between acute stress disorder and PTSD in injured children. Journal of the American Academy of Child and Adolescent Psychiatry, 43(4), 403–411.PubMedCrossRefGoogle Scholar
  32. Kenardy, J., Spence, S., & MacLeod, A. (2006). Screening for risk of persistent posttraumatic morbidity in children following traumatic injury. Pediatrics, 118, 1002–1009.PubMedCrossRefGoogle Scholar
  33. Kenardy, J., Cobham, V. E., Nixon, R., McDermott, B., & March, S. (2010). Protocol for a randomised controlled trial of risk screening and early intervention comparing child- and family-focused cognitive-behavioural therapy for PTSD in children following accidental injury. BMC Psychiatry, 10, 92.PubMedCrossRefGoogle Scholar
  34. Keppel-Benson, J. M., Ollendick, T. H., & Benson, M. J. (2002). Post-traumatic stress in children following motor vehicle accidents. Journal of Child Psychology and Psychiatry, 43(2), 203–212.PubMedCrossRefGoogle Scholar
  35. Khanna, M. S., & Kendall, P. C. (2009). Exploring the role of parent training in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 77(5), 981–986.PubMedCrossRefGoogle Scholar
  36. Kovacs, M. (1983). The children’s depression inventory: A self-rated depression scale school-aged youngsters. Unpublished manuscript, University of Pittsburgh, School of Medicine.Google Scholar
  37. Kowalik, J., Weller, J., Venter, J., & Drachman, D. (2011). Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis. Journal of Behavioral Therapy and Experimental Psychiatry, 42, 405–413.CrossRefGoogle Scholar
  38. La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (1996). Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64, 712–723.PubMedCrossRefGoogle Scholar
  39. Landolt, M. A., Vollrath, M. E., Gnehm, H. E., & Sennhauser, F. H. (2009). Post-traumatic stress impacts on quality of life in children after road traffic accidents: Prospective study. Australian and New Zealand Journal of Psychiatry, 43, 746–753.PubMedCrossRefGoogle Scholar
  40. Le Brocque, R. M., Hendrikz, J., & Kenardy, J. A. (2010). The course of posttraumatic stress in children: Examination of recovery trajectories following traumatic injury. Journal of Pediatric Psychology, 35(6), 637–645.PubMedCrossRefGoogle Scholar
  41. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  42. McDermott, B., & Cobham, V. E. (2012). Family functioning in the aftermath of a natural disaster. BMC Psychiatry, 12, 55.PubMedCrossRefGoogle Scholar
  43. McFarlane, A. C. (1987). Posttraumatic phenomena in a longitudinal study of children following a natural disaster. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 764–769.PubMedCrossRefGoogle Scholar
  44. McKay, M. M., Lynn, C. J., & Bannon, W. R. (2005). Understanding inner city child mental health need and trauma exposure: Implications for preparing urban service providers. American Journal of Orthopsychiatry, 75, 201–210.PubMedCrossRefGoogle Scholar
  45. McNally, R. J., Bryant, R. A., & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological Science in the Public Interest, 4(2), 45–79.Google Scholar
  46. Meiser-Stedman, R., Yule, W., Dalgleish, T., Smith, P., & Glucksman, E. (2006). The role of the family in child and adolescent posttraumatic stress following attendance at an emergency department. Journal of Pediatric Psychology, 31, 397–402.PubMedCrossRefGoogle Scholar
  47. Mirza, K. A. H., Bdadrinath, B. R., Goodyer, I. M., & Gilmour, C. (1998). Post-traumatic stress disorder in children and adolescents following road traffic accidents. British Journal of Psychiatry, 172, 443–447.PubMedCrossRefGoogle Scholar
  48. Murray, B., Kenardy, J., & Spence, S. (2007). Brief report: Children’s responses to trauma- and nontrauma-related hospital admission: A comparison study. Journal of Pediatric Psychology. doi: 10.1093/jpepsy/jsm078.PubMedGoogle Scholar
  49. Nader, K., Kriegler, J. A., Blake, D. D., & Pynoos, R. S. (1994). Clinician administered PTSD scale for children and adolescents (CAPS-CA). Los Angeles: Western Psychological Services.Google Scholar
  50. National Institute for Health and Clinical Excellence. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London: Gaskel and the British Psychological Society.Google Scholar
  51. Nixon, R. D. V., Ellis, A. A., Nehmy, T. J., & Bally, S. (2010). Screening and predicting posttraumatic stress and depression in children following single-incident trauma. Journal of Clinical Child and Adolescent Psychology, 39(4), 588–596.PubMedCrossRefGoogle Scholar
  52. Nixon, R. D. V., Sterk, J., & Pearce, A. (2012). A randomized trial of cognitive behaviour therapy and cognitive therapy for children with posttraumatic stress disorder following single-incident trauma. Journal of Abnormal Child Psychology, 40, 327–337.PubMedCrossRefGoogle Scholar
  53. Nock, M. K., & Kazdin, A. E. (2005). Randomized controlled trial of a brief intervention for increasing participation in parent management training. Journal of Consulting and Clinical Psychology, 73(5), 872–879.PubMedCrossRefGoogle Scholar
  54. Perrin, S., Smith, P., & Yule, W. (2000). Practitioner review: The assessment and treatment of post-traumatic stress disorder in children and adolescents. Journal of Child Psychology and Psychiatry, 41(3), 277–289.PubMedCrossRefGoogle Scholar
  55. Prinz, R. J., & Miller, G. E. (1994). Family-based treatment for childhood antisocial behaviour: Experimental influence on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645–650.PubMedCrossRefGoogle Scholar
  56. Rapee, R. M. (2009). Early adolescents’ perceptions of their mother’s anxious parenting as a predictor of anxiety symptoms 12 months later. Journal of Abnormal Child Psychology, 37(8), 1103–1112.PubMedCrossRefGoogle Scholar
  57. Rapee, R. M. (2012). Family factors in the development and management of anxiety disorders. Clinical Child and Family Psychology Review, 15, 69–80.PubMedCrossRefGoogle Scholar
  58. Reed, P. L., Anthony, J. C., & Breslau, N. (2007). Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: Do early life experiences and predispositions matter? Archives of General Psychiatry, 64(12), 1435–1442.PubMedCrossRefGoogle Scholar
  59. Roberts, N. P., Kitchiner, N. J., Kenardy, J., & Bisson, J. I. (2009). Systematic review and meta-analysis of multiple-session early interventions following traumatic events. American Journal of Psychiatry, 166(3), 293–301.PubMedCrossRefGoogle Scholar
  60. Runyon, M. K., Deblinger, E., & Steer, R. A. (2010). Group cognitive behavioral treatment for parents and children at risk for physical abuse: An initial study. Child and Family Behavior Therapy, 32(3), 196–218.CrossRefGoogle Scholar
  61. Saxe, G. N., Ellis, B. H., Fogler, J., & Navalta, C. P. (2012). Innovations in practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress-trauma systems therapy approach to preventing dropout. Child and Adolescent Mental Health, 17(1), 58–61.CrossRefGoogle Scholar
  62. Scheeringa, M. S., & Zeanah, C. H. (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14(4), 799–815.CrossRefGoogle Scholar
  63. Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37(3), 508–518.PubMedCrossRefGoogle Scholar
  64. Scheeringa, M. S., Salloum, A., Arnberger, R. A., Weems, C. F., Amaya-Jackson, L., & Cohen, J. (2007). Feasibility and effectiveness of cognitive-behavioral therapy for posttraumatic stress disorder in preschool children: Two case reports. Journal of Traumatic Stress, 20(4), 631–636.PubMedCrossRefGoogle Scholar
  65. Scheeringa, M. S., Weems, C. F., Cohen, J. A., Amaya-Jackson, L., & Guthrie, D. (2011a). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three- through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52(8), 853–860.PubMedCrossRefGoogle Scholar
  66. Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011b). PTSD in children and adolescents: Towards an empirically based algorithm. Depression and Anxiety, 28, 770–782.PubMedCrossRefGoogle Scholar
  67. Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., et al. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child and Adolescent Psychology, 37(1), 156–183.PubMedCrossRefGoogle Scholar
  68. Siqueland, L., & Diamond, G. S. (1998). Engaging parents in cognitive behavioral treatment for children with anxiety disorders. Cognitive and Behavioral Practice, 5, 81–102.CrossRefGoogle Scholar
  69. Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D. M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 1051–1061.PubMedCrossRefGoogle Scholar
  70. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36, 545–566.PubMedCrossRefGoogle Scholar
  71. Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
  72. Stallard, P., Salter, E., & Velleman, R. (2004). Posttraumatic stress disorder following road traffic accidents: A second prospective study. European Journal of Child and Adolescent Psychiatry, 13, 172–178.CrossRefGoogle Scholar
  73. Stallard, P., Velleman, R., Salter, E., Howse, I., Yule, W., & Taylor, G. (2006). A randomized controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents. Journal of Child Psychology and Psychiatry, 47, 127–134.PubMedCrossRefGoogle Scholar
  74. Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for posttraumatic stress disorder in children and adolescents. Clinical Psychology Review, 32, 122–138.PubMedCrossRefGoogle Scholar
  75. Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL™: Measurement model for the Pediatric Quality of Life Inventory™. Medical Care, 37, 126–139.PubMedCrossRefGoogle Scholar
  76. Wong, M. (2008). Interventions to reduce psychological harm from traumatic events among children and adolescents: A commentary on the application of findings to the real world of schools. American Journal of Preventive Medicine, 35(4), 398–400.PubMedCrossRefGoogle Scholar
  77. Zatzick, D., Roy-Byenw, P., Russo, J., Rivara, F., Droesch, R. A., Wagner, A., et al. (2004). A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Archives of General Psychiatry, 61, 498–506.PubMedCrossRefGoogle Scholar
  78. Zatzick, D., Koepsell, T., & Rivara, F. P. (2009). Using target population specification, effect size, and reach to estimate and compare the population impact of two PTSD preventive interventions. Psychiatry, 72(4), 346–359.PubMedCrossRefGoogle Scholar
  79. Ziegler, M. F., Greenwald, M. H., DeGuzman, M. A., & Simon, H. K. (2005). Posttraumatic stress responses in children: Awareness and practice among a sample of pediatric emergency care providers. Pediatrics, 115(5), 1261–1267.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Vanessa E. Cobham
    • 1
  • Sonja March
    • 2
  • Alexandra De Young
    • 1
  • Fiona Leeson
    • 3
  • Reginald Nixon
    • 3
  • Brett McDermott
    • 4
  • Justin Kenardy
    • 1
  1. 1.School of PsychologyUniversity of QueenslandBrisbaneAustralia
  2. 2.Department of PsychologyUniversity of Southern QueenslandToowoombaAustralia
  3. 3.School of PsychologyFlinders UniversityAdelaideAustralia
  4. 4.Mater Medical Research InstituteMater Health ServicesBrisbaneAustralia

Personalised recommendations