Publications by authors named "Alexandra C De Young"

13 Publications

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COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic.

Eur J Psychotraumatol 2021;12(1):1940760. Epub 2021 Aug 6.

Queensland Centre for Perinatal and Infant Mental Health (QCPIMH), Children's Health Queensland Hospital and Health Service (CHQ, HHS), Brisbane, Australia.

Background: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children.

Objectives: To describe the formation of a global collaboration entitled, 'COVID-19 Unmasked. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications.

Methods: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1-5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child's wellbeing, their own mental health, and parenting.

Data Analysis: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System - Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures.
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http://dx.doi.org/10.1080/20008198.2021.1940760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354018PMC
August 2021

Topical Review: Medical Trauma During Early Childhood.

J Pediatr Psychol 2021 Aug;46(7):739-746

Department of Counseling and Clinical Psychology, Columbia University Teachers College.

Objective: Early childhood is a high-risk period for exposure to traumatic medical events due to injury/illness. It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. The aim of this topical review is to evaluate empirical literature on the psychological impact of medical trauma during early childhood (0-6 years) to inform models of clinical care for assessing, preventing, and treating traumatic stress following injury/illness.

Methods: Topical review of empirical and theoretical literature on pediatric medical traumatic stress (PMTS) during early childhood.

Results: There are important developmental factors that influence how infants and young children perceive and respond to medical events. The emerging literature indicates that up to 30% of young children experience PMTS within the first month of an acute illness/injury and between 3% and 10% develop posttraumatic stress disorder. However, significant knowledge gaps remain in our understanding of psychological outcomes for infants and young children, identification of risk-factors and availability of evidence-based interventions for medical trauma following illness.

Conclusions: This topical review on medical trauma during early childhood provides: (a) definitions of key medical trauma terminology, (b) discussion of important developmental considerations, (c) summary of the empirical literature on psychological outcomes, risk factors, and interventions, (d) introduction to a stepped-model-of-care framework to guide clinical practice, and (e) summary of limitations and directions for future research.
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http://dx.doi.org/10.1093/jpepsy/jsab045DOI Listing
August 2021

Accuracy of delirium assessments in critically ill children: A prospective, observational study during routine care.

Aust Crit Care 2021 05 21;34(3):226-234. Epub 2020 Oct 21.

Paediatric Critical Care Research Group, Centre for Children's Health Research, Brisbane, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Australia.

Objectives: The objectives of this study was to explore the accuracy of the Cornell Assessment for Pediatric Delirium (CAP-D), Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU) when implemented in routine care as delirium screening tools, and to assess patient characteristics and clinical variables that may affect their validity.

Design: This is a prospective observational study.

Setting: The study was conducted in a 36-bed, mixed paediatric intensive care unit (PICU) at an Australian tertiary hospital.

Patients: The study included critically ill children developmentally aged 6 months to 17 years, with a PICU length of stay >18 h.

Interventions: No interventions were provided in the study.

Measurements And Main Results: Patients were screened for delirium by their bedside nurse (CAP-D and pCAM-ICU/psCAM-ICU) once daily, for up to 5 d. Delirium status identified using screening instruments was compared with delirium diagnosis using the diagnostic criteria for delirium (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). In this sample, the CAP-D retained its high sensitivity (91.3%) and good specificity (75.2%), whereas the psCAM-ICU and pCAM-ICU had moderate sensitivity (58.8% and 75.0%, respectively) and excellent specificity (89.8% and 84.9%, respectively). There was moderate agreement between the CAP-D and the psCAM-ICU (κ = 0.52, p < .001) and good agreement between the CAP-D and the pCAM-ICU (κ = 0.80, p < .01).

Conclusions: Although the CAP-D, psCAM-ICU, and pCAM-ICU all appear promising in their validation studies, when implemented in routine care, their performance can be variable. The CAP-D performed well in routine clinical practice, but follow-up diagnosis is required to confirm delirium. The psCAM-ICU and pCAM-ICU both provide valuable, objective assessments of delirium in critically ill children; however, further evaluation of their implementation in routine clinical practice is needed.
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http://dx.doi.org/10.1016/j.aucc.2020.07.012DOI Listing
May 2021

Preventive intervention for trauma reactions in young injured children: results of a multi-site randomised controlled trial.

J Child Psychol Psychiatry 2020 09 8;61(9):988-997. Epub 2020 Jan 8.

School of Psychology, University of Queensland, Brisbane, QLD, Australia.

Background: Young children are at particular risk for injury. Ten per cent to twenty-five per cent develop posttraumatic stress disorder (PTSD). However, no empirically supported preventive interventions exist. Therefore, this study evaluated the efficacy of a standardised targeted preventive intervention for PTSD in young injured children.

Methods: Injured children (1-6 years) were enrolled in a multi-site parallel-group superiority prospective randomised controlled trial (RCT) in Australia and Switzerland. Screening for PTSD risk occurred 6-8 days postaccident. Parents of children who screened 'high-risk' were randomised to a 2-session CBT-based intervention or treatment-as-usual (TAU). Primary outcomes were PTSD symptom (PTSS) severity, and secondary outcomes were PTSD diagnosis, functional impairment and behavioural difficulties at 3 and 6 months postinjury using blinded assessments. Trials were registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000325606) and ClinicalTrials.gov (NCT02088814). Trial status is complete.

Results: One hundred and thirty-three children screened 'high-risk' were assigned to intervention (n = 62) or TAU (n = 71). Multilevel intention-to-treat analyses revealed a significant intervention effect on PTSS severity over time (b = 60.06, 95% CI: 21.30-98.56). At 3 months, intervention children (M = 11.02, SD = 10.42, range 0-47) showed an accelerated reduction in PTSS severity scores compared to control children (M = 17.30, SD = 13.94, range 0-52; mean difference -6.97, 95% CI: -14.02 to 0.08, p adj. = .055, d = 0.51). On secondary outcomes, multilevel analyses revealed significant treatment effects for PTSD diagnosis, functional impairment and behavioural difficulties.

Conclusions: This multi-site RCT provides promising preliminary evidence for the efficacy of a targeted preventive intervention for accelerating recovery from PTSS in young injured children. This has important clinical implications for the psychological support provided to young children and parents during the acute period following a single-event trauma.
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http://dx.doi.org/10.1111/jcpp.13193DOI Listing
September 2020

PTSD in Children Below the Age of 6 Years.

Curr Psychiatry Rep 2018 09 17;20(11):97. Epub 2018 Sep 17.

Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.

Purpose Of Review: This review summarizes the latest evidence and developments in the validation of PTSD diagnostic criteria for children 6 years and under (PTSD<6Y), discusses the limitations of the current diagnostic criteria, and highlights areas for future research.

Recent Findings: Research has found that the DSM-5 PTSD<6Y, and a similar version in the DC:0-5, currently provides the most developmentally sensitive classification of PTSD for young children. In contrast, preliminary evidence suggests that the ICD-11 criteria might not appropriately capture PTSD in young children. The inclusion of PTSD<6Y, the first developmental subtype in the DSM-5, represents an important step towards having a diagnostic system that is developmentally sensitive and relevant across the life span. However, further validation work and research with regard to the definition of trauma and functional impairment as well as with the age-appropriate description of symptoms is needed, especially in the youngest age group (0-3 years).
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http://dx.doi.org/10.1007/s11920-018-0966-zDOI Listing
September 2018

Delirium in the Critically Ill Child: Assessment and Sequelae.

Dev Neuropsychol 2017 26;42(6):387-403. Epub 2017 Sep 26.

c Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland , Brisbane , QLD , Australia.

Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature. In particular, our knowledge of how to assess delirium is complicated by challenges in recognizing symptoms of delirium in pediatric patients especially in critical and intensive care settings, and our understanding of its impact on acute and long-term functioning remains in its infancy. This paper focuses on (a) the challenges associated with assessing delirium in critically ill children, (b) the current literature on the outcomes of delirium including morbidity following discharge from PICU, and care-giver well-being, and (c) the importance of assessment in determining impact of delirium on outcome. Current evidence suggests that delirium is a diagnostic challenge for clinicians and may play a detrimental role in a child's recovery after discharge from the pediatric intensive care unit (PICU). Recommendations are proposed for how our knowledge and assessment of delirium in children could be improved.
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http://dx.doi.org/10.1080/87565641.2017.1374961DOI Listing
February 2018

Coping with Accident Reactions (CARE) early intervention programme for preventing traumatic stress reactions in young injured children: study protocol for two randomised controlled trials.

Trials 2016 07 28;17:362. Epub 2016 Jul 28.

Department of Psychosomatics and Psychiatry and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.

Background: Accidental injury represents the most common type of traumatic event experienced by children under the age of 6 years. Around 10-30 % of young injured children will go on to develop post-traumatic stress disorder (PTSD) and other co-morbid conditions. Parents of injured children are also at risk of PTSD, and this is associated with short- and long-term consequences for their children's physical and psychological recovery. Despite the significance of this problem, to date, the mental health needs of injured young children have been neglected. One reason for this is due to the uncertainty and considerable debate around how to best provide early psychological intervention to traumatised children and adults. To address these gaps, researchers and psychologists in Australia and Switzerland have developed the Coping with Accident Reactions (CARE) programme, which is a two-session early intervention designed to prevent persistent PTSD reactions in young injured children screened as 'at risk'. Two separate international studies are being conducted to evaluate the effectiveness and feasibility of this programme.

Methods/design: The study design for the two proposed studies will employ a randomised controlled trial design and children (aged 1-6 years) who are screened as at risk for PTSD 1 week after an unintentional injury, and their parents will be randomised to either (1) CARE intervention or (2) treatment as usual. Assessment will be completed at baseline (2 weeks) and 3 and 6 months post-injury.

Discussion: This international collaboration provides an excellent opportunity to test the benefit of screening and providing early intervention to young children in two different countries and settings. It is expected that outcomes from this research will lead to significant original contributions to the scientific evidence base and clinical treatment and recovery of very young injured children.

Trial Registration: The Australian study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12614000325606 ) on 26 March 2014. The Swiss study was registered with ClinicalTrials.gov ( NCT02088814 ) on 12 March 2014.
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http://dx.doi.org/10.1186/s13063-016-1490-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964020PMC
July 2016

Prospective evaluation of parent distress following pediatric burns and identification of risk factors for young child and parent posttraumatic stress disorder.

J Child Adolesc Psychopharmacol 2014 Feb 4;24(1):9-17. Epub 2014 Feb 4.

1 Centre of National Research on Disability and Rehabilitation Medicine and School of Psychology, University of Queensland , Herston, Queensland, Australia .

Objective: Early childhood is a high-risk time for exposure to potentially traumatic medical events. We have previously reported that 10% of young children continue to have posttraumatic stress disorder (PTSD) 6 months after burn injury. This study aimed to 1) document the prevalence and prospective change in parental psychological distress over 6 months following their child's burn injury and 2) identify risk factors for posttraumatic stress symptoms (PTSS) in young children and their parents.

Methods: Participants were 120 parents of 1-6-year-old children with unintentional burn injuries. Data were collected within 2 weeks, 1 month, and 6 months of burn injury using developmentally sensitive diagnostic interviews and questionnaires.

Results: Within the first month, ∼ 25% of parents had a probable PTSD diagnosis, and moderate to extremely severe levels of depression, anxiety, and stress. Distress levels decreased significantly over time; however, 5% of parents still had probable PTSD at 6 months. Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS. Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size. Risk factors identified for parent PTSS included prior trauma history, acute distress, greater number of child invasive procedures, guilt, and child PTSS.

Conclusions: The findings from this study suggest that parents' responses to a traumatic event may play a particularly important role in a young child's psychological recovery. However, further research is needed to confirm the direction of the relationship between child and parent distress. This study identified variables that could be incorporated into screening tools or targeted by early intervention protocols to prevent the development of persistent child and parent PTSS following medical trauma.
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http://dx.doi.org/10.1089/cap.2013.0066DOI Listing
February 2014

Prevalence, comorbidity and course of trauma reactions in young burn-injured children.

J Child Psychol Psychiatry 2012 Jan 14;53(1):56-63. Epub 2011 Jun 14.

School of Psychology and Centre of National Research on Disability and Rehabilitation Medicine, University of Queensland, Herston, Qld, Australia.

Background: Infants, toddlers and preschoolers are the highest risk group for burn injury. However, to date this population has been largely neglected. This study examined the prevalence, onset, comorbidity and recovery patterns of posttrauma reactions in young children with burns.

Methods: Parents of 130 unintentionally burned children (1-6 years) participated in the study. The Diagnostic Infant Preschool Assessment was conducted with parents at 1 and 6 months postinjury.

Results: The majority of children were resilient. However, 35% were diagnosed with at least one psychological disorder, there was a high rate of comorbidity with posttraumatic stress disorder, and 8% of children did not experience recovery in distress levels over the course of 6 months.

Conclusions: These outcomes are likely to have serious repercussions for a young child's medical and psychosocial recovery as well as their normal developmental trajectories. It is recommended that screening, prevention and early intervention resources are incorporated into paediatric health care settings to optimise children's psychological adjustment following burn injury.
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http://dx.doi.org/10.1111/j.1469-7610.2011.02431.xDOI Listing
January 2012

Diagnosis of posttraumatic stress disorder in preschool children.

J Clin Child Adolesc Psychol 2011 ;40(3):375-84

School of Psychology and Centre of National Research on Disability and Rehabilitation Medicine, University of Queensland, Herston, QLD, Australia.

This study investigated the existing diagnostic algorithms for posttraumatic stress disorder (PTSD) to determine the most developmentally sensitive and valid approach for diagnosing this disorder in preschoolers. Participants were 130 parents of unintentionally burned children (1-6 years). Diagnostic interviews were conducted with parents to assess for PTSD in their child at 1 and 6 months postinjury and the Child Behavior Checklist for 1.5-5 was also completed. The proposed algorithm for PTSD in preschool children for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) provided the most developmentally sensitive and valid measure of PTSD. The rate of PTSD diagnosis was 25% at 1 month and 10% at 6 months. The predictive utility of Criterion A was not demonstrated. These findings provide support for the inclusion of the proposed algorithm for PTSD in preschool children.
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http://dx.doi.org/10.1080/15374416.2011.563474DOI Listing
August 2011

Trauma in early childhood: a neglected population.

Clin Child Fam Psychol Rev 2011 Sep;14(3):231-50

School of Psychology, University of Queensland, Brisbane, QLD, Australia.

Infants, toddlers and preschoolers are a high risk group for exposure to trauma. Young children are also vulnerable to experiencing adverse outcomes as they are undergoing a rapid developmental period, have limited coping skills and are strongly dependent on their primary caregiver to protect them physically and emotionally. However, although millions of young children experience trauma each year, this population has been largely neglected. Fortunately, over the last 2 decades there has been a growing appreciation of the magnitude of the problem with a small but expanding number of dedicated researchers and clinicians working with this population. This review examines the empirical literature on trauma in young children with regards to the following factors: (1) how trauma reactions typically manifest in young children; (2) history and diagnostic validity of posttraumatic stress disorder (PTSD) in preschoolers; (3) prevalence, comorbidity and course of trauma reactions; (4) developmental considerations; (5) risk and protective factors; and (6) treatment. The review highlights that there are unique developmental differences in the rate and manifestation of trauma symptomatology, the current Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV-TR) PTSD criteria is not developmentally sensitive and the impact of trauma must be considered within the context of the parent-child relationship. Recommendations for future research with this population are also discussed.
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http://dx.doi.org/10.1007/s10567-011-0094-3DOI Listing
September 2011

Predicting children's post-traumatic stress symptoms following hospitalization for accidental injury: combining the Child Trauma Screening Questionnaire and heart rate.

J Anxiety Disord 2008 Dec 2;22(8):1447-53. Epub 2008 Mar 2.

Centre of National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Australia.

This study investigated the utility of combining the Child Trauma Screening Questionnaire (CTSQ) [Kenardy, J. A., Spence, S. H., & Macleod, A. C. (2006). Screening for post-traumatic stress disorder in children after accidental injury. Pediatrics, 118, 1002-1009] and children's heart rate (HR; emergency department and 24-h post-admission) to identify children likely to develop post-traumatic stress disorder (PTSD) symptoms at 1 and 6 months post-injury. Children completed the CTSQ within 2 weeks of injury. PTSD symptoms were assessed with the Anxiety Disorders Interview Schedule for DSM-IV [Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV, Child Version, Parent Interview Schedule. Orlando, Florida: The Psychological Corporation], for 79 children aged 7-16 years. A combination of the CTSQ plus HR (CTSQ-HR) was better than the CTSQ alone or HR alone at identifying children likely to develop PTSD symptoms. These findings suggest that the CTSQ-HR screen may increase identification of children who are likely to develop PTSD symptoms, enabling development of targeted prevention programs.
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http://dx.doi.org/10.1016/j.janxdis.2008.02.007DOI Listing
December 2008

Elevated heart rate as a predictor of PTSD six months following accidental pediatric injury.

J Trauma Stress 2007 Oct;20(5):751-6

Centre of National Research on Disability and Rehabilitation Medicine, University of Queensland, Australia.

The present study investigated the relationship between elevated heart rate (HR) and posttraumatic stress disorder (PTSD) 6 months following accidental pediatric injury. The HR was taken in 101 children, aged 7 to 16 years, upon arrival at the hospital and again 24 hours following admission. Posttraumatic stress disorder was assessed 6 months later using the Anxiety Disorders Interview Schedule for DSM-IV (W. K. Silverman & A. M. Albano, 1996). Children who had an elevated HR (defined as greater than/equal to one standard deviation above the age and sex mean) at admission or 24 hours later were more likely to experience traumatic stress symptoms at 6 months. These findings suggest elevated HR could be used to aid in the early identification of children at risk of developing PTSD following a traumatic accident.
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http://dx.doi.org/10.1002/jts.20235DOI Listing
October 2007
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