Comparison of parent and child reports of emotional trauma symptoms in pediatric outpatient settings.

OBJECTIVE: Exposure to emotionally traumatic events is common among children who are treated in pediatric medical care settings, and it is important to recognize the emotional reactions that children might develop as a response to the trauma. Practitioners sometimes rely on parental reports of the child's emotional reactions, but these reports may be biased by the parent's own posttraumatic symptoms. Understanding the differences between parent and child reports of the child's emotional symptoms is essential to guide proper diagnosis and care. This study evaluated discrepancies in parental versus child reports of the child's emotional trauma symptoms in pediatric medical care settings.

METHODS: We enrolled children and adolescents (age: 8-19) who had not previously received a diagnosis of a psychiatric disorder and were treated in pediatric specialty care clinics at Mount Sinai Medical Center in New York. We used the UCLA posttraumatic stress reaction index, child, adolescent, and parent versions, to evaluate child and parent reports of symptoms of posttraumatic stress disorder (PTSD) in the child. The Impact of Event Scale was used to evaluate the parents' own posttraumatic symptoms. We conducted a "best estimate" psychiatric diagnostic procedure to determine whether the child met diagnostic criteria for PTSD and evaluated the association between the diagnostic status (as determined by the "best estimate" procedure) and the results of the questionnaires.

RESULTS: A total of 115 patients and parents consented to the study, and 76 completed the evaluation. Sixty-four percent of the parents identified the child's traumatic experience as their own most traumatic experience, too. The child's self-report of PTSD symptoms was significantly correlated with the diagnosis of PTSD in the child. In contrast, parents' reports of their child's PTSD symptoms were not significantly associated with the child's diagnosis. Parents' own posttraumatic symptoms were associated with parental reports of the child's overall PTSD symptoms (correlation coefficient: 0.283).

CONCLUSIONS: When a child is emotionally traumatized, the parent's own posttraumatic stress may influence his or her report and interpretation of the child's symptoms. Clinicians who evaluate children and adolescents for PTSD in medical care settings should directly seek the child's report and should not rely exclusively on parental reports. Parental reports of a child's PTSD symptoms can offer insights into the parent's own level of posttraumatic stress.