About AfterTheInjury.org

This website was developed by an interdisciplinary team of researchers and practitioners with expertise in pediatric injury, child health care, and traumatic stress. Primary authors of site content are Flaura Winston, MD, PhD, and Nancy Kassam-Adams, PhD. Our team includes pediatricians, psychologists, trauma surgeons, trauma nurses, and others. Since 1996, this team at The Center for Injury Research and Prevention has been at the forefront of research about the effect of injury on children and their parents.

Like all of the interventions developed by our team, the content of this website is based on research findings that have been published in peer-reviewed medical and psychological journals.

This website was made possible in part by Grant Number H34MC04365 from the Emergency Medical Services for Children (EMSC) program of the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA). This website is also proudly supported by a grant from Verizon. No hosting or funding from advertising has been received to develop this site.

The content on this website is not meant to be formal medical or psychological diagnosis or advice. See Terms and Conditions for more details. If you are concerned with how you or your child is doing, please contact your child's or your doctor, mental health professional, or healthcare provider. Only he or she can provide a thorough assessment of your child's needs.

About the Center for Injury Research and Prevention

The Center for Injury Research and Prevention is a comprehensive pediatric trauma research facility at The Children's Hospital of Philadelphia dedicated to addressing injury, the leading cause of death for children and adolescents. Through projects such as the Young Driver Research Initiative and the Center for Child Injury Prevention Studies, the Center's mission is to advance the safety of children, adolescents and young adults through childhood injury research and to apply its resources to developing effective interventions to prevent these injuries from recurring.

For more than a decade, the Center's Child and Adolescent Reactions to Injury and Trauma (CARIT) research program has addressed traumatic stress related to pediatric injury. Our team conducts rigorous scientific studies that help broaden the understanding of how and why traumatic stress and other reactions develop after pediatric injury and how best to promote emotional recovery for injured children and their parents. The goal of our research program is to translate these results into practical, evidence-based information and interventions for parents, children, and healthcare providers.

About the Primary Authors

Dr. Winston is a pediatrician and injury researcher. She is Founder and Co-Scientific Director of the Center for Injury Research and Prevention, and Professor of Pediatrics at the University of Pennsylvania School of Medicine.

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Dr. Kassam-Adams is a psychologist. She is Associate Director for Behavioral Research at the Center for Injury Research and Prevention, and co-directs the Center for Pediatric Traumatic Stress, at the Children's Hospital of Philadelphia.

The authors' research over the past decade has focused on understanding posttraumatic stress in injured children and their parents, and developing and evaluating assessment and intervention tools for parents and health care providers to help children recover.

Learning From Research to Help Injured Children and Their Families 

The information and guidance included in this website are based on a growing body of research about children and parents' reactions to pediatric injury and other medical events. Selected peer-reviewed research articles by our team and others are listed below.

Understanding Traumatic Stress and Child Injury 

*DeVries APJ, Kassam-Adams,N, Cnaan A, et al. (1999). Looking beyond the physical injury: Posttraumatic stress disorder in children and parents after pediatric traffic injury. Pediatrics. 1999:104:1293 -1299.

*Fein J, Kassam-Adams N, Gavin M, Huang R, Blanchard D, Datner E. (2002). Persistence of post-traumatic stress in violently injured youth seen in the Emergency Department. Arch Pediatr Adolesc Med; 156(8):836-840.

Hall E, Saxe G. Stoddard F. et al. (2006). Posttraumatic stress symptoms in parents of children with acute burns. J Pediatr Psychol; 31:403-412.

Holbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise M, Anderson JP. (2005). Long-term posttraumatic stress disorder persists after major trauma in adolescents: New data on risk factors and functional outcome. Journal of Trauma-Injury Infection & Critical Care; 58(4):764-769.

Kahana SY, Feeny NC, Youngstrom EA, Drotar D. (2006). Posttraumatic stress in youth experiencing illnesses and injuries: an exploratory meta-analysis. Traumatology; 12:148-161.

*Kassam-Adams N, Fein J. (2003). Posttraumatic stress disorder and injury. Clinical Pediatric Emergency Medicine; 4:148-155.

*Kassam-Adams N, García-España JF, Miller VA, Winston F. (2006). Parent-child agreement regarding children's acute stress: the role of parent acute stress reactions. J Amer Acad Child & Adol Psychiatry; 45(12):1485-1493.

*Kassam-Adams N, Winston FK. (2004). Predicting child PTSD: the relationship between acute stress disorder and PTSD in injured children. J Amer Acad Child & Adol Psychiatry; 43(4):403-411.

Levi RB, Drotar D, Yeates KO, Taylor HG. (1999). Posttraumatic stress symptoms in children following orthopedic or traumatic brain injury. J Clin Child Psychol; 28(2):232-243.

Littleton, H., Horsley, S., John, S., & Nelson, D. (2007). Trauma coping strategies and psychological distress: A meta-analysis. Journal of Traumatic Stress; 20, 977-988.

Meiser-Stedman R, Yule W, Smith P, et al. (2005). Acute stress disorder and posttraumatic stress disorder in children and adolescents involved in assaults or motor vehicle accidents. Am J Psychiatry; 162:1381-1383.

Stallard, P., Velleman, R., & Baldwin, S. (2001). Recovery from post-traumatic stress disorder in children following road traffic accidents: The role of talking and feeling understood. Journal of Community and Applied Social Psychology; 11, 37-41.

Stoddard, F., Saxe, G., Ronfeldt, H., Drake, J., Burns, J., Edgren, C., et al. (2006). Acute stress symptoms in young children with burns. J Am Acad Child Adolesc Psychiatry; 45(1), 87-93.

*Winston FK, Kassam-Adams N, Vivarelli-O'Neill C, Ford J, Newman E, Baxt C, et al. (2002). Acute stress disorder symptoms in children and their parents after pediatric traffic injury. Pediatrics;109(6):e90.

*Winston, FK, Baxt, C, Kassam-Adams, N, Elliott, M, & Kallan, M. (2005). Acute traumatic stress symptoms in child occupants and their parent drivers after crash involvement. Archives of Pediatrics and Adolescent Medicine, 159(11):1074-1079.

Prevention and Intervention for Injury-related Traumatic Stress

Kenardy J. A., Spence SH, Macleod AC. (2006). Screening for posttraumatic stress disorder in children after accidental injury. Pediatrics; 118:1002–1009.

Kazak AE. (2006). Pediatric psychosocial preventative health model (PPPHM): research, practice, and collaboration in pediatric family systems medicine. Families, Systems, & Health; 24(4):381-395.

*Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, Rourke M. (2006). An integrative model of pediatric medical traumatic stress. J Pediatr Psychol; 31(4):343-355.

Smith P, Yule W, Perrin S, Tranah T, Dalgleish T, Clark TM. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry; 46:1051-1061.

*Stuber ML, Schneider S, Kassam-Adams N, Kazak AE, Saxe G. (2006). The medical traumatic stress toolkit. CNS Spectrums;11(2):137-142.

*Winston FK, Kassam-Adams N, Garcia-España JF, Ittenbach R, Cnaan A. (2003). Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA;290(5):643-649.

*Research from the Center for Injury Research and Prevention team