Prediction and Prevention of Posttraumatic Stress Disorder after Road Traffic Accidents in Children and Adolescents
Coping with Traumatic Events in Children and Adolescents

Traumatic events (for example road traffic accidents) often cause severe and
persisting psychological complaints. About one-fourth of children and
adolescents develop Post-traumatic Stress Disorder (PTSD). For more than half
of them, the disorder becomes chronic (duration > 6 months). Comorbid disorders
include depression, physical complaints and behavioural problems (Hubbard,
Realmuto, Northwood & Masten, 1995), which can result in developmental delay.
It is important to prevent this to occur through early intervention.
Cognitive-behavioral therapy (CBT) for individuals with Acute Stress Disorder
(ASD) appears to be effective in preventing chronic PTSD (Bryant et al., 1999).
Therefore, early intervention guidelines develloped bij the National Centre for
PTSD (Litz et al., 2002), suggest that CBT appears to be the most justified
early intervention. However, there has been no controlled outcome research on
such early interventions with children and adolescents.

The objective is to investigate wether a brief CBT with parental involvement
among children and adolescents with ASD reduces the risk of PTSD compared to a
waitlist control group.

This is a randomised clinical trial using two conditons: CBT comprising 5
sessions, in which at least one parent/caretaker is involved, and a
waitlist-control condition (which is subsequently invited to take part in the
CBT). The participants are recruited with help from Victim Assistance.
Individuals with ASD after a single stressful event (burglary, accident,
assault, etc) will be randomly assigned to one of the two conditions. There
will be three assessments: at baseline, after the intervention/wait list, and
at follow-up. The planned enddate of data collection is December 1, 2010.

Cognitive behavior therapy, 5 sessions for the child/adolescent. For younger
children parents will be involved in the sessions. For adolescents this is not
a necessity; age and invidual development and preference will be taken into
account. Sessions take about one hour consisting of psychoeducation, cognitive
restructuring, and exposure excercises.

The interviews and questionnaires have been used in earlier studies. They
require attention and concentration, and can result in fatigue. (Temporary)
emotions can also be evoked by completing these measures and taking about the
event. This is noted in the informed consent. Participants are told that they
can contact the researcher if they wish talk about this.
Based on earlier similar studies of the effectiveness of similar CBT in anxious
children, we expect no risks or side-effects following the CBT-protocol. This
is a intervention-method following international guidelines for treating
ASD/PTSD-symptoms. For participants, the advantages can be symptoms deminishing
following the intervention.
If severe psychological problems are detected, that are beyond the scope of the
intervention, then this will be discussed with the participants and their
parents, who can be referred for additional professional help.