Issue link: https://viewer.e-digitaledition.com/i/1093873
University College of Medicine, Associate Director of the Center for Pediatric Trauma Research at Nationwide Children's, and Principal Investigator in the Center for Injury Research and Policy, says in a news release about the most recent study. "[I]t's clear that there are often serious mental health concerns after children go home. We, as healthcare providers, need to do a better job assessing children for mental health needs, identifying high-risk children and referring them to mental health providers before sending them home." CORRELATION VS. CAUSATION Experts caution that the findings do not necessarily demonstrate that injuries cause mental health issues in children. "There is not a direct correlation between an injury and an emotional response, except in cases of trauma-related injuries such as abuse, assault and neglect," says David Adams, PhD, ABPP, FAACP, Director of Atlanta Medical Psychology. "Children, like adults, are variable in their response to physical and emotional demands. Some weather this period with appreciable optimism and strength. Others become dependent, feel helpless in a healthcare environment and lack the resources to cope without psychological intervention." n Questions about Causation THERE ARE SOME LIMITATIONS regarding interpreta- tion of the findings of the National Children's Hospital study linking childhood injuries and mental health issues. For example, children observed in the study may have had pre-existing mental health conditions that were diagnosed only after extended time spent with healthcare providers, Julie Leonard, MD, MPH, Associate Professor of Pediatrics at Nationwide Children's and Ohio State University College of Medicine, Associate Director of the Center for Pediatric Trauma Research at Nationwide Children's, and Principal Investigator in the Center for Injury Research and Policy, explains in a HealthDay article about the study. Moreover, an injury could simply have exacerbated existing mental health issues, Reshma Naidoo, PhD, PSA Director of Cognitive Neuroscience at Nicklaus Children's Hospital in Miami, pediatric neuropsychologist and neuroreha- bilitation specialist, tells MD News. And regardless of age or mental health, Naidoo says, an injury causes some level of stress, and providers may have difficulty differentiating between a pre-existing condition and a predictable response to physi- cal trauma. "You probably would be looking at diagnostic criteria, severity and the length of the problem," Naidoo says. "The expected amount of stress, I would say, is difficult to know ... [but] the stress is situational. Mental health [issues] tend to be of longer duration and tend to be pervasive and debilitating across environments. Stress tends to be situation-limited and time-limited, unless the stressor is chronic." Naidoo suggests mental health screenings should be part of an injured child's course of treatment. As a follow-up, children who seem to have a mental health condition should receive behavioral therapy, as should their parents or caretakers. "It's a very effective way to provide tools and mechanisms to the child and the family to decrease stressors before they become insurmountable," Naidoo says. "It becomes something in the parents' toolkit that they can forever draw on, teaching parents how to handle anxiety [in a way] that's ... more functional." M D N E W S . C O M /// M D N E W S C E N T R A L P E N N S Y LVA N I A ■ 2 019 1 5