Research In Action

Many millions of children worldwide are exposed to potentially traumatic acute events, including intentional and unintentional injuries, other acute medical events, disaster, and violence. While most children recover well after exposure to a single traumatic event, several decades of research -- here at CHOP and around the world -- have told us that a significant minority will have ongoing emotional distress that creates some degree of impairment.

One of the big challenges in the field of traumatic stress studies is the question of when and how to intervene to prevent the likelihood of developing persistent and impairing emotional distress. Unfortunately, the state of the science does not yet include an evidence-based screening tool that we can follow as the gold standard.

Several promising screening tools, including the Screening Tool for Early Predictors of PTSD (STEPP), the Child Trauma Screening Questionnaire (CTSQ), and the Pediatric Emotional Distress Scale (PEDS-ES), have been created and tested, yet there are few replication studies of these tools to help determine if any should be chosen as the gold standard. To work toward that goal, CIRP@CHOP researchers recently summarized the research on screening tools for risk of PTS in injured children in the European Journal of Psychotraumatology, as well as reported on their evaluation of a multi-part screening protocol and provided replication data for STEPP and CTSQ. 

State of the Science

I recently chaired an expert panel at the annual meeting of the International Society for Traumatic Stress Studies (ISTSS) in New Orleans. Panel members included key developers of screening tools and leaders in this area of research from around the world. We discussed new research and raised the following questions toward our development of a gold standard for pediatric PTS screening:

• Do we have adequate tools for the wide range of types of trauma that children experience?   
• Do we know enough about timing of screening?
• What is the role of biomarkers in screening for risk?
• What have we learned about where, when, and how screening can be implemented effectively?
• How can we use technology to implement screening and to act on the results?

Although we believe that great progress has been made in this area of research over the past decade, there’s a compelling need for the next generation of studies to:

• test existing screening tools in new populations (i.e., beyond injury to disaster, violence, and other traumas)
• consider how best to screen children with special health care needs and/or developmental disabilities
• investigate new biomarkers as their assessment becomes more feasible
• use technology (ehealth and mobile technology) to enhance our capability to reach and monitor children after trauma

We hope to use this knowledge to advance the science toward widely accessible and low-cost monitoring and preventive interventions that can be implemented seamlessly into pediatric healthcare systems.