| Summary: | Background: Recent studies have highlighted the importance of peritraumatic reactions and cognitive appraisals on the development of PTSD among adults. Cognitive theories predict firstly, intense stress and dissociation during trauma disrupt mental processing, leading to fragmented memory and increased risk of PTSD and secondly, negative cognitive appraisals of the trauma and/or sequelae maintain PTSD. Emerging evidence suggests that subjective stress and cognitive appraisals are also key factors in the development of PTSD in children but little is known about the effects of peritraumatic dissociation within this age group. This prospective study investigated the influence of these factors, as well as pre-trauma risk factors, among 7-14 year olds attending A&E following a frightening event. Method: Children were assessed for symptoms of depression, anxiety, and PTSD within 4 weeks of the event and again at 2-3 months. Children provided a trauma narrative and described their peritraumatic response and cognitive appraisals. Parents provided information on pre-trauma risk factors. Results: At follow-up, a significant minority reported clinical levels of depression and a third reported symptoms sufficient to warrant a diagnosis of PTSD. More negative appraisals, greater subjective stress and dissociation during the trauma were associated with more trauma symptoms at both time points. However, these variables did not predict chronic trauma symptoms after controlling for pre-trauma risk factors. Conclusions: This exploratory study underscores the importance of assessing pre-trauma risk factors in identifying those children most at risk after traumatic events and brings into question claims that peritraumatic dissociation is a causal factor in the development of PTSD.
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