Young children may experience Post Traumatic Stress Disorder (PTSD) for years without it being recognised by their parents according to new research from the University of East Anglia (UEA).
Researchers investigated how children under 10 experience PTSD weeks, months and years after a traumatic event.
They found that children's suffering is often under-recognised by parents - despite being shaped to a large extent by the parents' own stress in response to the child's trauma.
Lead researcher Dr Richard Meiser-Stedman, from UEA's Norwich Medical School, said: "When people talk about PTSD they often think about soldiers returning from war zones. But children who experience traumatic events such as car accidents, assaults, and natural disasters are also at risk of developing post-traumatic stress disorder.
"Symptoms can include traumatic memories and nightmares, avoiding reminders of the trauma, and feeling like the world is very unsafe.
"We wanted to find out about how prevalent PTSD is in children three years after a trauma, as well as how well parents recognise that their child is affected.
"We were also interested in whether early signs of stress soon after a trauma could predict PTSD further down the line. And whether factors such as trauma severity, intellect, and parental mental health can predict whether a child will go on to experience more chronic PTSD."
The research team followed more than 100 children aged between two and 10 who had been involved in a road accident - such as being involved in a car crash, being hit as a pedestrian, or knocked off their bike. All had been taken to A&E with varying injuries - including bruising, fracture or losing consciousness.
They were assessed for PTSD between two and four weeks after the incident, then again at six months, and finally after three years.
The team assessed the children using standard criteria for diagnosing PTSD in young children. Those over the age of seven were interviewed, as well as all parents or carers.
Intellectual ability, parental mental health, and demographic variables were taken into account.
- - Children showing signs of stress soon after a trauma will not necessarily go on to suffer PTSD after three years.
- Some children may develop PTSD that persists for years following a trauma - but this is only likely to happen in a minority of cases. Most will 'bounce back' naturally in time.
- Most parents of children still experiencing difficulties after three years did not recognise their child's PTSD. Relying on parent reports of PTSD may therefore be inadequate for identifying chronic patterns in young children.
- Trauma severity was linked with incidence of PTSD up to six months after an accident, but not three years after.
- Child intelligence and age were not linked with incidence of PTSD.
- Children were more likely to suffer PTSD after a trauma if their parents also suffered PTSD - both soon after the event, and even three years afterwards. But even these parents may not spot their child's suffering.
Dr Meiser-Stedman said: "This study reveals some really interesting links between how children and their parents respond to a trauma.
"We found that children may experience PTSD for years without it being recognised by their parents. We also found a strong link between parents suffering PTSD and their children suffering as well - even years after the traumatic event.
"This could be because parental stress early on is worsened by their children's symptoms, or because the child's responses are shaped by their parents' initial reactions - or a bit of both, leading to an amplification of symptoms for both parties.
"Interestingly, even in these cases, the parents were still unlikely to acknowledge their children's suffering.
"This study strengthens the case for considering parental mental health, and providing support for both children and their parents in the aftermath of a trauma to reduce the long-term effects for both," he added.
The research was undertaken in collaboration with colleagues at King's College London, King's College Hospital, and the Medical Research Council Cognition and Brain Sciences Unit at Cambridge.
'Posttraumatic stress disorder in young children three years post-trauma: prevalence and longitudinal predictors' is published in the Journal of Clinical Psychiatry on 8 November 2016.