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

在英国，很大一部分儿童暴露于潜在的创伤经历（例如，事故，袭击），这些经历与心理困难的发展有关。特别是，儿童在创伤后容易出现创伤后应激症状，包括对事件的生动和侵入性记忆，避免提醒创伤，以及更广泛的焦虑和情绪问题。这些问题影响了相当大比例的英国儿童。例如，在英国，每年大约有80,000名儿童卷入机动车事故，研究表明，这些儿童中大约三分之一的人会因此患上创伤后应激障碍（PTSD）。这项拟议的研究将帮助我们了解影响儿童创伤后心理适应的因素，特别是为什么有些儿童而不是其他人会出现创伤后应激障碍的症状。迄今为止，研究的重点是了解可能导致儿童创伤后困难的个体特征。已经确定了一些重要的因素，包括对创伤的特别消极的解释（例如，作为世界极其危险的标志，或者自我非常脆弱），对事件的不连贯和不完整的记忆，以及有问题的应对方式（例如，压抑对创伤的想法，或沉溺于它）。除了这些个人因素外，父母抚养孩子的方式可能也很重要，但尚未得到系统的研究。这一遗漏很重要，因为对大多数儿童来说，他们的家庭是他们创伤后的主要支持来源。目前，还没有足够的证据来告诉父母如何在创伤经历后最好地支持他们的孩子。本研究将探讨影响儿童创伤后心理适应的父母因素。基于现有的有关儿童过程的文献，以下行为将被调查：父母参与与孩子共同回忆创伤；父母自己对创伤的解释，以及他们将这些解释传达给孩子的程度；父母支持或阻止孩子有问题的应对方式。更一般地说，我们将研究在何种程度上以限制孩子自主的限制性方式为特征，因为这之前被认为与儿童的焦虑问题有关。我们将对孩子和他们的父母进行详细的研究，跟踪他们在创伤后几个月的心理调整。7-12岁的儿童将通过医院事故和急诊部门招募，并将在创伤发生后立即和3个月和6个月后与父母一起完成评估。将完成对创伤后父母如何与儿童互动的详细评估，并评估儿童的创伤后应激障碍症状。通过这种方式，我们将确定有助于儿童后期适应的父母行为，即使考虑到儿童对创伤的最初反应。除了这个密集的观察性研究，我们还将进行一个基于父母和孩子问卷调查的更大的研究，这将提供关于关键父母过程的额外证据，也将允许父母和孩子过程之间的具体联系被确定。基于前面的研究，我们将为父母提供创伤后如何支持他们的孩子的初步指导

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