Is it harmful to ask children about their (potential) traumatic history or posttraumatic stress reactions? It’s a recurring question, especially in research settings but also in the context of clinical services and day-to-day interactions with children. Often we decide to ask or not to ask based on gut feelings, but who knows whether they are correct?
Three issues are of particular interest and importance I think: 1) Is it necessary to do trauma research with children while we could also do studies with adults and translate the findings? 2) How do we get an idea of whether it actually hurts to ask about trauma? and 3) What empirical evidence do we have so far?
Is it necessary to do research in children instead of adults?
Yes it is! Children are not little adults; they really have their distinctive characteristics. Salmon and Bryant (see references below) pointed out that children differ from adults in a number of ways. For example, they can’t fully grasp and convey complex emotions until about 10 years of age. In addition, their way of processing information (about the event, about other people’s reactions) is not yet fully developed, and they have less of a frame of reference than adults have, which may result in distinctive interpretations of an event. And finally, they are in a completely different situation as they depend to a large extent on their caregivers.
Another reason to do research in children, is that they run the risk to remain ‘silent consumers’. We tend to think for, and decide about them, without asking children themselves about their opinion. In my view, giving children a voice is essential. In the interview studies we did with eight to twelve year olds, they were very eager to give their view and tell about what they thought was important for future child survivors of traumatic events (some of the tips they gave: ‘to have a cuddly toy to make you laugh again’ and to ask parents and friends for help and comfort).
How do we know whether it is harmful?
We could do an experiment, asking a group of children questions about trauma while asking other children neutral questions, and then measure the difference in distress in the short and long run. But we can also integrate our quest for knowledge in ongoing research. If we measure children’s distress caused by a study that has been approved by the appropriate ethics committee, we don’t do any potential additional harm while we can systematically gather data. Nancy Kassam-Adams and Elana Newman from the US have started this endeavor a couple of years ago in a hospital setting. They studied children’s and parents’ reactions to a study on acute stress symptoms to traffic-related injury with the Reactions to Research Participation Questionnaire (the RRPQ-C for children and RRPQ-P for parents). The RRPQ is a quick 12-item measure that can easily be included in many studies. It is freely available in at least English and Dutch, I’ll describe it into more detail in a separate post.
In addition to measuring children’s reactions to trauma research, we should also measure reactions to other types of research. For example, studies on learning, on other psychology topics, and studies in medicine. This would provide us with a baseline regarding children’s reactions to research in general. Because, if we find distress reactions after trauma research, how do they compare to distress reactions after a task that had to be done under time-pressure, one that was extremely boring, or after a body examination that was quite scary?
What is the evidence so far?
Current empirical knowledge indicates that asking children about trauma does not hurt. For example, in the studies we did in classrooms and in clinical samples, we asked teachers and parents afterwards whether the children showed a change in behavior or an increase in stress symptoms. The adults did not report any worries or doubts, with the exception of one family who found out that their child needed some more help. They did not regret participation. In Kassam-Adams and Newman’s study only 5% of the 200 children reported being upset or sad. In contrast, 77% felt good about helping others by taking part in the study.
Salmon, K., & Bryant, R. (2002). Posttraumatic stress disorder in children: The influence of developmental factors Clinical Psychology Review, 22 (2), 163-188 DOI: 10.1016/S0272-7358(01)00086-1
Kassam-Adams N, & Newman E (2005). Child and parent reactions to participation in clinical research. General hospital psychiatry, 27 (1), 29-35 PMID: 15694216
Alisic, E., van der Schoot, T., van Ginkel, J., & Kleber, R. (2008). Looking Beyond Posttraumatic Stress Disorder in Children The Journal of Clinical Psychiatry, 69 (9), 1455-1461 DOI: 10.4088/JCP.v69n0913