Parents of children who have suffered a stroke can experience post-traumatic stress disorder (PTSD), and the children show signs of clinical anxiety, factors that could interfere with treatment and outcomes, according to research presented at the American Stroke Association's International Stroke Conference 2015.
A preliminary study conducted at Boston Children's Hospital examined 10 fathers, 23 mothers of children ranging in ages from infant to teenager. It also enrolled 9 pediatric stroke patients' ages 7-18 years. The children had experienced their strokes in either 2013 or 2014.
Fifty-five percent of the parents met at least one of the PTSD criteria and 24 percent met all the criteria for PTSD. While PTSD was not seen among the children, 22 percent had clinically significant levels of anxiety.
"Our concern is that PTSD in parents of a child with stroke or pediatric stroke patients experiencing anxiety may have a harder time complying with therapy, which could affect health outcomes of the child," said Laura Lehman, M.D., lead researcher and neurologist at Boston Children's Hospital. "The data are preliminary but we could use this information to screen families for potential PTSD and emotional problems after stroke so that we can plan more targeted interventions, such as support groups, and determine who is at risk. We want to ensure that PTSD or other emotional problems do not interfere with the child's recovery."
PTSD symptoms can include reliving the traumatic event several months after it happened whether through dreams or while awake, feeling emotional distress, repetitive negative thoughts, feeling hopeless about the future, and avoiding situations that may bring back memories of the traumatic event. PTSD can occur several months or even years after the traumatic event.
PTSD has been seen among parents of critically ill children, and has been seen in families where children were treated in pediatric intensive care units, for cancer or other life-threatening diseases, and those who were undergoing organ transplants, Lehman said. However, PTSD in pediatric stroke patients or their parents has not been studied.
PTSD was observed among parents whose children had chronic medical conditions including congenital heart disease and moyamoya as well as parents of children with no medical histories, Lehman said. Moyamoya disease is a rare, progressive cerebrovascular disorder caused by blocked arteries at the base of the brain.
According to the American Stroke Association, stroke is one of the top causes of death for children in America, estimated to affect about 3,000 children and young adults every year. Between 20 percent to 40 percent of children die after a stroke. The risk is greatest during the first year of life, with the risk from birth through age 18 being 11 per 100,000 children. Sickle cell disease and congenital heart disease are two common risk factors for pediatric stroke; boys are also at a higher risk than girls and African Americans are at a higher risk than Caucasian or Asian children.
"We were prompted to look at this issue based on our own clinical experiences here at Boston Children's Hospital," she said. "When something happens to a child, it happens to the whole family. The psychosocial part of recovery after stroke is just as important as the physical recovery, so our hope is to use this data to more effectively treat these families."
Co-authors are Kristin Maletsky, B.A.; Fareesa Islam, MPH; Michael J Rivkin, M.D.; and Christine Mrakotsky, PhD. Author disclosures are on the abstract.
There was no funding for this study.
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Note: Actual presentation is 6:15 p.m. CT/7:15 p.m. ET, Thursday, Feb. 12, 2015, in Hall D.
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