Els van Meijel

73 Results of a 2–4-year follow-up study | Chapter 4 and long-term PTSD or PTSS. A recent systematic review and meta-analysis on trauma-focused psychotherapy emphasized the effectiveness of both Cognitive Behavior Therapy and EMDR in reducing posttraumatic stress symptoms (Khan et al., 2018), which is all the more reason to promote evidence-based trauma-focused psychotherapy. Some children (or their parents on their behalf) do not seek treatment, even if they are advised to do so. Likewise, dropping out of therapy is a well-known problem (Stallard, 2006). Possible barriers to seeking or accepting mental health treatment are low perceived need and a desire to handle the problems on one’s own (Andrade et al., 2014). Perceived stigma, time commitment or costs may also play a role in some families (Smith et al., 2018). Possible reasons for drop-out are perceived ineffectiveness of treatment and negative experiences with treatment providers (Andrade et al., 2014). With regard to injured children, the NICE guideline suggests that injured children who are still undergoing medical treatment, or who have to cope with permanent physical disability, probably judge these problems as more important than the need for treatment for psychological problems (NICE, 2005). Moreover, since avoidance is one of the symptoms of PTSD, it is likely that seeking and completing treatment will have to be promoted actively. Healthcare professionals can actively follow up children with PTSD who miss scheduled appointments (NICE, 2005). Furthermore, we will have to find effective ways to emphasize the importance of treatment, perhaps by exploring the use of peers and social media. Strengths and limitations A few limitations in this study need to be considered. First, since the follow-up assessment was not scheduled in the design of the initial study, the time between the first and the follow-up assessment ranged from 2 to 4 years. Therefore, although we conducted a long-term follow-up study, the findings may not be generalizable to other samples due to the resulting variability in children’s development and possible transitions in life. Second, follow-up participants reported fewer posttraumatic stress symptoms at T1 than non-participants did. If the loss to follow-up in the group with more symptoms would have been lower, it is likely that the prevalence of PTSD could have been higher. Third, in an ideal situation, we would have used logistic regression