Els van Meijel

116 Chapter 7 | General discussion continuation of PTSD. The model also suggests that the child’s pain can negatively affect the parents and other members of the family (Price et al., 2016). Our findings on long-term PTSD in children, and the association with permanent physical impairment (van Meijel et al., 2019) fit into phase III of the model and emphasize the need for long-term monitoring and support after accidental injury. One of the assumptions of the model of PMTS is that a contextual approach to child posttraumatic stress is essential to effective interventions (Price et al., 2016). As parent and child PTSS are related (Kolaitis et al., 2011), parents play an important role in this context. In our study on parental posttraumatic stress (see chapter 5), acute parental stress was significantly associated with short and long-term severity of parental PTSS. Therefore, parents should be supported and assisted from the acute phase after their child’s accident. Our findings also stress the importance of systematically screening and monitoring the parents of accidentally injured children. (See also ‘Clinical implications’.) Implications of the introduction of DSM-5, new criteria for PTSD Shortly after finishing the inclusion of data for this study, criteria for PTSD were revised and a new version of the DSMwas launched in 2013 (APA, 2013). Although symptoms are generally comparable between DSM-IV and DSM-5, the following changes need to be mentioned (National Center for PTSD, 2019). As a consequence of a new qualification of traumatic events (criterion A1), the unexpected death of family or close friends is no longer included. Criterion A2 of DSM-IV, a response of intense fear, hopelessness or horror to a traumatic event, was removed fromDSM-5. The avoidance and numbing criterion C in DSM-IV was separated into criterion C, avoidance, and criterion D, negative alterations in cognitions and mood. Newly added symptoms were: overly negative thoughts and assumptions about oneself or the world, negative affect and risky or destructive behavior. In a study by Kilpatrick and colleagues, it was suggested that criterion A2 did not improve diagnostic accuracy but research in Dutch children and adolescents indicated that the subjective reaction during a traumatic event is of great importance to the assessment of PTSD (Kilpatrick et al., 2013; Verlinden et al., 2013). The specific implications of these results for accidentally injured children are unknown. However,