Different clinical courses of children exposed to a single incident of psychological trauma: a 30-month prospective follow-up study.

BACKGROUND: We investigated the distinct longitudinal trajectories of posttraumatic stress symptoms in a sample of 167 children, who witnessed death of two mothers of their schoolmates. METHODS: The cohort was followed-up at 2 days (T1), 2 months (T2), 6 months (T3), and 30 months (T4) after the traumatic event. The children's posttraumatic stress symptoms (T1-T4), depression (T1, T3 and T4), state anxiety (T1, T3 and T4), and quality of life (T4) were assessed, along with parental stress related to child rearing (T4). Different trajectory patterns of the children's posttraumatic stress symptoms were identified using growth mixture modeling (GMM). RESULTS: Four different patterns of symptom change were identified, which were consistent with the prototypical model, and were named Recovery (19.9%), Resilience (72.7%), Chronic Dysfunction (1.8%), and Delayed Reactions (5.6%). Significant differences were found in depression and anxiety scores, children's quality of life, and parental rearing stress according to the distinct longitudinal trajectories of posttraumatic stress symptoms. CONCLUSIONS: The present study suggests that individual differences should be taken into account in the clinical course and outcome of children exposed to psychological trauma. The two most common trajectories were the Resilience and the Recovery types, together suggesting that over 90% of children were evidenced with a favorable 30-month outcome. The latent classes were associated with significant mean differences in depression and anxiety scores, supporting the clinical validity of the distinct trajectories.

Val/Val genotype of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with a better response to OROS-MPH in Korean ADHD children.

Research on psychostimulants, analysis of animal models and genetic association studies all suggest that the brain-derived neurotrophic factor gene (BDNF) may be a good candidate for pharmacogenetic studies of attention deficit hyperactivity disorder (ADHD). Yet to date there have been no pharmacogenetic studies of BDNF in ADHD. A total of 102 drug-naive ADHD children (8.7±2.1 yr) were treated with osmotic release oral system-methylphenidate (OROS-MPH) for 12 wk, and four kinds of response criteria were applied, based first, on a combined threshold of the ADHD Rating Scale - IV (ARS) and the Clinical Global Impression - Improvement scale (CGI-I); second, on scores of 1 or 2 vs. 3-7 on the CGI - Severity scale; third, on a >50% reduction in ARS scores; and fourth, on satisfaction of all of the aforementioned criteria. The Val66Met polymorphism of BDNF and six single nucleotide polymorphisms from the SLC6A2, ADRA2A and NTF-3 genes were tested for association with each criterion. Relative to other genotypes, homozygosity for the Val allele of the BDNF Val66Met polymorphism was associated with a greater relative frequency of good response under all four response criteria (after controlling for baseline ARS score, age, gender, final dose (mg/kg) of OROS-MPH at 12 wk, and level of academic functioning). This association was significant at the uncorrected level for the first and third response criteria (p=0.013 and p=0.018, respectively) and significant at a Bonferroni-corrected level for the second and fourth response criteria (p=0.0002, p=0.0003, respectively). Our findings support an association between homozygosity for the Val allele of BDNF and better response to OROS-MPH in Korean ADHD children as assessed by four different response criteria.

The effect of persistent posttraumatic stress disorder symptoms on executive functions in preadolescent children witnessing a single incident of death.

We compared executive functions (EFs) of traumatized preadolescent children with and without marked posttraumatic stress disorder (PTSD) symptoms to the performance of a nontraumatized control group, and examined the relationships between EF deficits and functional status in traumatized preadolescent children. Fifty-one preadolescent children who had witnessed a death at school 30 months prior (26 with marked PTSD symptoms and 25 without) and 30 healthy controls who had not been traumatized participated. EFs were examined using the Comprehensive Attention Test (CAT). The functional state of traumatized children was measured by the Parent Report Form-Children's Health and Illness Profile-Children's Edition (PRF-CHIP-CE). The traumatized children, regardless of status of PTSD symptomatology, showed poorer working memory performance than nontraumatized healthy controls. The traumatized children with marked PTSD symptoms performed more poorly on measures of interference control compared to those children without marked PTSD symptoms. Lower levels of EFs were associated with lower risk avoidance and diminished academic achievement in traumatized children. These results indicate that an inhibitory control deficit is specifically associated with the current PTSD symptoms but not with trauma exposure per se.

A 30-month prospective follow-up study of psychological symptoms, psychiatric diagnoses, and their effects on quality of life in children witnessing a single incident of death at school.

OBJECTIVE: We explored the course of trauma-related psychological symptoms and psychiatric diagnoses in 167 children who, as fourth graders, witnessed death at school and assessed the long-term effects of their symptoms on quality of life and their parents' rearing stress. METHOD: 167 children were evaluated using diverse self-rating symptom scales at 2 days (T1: May 19, 2007), 2 months (T2: July 16, 2007), 6 months (T3: November 12-17, 2007), and 30 months (T4: November 16-21, 2009) after the accident. All children were interviewed with the Diagnostic Interview Schedule for Children-Version IV (DISC-IV) at T1. High-risk children were assessed with the DISC-IV at T3 and T4. Children's quality of life and parental stress were assessed in all children and parents using the Parenting Stress Index and the Child Health and Illness Profile at T4. RESULTS: The mean scores and prevalence of severe posttraumatic stress disorder (PTSD) and anxiety symptoms decreased significantly over time (P < .001), but depressive symptoms did not. Although the prevalence of DISC-IV-based diverse anxiety disorders decreased significantly over time, 45% of high-risk subjects evaluated with the DISC-IV met criteria for an anxiety or depressive disorder at T4. Linear and logistic regression analyses showed that depressive symptoms at 6 months predicted more severe parental stress (ß = 0.51; odds ratio [OR] = 2.88), less satisfaction (ß = -0.25; OR = 2.66), and lower achievement (ß = -0.41; OR = 1.50) at 30 months. PTSD symptoms were not associated with parental stress or quality of life at T4. CONCLUSIONS: This study provides new evidence regarding the long-term course of trauma-related symptoms and diagnostic changes in children exposed to a single trauma. Children's depressive symptoms predicted lower children's quality of life and higher parental rearing stress after 2 years. Careful assessment and management of depressive symptoms can potentially reduce parental stress and improve quality of life of children.