Early psychological intervention in accidentally injured children ages 2–16: a randomized controlled trial

Road traffic accidents (RTA) and burns are frequent events in children. Although many children recover spontaneously, a considerable number develop long-term psychological sequelae. Evidence on early psychological interventions to prevent such long-term problems is still scarce for school-age children and completely lacking for pre-school children. To evaluate the efficacy of an early two-session cognitive-behavioral intervention in 108 children ages 2–16 after RTAs and burns. Children assessed at risk for the development of posttraumatic stress disorder (PTSD) were randomly assigned to either a control group offered treatment as usual or an intervention group. Primary outcomes were PTSD, behavioral problems, and depression symptoms. Baseline and blinded 3- and 6-month follow-up assessments were conducted. In pre-school children, no intervention effects were found. School-age children in the intervention group exhibited significantly fewer internalizing problems at 3-month follow-up relative to controls and a borderline significant time-by-group effect for PTSD intrusion symptoms was found (<i>p=</i>0.06). This is the first study examining the efficacy of an indicated, early psychological intervention among both school-age and pre-school-age children. Because the intervention was ineffective for young children, no evidence-based practice can currently be suggested. Given that parents of pre-school children perceived the intervention as helpful, brief counseling of parents in terms of psychoeducation and training in coping skills still should be provided by clinicians, despite the current lack of evidence. To prevent trauma-related disorders in school-age children, the intervention might be used in a step-wise manner, where only children at risk for long-term psychological maladjustment are provided with psychological support.

道路交通意外（Road Traffic Accidents, RTA）与烧伤是儿童群体中频发的健康事件。尽管多数儿童可自发康复，但仍有相当比例的患儿会出现长期心理后遗症。目前针对学龄儿童（School-age children）、学龄前儿童（Pre-school children）的早期心理干预措施，以预防此类长期心理问题的相关研究证据仍较为匮乏，而学龄前儿童相关的证据更是完全缺失。本研究旨在评估一项早期、含两次疗程的认知行为干预（Cognitive-Behavioral Intervention）对108名年龄介于2至16岁、曾发生道路交通意外或烧伤的儿童的干预疗效。经评估存在创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）发病风险的儿童，被随机分配至常规治疗对照组与干预组。主要结局指标包括创伤后应激障碍、行为问题与抑郁症状。研究开展了基线评估，以及设盲的3个月、6个月随访评估。在学龄前儿童群体中，未观察到干预效果。与对照组相比，干预组学龄儿童在3个月随访时的内化行为问题显著更少，且创伤后应激障碍闯入症状存在临界显著的时间×组间交互效应（<i>p=</i>0.06）。本研究是首个同时针对学龄与学龄前儿童开展的、适配风险人群的早期心理干预疗效研究。鉴于该干预对年幼儿童无效，因此目前尚无可推荐的循证实践方案。尽管目前尚无相关证据，但鉴于学龄前儿童的家长认为该干预具有帮助，临床医师仍应为家长提供简短的咨询服务，包括心理教育与应对技巧培训。为预防学龄儿童发生创伤相关障碍，可采用阶梯式策略开展该干预：仅为存在长期心理适应不良风险的儿童提供心理支持。