A dvances in medical technology are observed and experienced most dramatically in the environment of the PICU. This has resulted in significant changes in the nature of the PICU population. An analysis of admission data from 54 PICUs in the United States found that children with an underlying complex chronic health condition now comprise over half of all admissions (1). Many previously healthy children go on to leave the PICU with a chronic condition or remain technology dependent (2). Mounting evidence suggests PICU hospitalization can have significant psychological repercussions for children and their parents. Of the more than 210,000 children admitted annually to PICUs in North America (3, 4), approximately 25% will exhibit negative psychological outcomes after discharge (5, 6). Decreases in attention span, self-esteem, and self-confidence, altered relationships, increased medical fears, and depression have been identified up to 6 months after discharge. Decreased emotional well-being (based on healthrelated quality-of-life studies), increased anxiety, hallucinations, delusions, and posttraumatic stress disorder have been identified up to 1 year after discharge (5-9). Pediatric critical illness is potentially detrimental to other members of the family (10). Posttraumatic stress disorder, for example, has been identified in 18%-48% of parents after their child's PICU admission (11).In the pediatric critical care community, there is currently no consensus on how best to conceptualize this important area of study. The most recent trend has been to focus on posttraumatic stress as a conceptual framework for studying the impact of PICU hospitalization, and posttraumatic stress disorder (PTSD) as the primary outcome. However, a review of psychiatric morbidity in pediatric critical illness survivors concluded that future research would benefit from considering outcomes other than PTSD, focusing on children within a particular developmental stage (trauma-exposed adolescents, for example, may be at even greater risk for subsequent psychopathology than younger children), and clarifying whether psychiatric morbidity results from premorbid factors, the critical illness itself, or children's subsequent treatments (6). In one of the first articles to examine mediators of acute stress disorder (ASD) and later PTSD in critically ill youth after PICU hospitalization, In this issue of Pediatric Critical Care Medicine, Dr. Stowman and colleagues (12) have begun to address some of these concerns.Stowman and colleagues (12) followed 50 youth ages 9 to 17 years with a range of PICU admitting diagnoses to examine potential mediators of ASD and later PTSD symptoms, including youth anxiety, depression, negative effect, and hospital fear, and parent anxiety and depression. Parents were also assessed for ASD and PTSD symptoms. Power calculations were not reported. Measures were administered in the PICU and again 4 to 7 weeks later. Twenty-six percent of youth were classified as PTSD-positive, which is substantially higher than a previou...