Parenting and PTSD in road traffic accidents

As a Consultant Child and Adolescent Psychiatrist and medicolegal expert witness, I've seen firsthand the complex interplay between parents and children who have experienced post-traumatic stress disorder (PTSD) following road traffic accidents (RTAs). These form part of cases referred following a road traffic accident which often involvees families with parents and child/ren.

The bidirectional impact of PTSD in these cases is a crucial aspect that often goes overlooked.

The Prevalence of PTSD in Parents and Children After RTAs

Research shows that both parents and children can develop PTSD following an RTA, even if they weren't directly involved in the accident. A meta-analysis by Wilcoxon et al. (2021) found that approximately 17% of parents develop PTSD following their child's single-incident trauma, such as an RTA. For children involved in RTAs, the rates can be even higher. A prospective study by Stallard et al. found that 34.5% of children involved in RTAs met the criteria for PTSD 6 weeks after the accident.

The Bidirectional Nature of PTSD

The relationship between parent and child PTSD is not a one-way street. Scheeringa and Zeanah's model of "relational PTSD" proposes that trauma affects both the parent and child, with their subsequent distress impacting one another. This bidirectional relationship can create a cycle where parental PTSD exacerbates child PTSD symptoms and vice versa.

How Parental PTSD Affects Children

Parents with PTSD may struggle to provide the emotional support and stability their children need post-trauma. Research has shown that:

1. Parental PTSD can lead to disconnected and insensitive parenting behaviors, affecting child attachment security.

2. The avoidance symptoms of PTSD can interfere with parents' ability to engage in activities with their children.

3. Parents with PTSD may have difficulty regulating their emotions, leading to increased anger and aggression towards their child/ren. The subsequent guilt can also lead to parenting difficulties.

4. Parents often describe difficulty in sharing their own traumatic experiences for fear of upsetting the child/ren.

5. Parental head injury, if comorbid with PTSD, can lead to a change in personality leaving the child bewildered.

How Child PTSD Affects Parents

Conversely, a child's PTSD symptoms can significantly impact parental mental health:

1. Parents of children with PTSD are at higher risk of developing PTSD themselves.

2. Caring for a child with PTSD can increase parental stress and decrease overall well-being.

3. Parents may experience feelings of guilt or helplessness in response to their child's trauma. This can impact on the manner that the child percieves their parent too.

The Importance of Family-Centered Interventions

Given the bidirectional nature of PTSD in families affected by RTAs, it's crucial to adopt a family-centered approach to treatment. This might include:

1. Screening both parents and children for PTSD following an RTA. Currently, this occurs in silos but does not address the impact of the PTSD on parenting itself.

2. Providing psychoeducation to families about the potential for PTSD and its bidirectional effects. Parents, in my medicolegal practice, have described a feeling of 'relief' to be able to discuss the impact of the RTA on their parenting.

3. Offering trauma-focused cognitive behavioral therapy (TF-CBT) and / or EMDR for both parents and children when indicated.

4. I have been recommending Family Therapy to affected families to allow their suppressed conversations to occur in a safe space with a trained family therapist.

Conclusion

Understanding the bidirectional impact of PTSD in families affected by RTAs is crucial for effective treatment and support. By addressing both parent and child PTSD simultaneously, we can break the cycle of mutual exacerbation and promote healing for the entire family unit.

Solicitors need to give thought to the impact of the PTSD on parenting too.

Family Therapy, where indicated and available, can be a successful intervention to allow parents to resume parenting with confidence.

What is your professional / personal experience? Does the above align with it?