Injury talk: spontaneous parent-child conversations in the aftermath of a potentially traumatic event

Abstract

Background While talking about traumatic experiences is considered central to psychological recovery, little is known about how these conversations occur in daily life. Objective We investigated spontaneous injury talk among parents and children in the aftermath of a child's hospitalisation due to physical trauma, and its relationship with children's socioemotional functioning. Methods In a prospective naturalistic observation study, we audio-sampled the daily life of 71 families with the Electronically Activated Recorder after their child (3-16 years old) was discharged from hospital. We collected close to 20 000 snippets of audio information, which were double-coded for conversation characteristics, and measured children's socioemotional functioning with the Strengths and Difficulties Questionnaire (SDQ) at 6 weeks and 3 months postinjury. Findings The children were involved in injury talk for, on average, 46 min/day, 9 min of which referred to emotions. Children had significantly more injury conversations with their mothers than with their fathers. The tone of injury conversations was significantly more positive than that of non-injury conversations. More direct injury talk was associated with fewer problems on the emotion subscale of the SDQ at 3 months. Other associations between aspects of injury talk and children's socioemotional functioning were mostly non-significant, although they appeared to be stronger at 3 months than at 6 weeks. Conclusions Families spontaneously talked about the injury and associated issues for about the same amount of time per day as a therapist might within a session (a 'therapy hour'). Clinical implications Making full use of naturally occurring injury talk may be a valuable direction for parent and family-focused postinjury interventions. However, the study design prevents causal inference, and further exploration is warranted. BaCkgrOundThe consequences of injuries in childhood can go beyond physical health. While most children recover well, a minority experience long-term distress, impairing functioning and development.1 In particular, children admitted to hospital after injury are at risk of mental health problems (eg, post-traumatic stress or depressive symptoms), academic underperformance and social difficulties.

A mixed-methods investigation of parent-child posttrauma discussion and the effects of encouraging engagement

“…The majority of parents in our study described spontaneously engaging in trauma-focused conversations with their children as a positive way to facilitate child coping, consistent with previous evidence suggesting that in the aftermath of an acute event, trauma talk is common for many families (Alisic et al, 2017;Williamson et al, 2016). This largely positive view of trauma conversations also extended to the structured narrative task, which was perceived as creating an opportunity for the child to engage in a conversation about their trauma if they had not already, or to talk more deeply about their emotions, helping to process their reactions.…”

“…For children, parents are a key source of informal support following trauma exposure (Williamson, Creswell, Butler, Christie, & Halligan, 2017). Recent work that recorded daily conversations of children exposed to acute trauma found that families initially spent an average of 46 minutes per day discussing the child's injury and the emotions associated with it (Alisic et al, 2017). Other evidence indicates that too much or too little trauma talk can potentially lead to higher levels of child distress posttrauma (Stein et al, 2004;Wilson, Lengua, Meltzoff, & Smith, 2010).…”

“…In terms of the content of parent-child trauma discussion, a parent's focus on threat or the child's vulnerability, overprotection, and encouragement of avoidant coping have all been associated with higher child posttrauma distress (Ehlers, Mayou, & Bryant, 2003;Hiller et al, 2018). Conversely, parents can use such conversations to model positive coping strategies and discuss emotions, thus helping the child to process their traumatic experiences adaptively (Alisic et al, 2017;Hiller et al, 2018;Marsac, Donlon, Winston, & Kassam-Adams, 2013;Sales & Fivush, 2005).…”

“…Taken together, research suggests that parents frequently talk to their children about trauma, and that the trauma-focused support they provide can influence child adjustment (Alisic et al, 2017;Hiller et al, 2018). Nonetheless, there are a range of potential barriers that may prevent parents from providing effective support for their children posttrauma.…”

Best practices for Electronically Activated Recorder (EAR) research: A practical guide to coding and processing EAR data

“…Of note, the authors explained that they increased the number of coders to six per participant after low initial inter-coder reliability with three coders per participant, and commented that some of the dimensions (e.g., neuroticism) were difficult to detect acoustically. Other investigators have rated the degree of specific emotions expressed (e.g., upset or happy; 5-point scale), maternal responsiveness (a composite comprised of expressed warmth, emotional support, and pride; 5-point scale), and the overall emotional tone of an interaction (ranging from negative to positive; 7-point scale) in each sound file with acceptable to excellent inter-coder agreement (Alisic et al, 2015(Alisic et al, , 2017Farrell et al, 2019;Mangelsdorf, Mehl, Qiu, & Alisic, 2019;Tobin et al, 2015a;Tobin et al, 2015b).…”