Children and Acute Trauma: Individual and System Responses

We began putting together this special trauma issue a year ago following two distinctly different but similarly impactful traumatic events: Hurricane Sandy and the school shooting at Sandy Hook Elementary in Newtown, CT. It occurred to the editorial board that while communities, governments, and professionals agreed wholeheartedly that something must be done for children and families exposed to mass trauma, pediatric randomized trials after such events were limited. We invited two eminent scholars in the field, Judith Cohen, MD, of Drexel University, and Michael Scheeringa, MD, of Tulane University, to help us assemble a look at the cutting edge of research in pediatric traumatic stress, and at where more needs to be done.

If there is a unifying theme to these excellent articles, it is that childhood traumatic stress responses are both similar and distinct from adult manifestations. Developmental differences relative to adults require that we base our understanding on empirical data from rigorous studies with pediatric populations. In addition, we must be aware of important caregiver and family factors that may impact outcomes and treatment strategies. We cannot think of a better takeaway for caregivers and clinicians alike, particularly when considering mass responses from a year ago.

In particular, Meiser-Stedman et al. show that common-sense approaches to thought-control that are proven in adult patients are in fact not beneficial and even harmful to young people undergoing cognitive development. Articles from De Young et al. and Cobham et al. show that the fabric of a young family is inextricably linked with the response of young people to traumatic stress whether from exposure to disaster or severe injury. Weems et al. take a fascinating look at the nuanced interplay of previous exposure to trauma that predicts resilience and maladaptive coping in pediatric populations, and reach a sobering if instructive conclusion: We cannot ever assume that a child is immune to a traumatic stress response or to sub-threshold symptoms that are nonetheless impairing.

Pfefferbaum et al., Scheeringa et al., and Newman and Shapiro look at the broader landscape through various lenses. Newman and Shapiro offer an engaging discussion of the responding clinician's relationship with the press and the pitfalls and potential advantages of the media's presence after a traumatic event. Pfefferbaum and her colleagues present a much-needed overview of treatment interventions for PTSD and PTSS, and the evidence supporting their use in pediatric populations. Finally, Scheeringa et al. use case studies, well-reasoned metrics, and professional experience to approach perhaps the toughest question of all: How should we organize and prosecute large-scale responses to traumatic events such as terrorist attacks and natural disasters? And how will we know if they work?

We hope you will find this collection both intriguing and educational. Our thanks again to Drs. Cohen and Scheeringa.