Children and trauma : a broad perspective on exposure and recovery

The purpose of this dissertation was to generate a broad overview of children’s exposure to and recovery from trauma in order to promote theory building and the design of prevention and intervention activities. First, a general population study was conducted in 1770 primary school children. They filled out a questionnaire in a quiet classroom setting. Fourteen percent of the children reported traumatic exposure, a figure that is relatively low compared to American findings. We did not find differences in exposure based on gender, ethnicity, or region of residence. Second, we studied the psychosocial well-being (quality of life, posttraumatic stress, and posttraumatic growth) of the general population sample. Posttraumatic stress and quality of life showed a positive association. Posttraumatic growth and posttraumatic stress were positively related to each other as well, implying that trauma-specific negative and positive consequences can co-exist. In the third paper, we described the development and validation of the Children’s Responses to Trauma Inventory (CRTI), a child-oriented questionnaire to measure posttraumatic stress in children. Based on the general population sample and a number of earlier studies, it was concluded that the CRTI is a promising instrument. After that, we reviewed longitudinal studies on posttraumatic stress in children in a meta-analysis. We looked at the theoretical basis of studies and at evidence for risk and protective factors. Explicit theoretical frameworks were present in a minority of the studies. Important predictors of long-term posttraumatic stress in children and adolescents were symptoms of acute and short-term posttraumatic stress, depression, anxiety, and parental posttraumatic stress. Female gender, injury severity, duration of hospitalization, and elevated heart rate shortly after hospitalization yielded small effect sizes. Age, minority status, and socioeconomic status were not significantly related to long-term posttraumatic stress reactions. In order to combine large-scale quantitative information with in-depth qualitative knowledge, we subsequently studied children’s and parents’ views on recovery from trauma in semi-structured interviews (25 children and 33 parents). Our fifth paper described children’s perspectives. The long aftermath of a traumatic event, the experience of step-by-step recovery including positive elements, and feeling supported by friends, parents, and cuddly toys were important to the children, and they showed a wide variety of coping behaviors. In the sixth paper we focused on parents’ perspectives on recovery of their child. Responsive parenting was a central theme in the interviews. It consisted of being aware of a child’s needs and acting upon these needs. Fourteen strategies, such as comparing behavior with siblings' behavior and providing opportunities to talk, were identified. Finally, we studied teachers’ views on supporting children who have been exposed to trauma. We carried out 21 semi-structured interviews and conducted a follow-up with a questionnaire filled out by 765 teachers in a national sample. Teachers struggled with their role, and searched for better knowledge and skills. One of the main dilemma’s faced by the teachers was how to balance a mission of education with a need to help individual students. The clinical implications of the findings are further discussed in the dissertation