Parental Responses to Child Trauma: the Role of Trauma Specific Behaviours and Parenting Style in Facilitating Child Psychological Adjustment

Lead Research Organisation: University of Bath
Department Name: Psychology

Abstract

A significant proportion of children in the UK are exposed to potentially traumatic experiences (e.g., accidents, assaults) which are associated with the development of psychological difficulties. In particular, children are vulnerable to developing post-traumatic stress symptoms following trauma, including vivid and intrusive memories of the event, avoidance of reminders of the trauma, and broader problems with anxiety and mood. Such problems affect a significant proportion of UK children. For example, approximately 80,000 children are involved in motor vehicle accidents in the UK annually, and research suggests that approximately one third of these children will develop post-traumatic stress disorder (PTSD) as a consequence. The proposed research will help us to understand what factors influence child psychological adjustment following trauma, and particularly why some children and not others develop the symptoms of PTSD.

To date, research has focused on understanding individual characteristics that might contribute to child difficulties following trauma. Some important factors have been identified, including a particularly negative interpretation of the trauma (e.g., as a sign that the world is extremely dangerous, or the self is highly vulnerable), a disjointed and incomplete memory for the event, and problematic ways of coping (e.g., by suppressing thoughts of the trauma, or dwelling on it). In addition to these individual factors, the way in which children are supported by their parents is likely to be important, but has not been systematically studied. This omission is significant, as for most children their families are their main source of support following trauma. At present, there isn't sufficient evidence available to inform how parents can best support their child following a traumatic experience.

The proposed research will examine parental factors that influence child psychological adjustment following trauma. Based on the existing literature on relevant child processes, the following behaviours will be investigated: parental engagement in co-recollection of the trauma with the child; the parent's own interpretations of the trauma, and the extent to which they communicate these to the child; and parental support for or discouragement of problematic coping styles in the child. More generally, the degree to which parenting is characterised by a restrictive style that limits child autonomy will be examined, as this has previously been linked problems with anxiety in children.

We will conduct a detailed study of children and their parents, which tracks their psychological adjustment in the months following trauma. Children aged 7-12 years will be recruited through hospital accident and emergency departments, and will complete assessments with their parents immediately following the trauma, and 3- and 6-months later. Detailed assessments of how parents interact with children following trauma will be completed, and child PTSD symptoms will be assessed. In this way, we will identify parental behaviours that contribute to later child adjustment, even once initial child reactions to the trauma are taken into account. In addition to this intensive, observational study we will also conducted a larger study based on parent and child questionnaires, which will provide additional evidence regarding key parental processes, and will also allow specific links between parental and child processes to be identified. Based on the preceding studies, we will develop preliminary guidance for parents on how to support their child following trauma

Planned Impact

It is relatively common for children to experience potentially traumatic events, and to develop PTSD symptoms as a consequence. Potentially, parents of traumatised children may play an important role in facilitating child psychological adjustment. Despite this, at present, there is no systematic psychological advice or support given to families following the experience of trauma. This may represent a significant missed opportunity, as providing parents with guidance on how best to help their child post-trauma has the potential to improve child outcomes. At the same time, systematic investigation of the role of parents in influencing child psychological adjustment following trauma has not been conducted, and therefore there isn't an adequate evidence base to support the development of empirically-driven intervention targeting parental factors.

The proposed research comprises a comprehensive examination of parental influences in relation to child psychological adjustment post-trauma. In the event that significant parental influences are identified, preliminary work will be completed in relation to drafting guidance for parents of traumatised children. Consquently, there is clear potential for impact at multiple levels. Academically, the research is likely to be of immediate benefit to other researchers who are working to understand child psychological difficulties post-trauma; and may be of particular importance to those who are working to develop more effective psychological treatments for PTSD in children. In the longer term, the proposed work may have impact for policy makers, hospitals and other agencies who deal with child trauma, and for children and families who themselves experience traumatic events. Specifically, if the output from our research ultimately allows for a more informed approach to supporting traumatised children and their families it may: a) at a policy level, result in the routine provision of information for families affected by child trauma; b) provide guidance for professionals who routinely interact with child trauma populations; c) contribute to the development of psychological interventions for child PTSD that target parental behaviours of importance; and d) through each of these routes, be of value in aiding traumatised children in their psychological recovery.

PTSD, and other psychological reactions to trauma, can be both highly persistent and extremely disabling. Child sufferers may experience broader adjustment problems, including school failure and social problems, in addition to the severe distress associated with their psychological difficulties. As such, our research has the potential for longer term positive impact on wellbeing in children experiencing trauma.

Publications

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Hiller RM (2018) A longitudinal investigation of the role of parental responses in predicting children's post-traumatic distress. in Journal of child psychology and psychiatry, and allied disciplines

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Williamson V (2018) Caregiver experiences of public services following child trauma exposure: a qualitative study. in International journal of mental health systems

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Williamson V (2018) The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation. in European journal of psychotraumatology

 
Description Data analyses are still being completed. However, initial key findings are as follows.

1. Meta-analysis of data from the existing literature tracked the occurrence and severity of PTSD over the course of a year following trauma exposure in young people. Results indicated that PTSD symptoms (e.g., bad dreams about the trauma, feeling 'jumpy' or easily startled) are relatively common to experience within the first month of a traumatic event. For children who experience high symptoms of PTSD and meet criteria for a diagnosis, about 50% will show a reduction in symptoms to below clinical levels, across the 6 months after the event. However, there is little evidence of further change in rates of PTSD or symptom severity after 6 months. Therefore, if a child still meets criteria for a PTSD diagnosis 6 months post-trauma, it is unlikely that they would lose a PTSD diagnosis without formal intervention.

2. A study carrying out in-depth interviews with parents to investigate responses to their child's trauma highlighted the fact that parents use many positive strategies to support their child after a traumatic event, including; providing extra care, opportunities to discuss what happened, and making an effort to resume normal routines. However, they also sometimes provide support in ways that may prolong child distress, for example by advocating avoidance of trauma related places or activities, or being highly protective in order to prevent future harm. The way that parents respond to children following trauma are heavily influenced by parents' own feelings of helplessness and anxiety following the event.
Some parental responses were also influenced by their perceptions of care from medical staff; confusing or limited information about child recovery contributed to parents' anxiety and difficulty resuming normal routines. Parents described a need for more guidance and support regarding their child's physical and emotional recovery.

3. We have also generated evidence in relation to the potential for parents to influence child recovery following trauma, through the support they provide. First, a meta-analysis of the existing literature indicated that general negative parental responses to children following trauma (particularly overprotective parenting) are reliably associated with child PTSD symptom levels. Second, our own longitudinal research examined trauma specific parental responses, and found that how the parent particularly intervenes in relation to the child's initial posttraumatic distress is a relatively strong predictor of subsequent child symptoms 6 months later, even once the child's initial symptom levels are taken into account. In particular, the way that the parent perceives the child following the event (e.g., as damaged or vulnerable) was just as important as the way that they responded (e.g., by promoting avoidance of trauma material or forgetting). An overwhelming majority of parents reported needing more information about how to help their child posttrauma. Nonetheless, overall, parental responses were highly supportive and positive.

4. We have extended our UK research to examine a high risk international population in South Africa, in a community where children are vulnerable to multiple traumas and comparatively severe events. This research has highlighted the need to consider contextual factors when attempting to understand parental responses to child posttraumatic distress. For example, parents from the community strongly encouraged avoidance of trauma related places and activities, frequently gave dire warnings to the child about their vulnerability and the likelihood of future trauma, and endorsed forgetting as a main coping strategy for the child. These responses would be considered problematic according the outcomes of our UK study, but may be highly appropriate when the actual level of ongoing threat that is present for families in the community is markedly high.
Exploitation Route Our findings are relevant to clinicians and families supporting children following trauma. We are currently working with clinicians to generate a set of guidelines for clinicians that may be useful in their practice, and are working to establish how our research can feed into family based interventions. We are seeking funding to extend our work with respect to the latter. Our longer term aim is that our research findings directly result in improved support for young people and their families posttrauma.
Sectors Healthcare

 
Description The findings from our project are only just beginning to show impact, and we expect this process to continue. Specifically, our research has significant implications for children and their families following trauma, in demonstrating that the way in which parents provide support may influence later child adjustment. In our pathways to impact document we particularly aimed to communicate relevant findings to stakeholders including families and policy makers in the short to medium term; and to influence interventions in the longer term. We have begun to achieve these impacts, as follows. 1. We have completed dissemination activities with hospital clinical teams in our local region, and have disseminated findings to a wider range of emergency department clinicians via presentation at their regional and national conferences. This process is ongoing, and we are working with hospitals to establish how we can embed key messages for within emergency department clinical teams, so that they are well placed to communicate those messages to parents of trauma exposed children. 2. We have communicated our findings to wider societal audiences, by contributing to public engagement activities such as 'A Pint of Science.' These activities have been successful in establishing links with charities that work with trauma exposed children (e.g., YoungMinds), and again, the process of working together to establish whether and how our research can feed into their activities is underway. We are working with "We the Curious" in Bristol to find ways to achieve wider dissemination to families via this science centre. We have taken up opportunities for radio interviews and have disseminated our research via The Conversation. 3. We have contributed to brief guidance for parents that was widely shared following the Manchester Arena bombing. We are working together to develop a website that will support such communication in a wider way in the future. 4. In February, we contributed to a government consultation on the interplay between parental and child mental health, and the capacity for engaging parents in effectively supporting children's mental health. 5. We have applied for funding to evaluate ways in which parental interventions can have an impact on children's mental health following trauma, which is key to maximising the impact of our research. Unfortunately, our application was unsuccessful, but we will pursue this further.
First Year Of Impact 2017
 
Description Contribution to policy workshop/briefing document relating to parental influences on child mental health
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Advanced Fellowship (Fellow Kirsty Donald, University of Cape Town; Host Sarah Halligan)
Amount £110,000 (GBP)
Organisation Newton Fund 
Sector Public
Country United Kingdom
Start 10/2015 
End 09/2018
 
Description British Academy Small Grant (Co-I; PI Rachel Hiller, post doc)
Amount £5,895 (GBP)
Organisation The British Academy 
Sector Academic/University
Country United Kingdom
Start 10/2015 
End 01/2017
 
Description ESRC Future Research Leaders - Mentor for PI Rachel Hiller
Amount £182,264 (GBP)
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 12/2016 
End 12/2018
 
Description GCRF Networking Grant
Amount £25,000 (GBP)
Organisation Academy of Medical Sciences (AMS) 
Sector Charity/Non Profit
Country United Kingdom
Start 03/2018 
End 02/2019
 
Description GW4 ACCELERATOR AWARD: A biosocial approach to trauma and posttraumatic stress disorder (PTSD) in young people
Amount £74,000 (GBP)
Funding ID GW4-AF9-006 
Organisation GW4 
Sector Academic/University
Country United Kingdom
Start 11/2018 
End 11/2019
 
Description GW4 Initiator Scheme
Amount £14,500 (GBP)
Organisation GW4 
Sector Academic/University
Country United Kingdom
Start 08/2016 
End 12/2016
 
Description International Partnership and Mobility Scheme
Amount £29,000 (GBP)
Organisation The British Academy 
Sector Academic/University
Country United Kingdom
Start 10/2014 
End 09/2017
 
Description Mapping the mental health and service-use of young people in out-of-home care
Amount £34,266 (GBP)
Funding ID MQDS17/29 
Organisation MQ Transforming Mental Health 
Sector Charity/Non Profit
Country United Kingdom
Start 08/2018 
End 08/2019
 
Title How do children and their families react following a traumatic event? 
Description Interview and questionnaire data of parent report of child trauma exposure in Khayelitsha, Cape Town. 
Type Of Material Database/Collection of data 
Year Produced 2017 
Provided To Others? Yes  
 
Description Mark Tomlinson/Stellenbosch University 
Organisation University of Stellenbosch
Department Department of Psychology
Country South Africa 
Sector Academic/University 
PI Contribution We are providing intellectual input/analysis for a funded project (PI Mark Tomlinson).
Collaborator Contribution Mark Tomlinson is collecting data from a deprived South African sample of young people whose mothers had depression in the perinatal period, and is allowing us access to those data.
Impact We have agreed/obtained funding to develop a collaboration around the high risk populations that Prof. Tomlinson studies in South Africa. We have collected preliminary data to support this future project.
Start Year 2014
 
Description University of Cape Town/Kirsty Donald 
Organisation University of Cape Town
Department Department of Psychiatry and Mental Health
Country South Africa 
Sector Academic/University 
PI Contribution We are supporting a Newton Advanced Fellowship held by Kirsty Donald which will enable us to work collaboratively on a UCT based cohort study which includes indices of child trauma exposure/PTSD. We are supporting training on family based assessments, longitudinal data analysis and are assisting with research conceptualization.
Collaborator Contribution The partnership will allow us to examine research questions relevant to our group in a unique longitudinal dataset deriving from an LMIC setting.
Impact None to date.
Start Year 2015
 
Description BBC Wiltshire Interview - PROTECT Project 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Team member took part in a radio interview related to child trauma/PTSD and the research being completed by our team. Clear outcomes are difficult to document in terms of impact, but our team has subsequently developed plans to engage in follow-up activities as our work develops.
Year(s) Of Engagement Activity 2015
URL http://www.bath.ac.uk/play/video/1424108040.
 
Description Cabinet offices workshop 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I contributed to a Cabinet Office workshop focused on supporting parents of children and young people with mental health problems. The workshop was lead by the cabinet offices EDS team, with the long term aim being to influence policy in this area. Other attendees present included academics, Public Health England. This meeting provided a foundation for ESRC Emerging Minds Mental Health Network Plus Award (PI Cathy Creswell).
Year(s) Of Engagement Activity 2018
 
Description Conference talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Conference talk to a medical audience, aim to raise awareness of research findings relevant to emergency medicine practitioners.
Year(s) Of Engagement Activity 2017
 
Description Presentation at regional conference for emergency medicine clinicians 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Disseminating research outcomes to a clinical audience
Year(s) Of Engagement Activity 2017
 
Description Talk at A Pint of Science, Bath 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact We gave a talk on our research studies at the Pint of Science festival in Bath, which aims to share academic research with members of the public. Approx 25 individuals attended, including two representatives from relevant regional charities, which has prompted follow-up conversations about the relevance of our research to their organisations.
Year(s) Of Engagement Activity 2018
URL https://pintofscience.co.uk/events/bath
 
Description The Bridge article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact We published an invited summary of a key paper from our grant in The Bridge, an online publication of the Association for Child and Adolescent Mental Health. This publication provides accessible research summaries that reach a wider audience than the journal articles they are based on. Our article was included in a special issue focused on child trauma.
Year(s) Of Engagement Activity 2019
URL https://www.acamh.org/app/uploads/2019/02/PTSD-March.pdf
 
Description The Conversation article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact We published a summary of our research in The Conversation, a public facing research dissemination website. This led to subsequent invitations to contribute to media broadcasts for myself/members of my team (Rachel Hiller, Hope Christie).
Year(s) Of Engagement Activity 2018
URL http://theconversation.com/how-parents-can-support-children-after-traumatic-events-89546