The Preliminary Development and Validation of a Trauma-Related Safety-Seeking Behavior Measure for Youth: The Child Safety Behavior Scale (CSBS)

Psychometric accuracy of the Dutch Child and Adolescent Trauma Screener

Objective: The aim of this study is to investigate the psychometrics of the Dutch version of the Child and Adolescent Trauma Screener (CATS-2). By this, an international recognized instrument to screen symptoms of post-traumatic stress (PTSS) in children and adolescents according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) becomes available for Dutch youth.Procedure and Method: Based on the validated CATS-2 we established the Dutch version, named the KJTS. A total of 587 children and adolescent, age 7-21, and 658 caregivers referred to mental health care services in Amsterdam was included in the study to examine psychometric properties. The construct was tested by confirmatory factor analysis (CFA). Furthermore reliability, convergent-divergent patterns and diagnostic test accuracy were examined.Results: The underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported by CFA showing a good fit for the selfreport (CFI = .95, TLI = .94), and an acceptable fit for the caregiver report (CFI = .90, TLI = .89). The KJTS showed excellent reliability (alpha = .92) on both selfreport and caregiver report. The convergent-discriminant validity pattern showed medium to strong correlations with measures of internalization problems, such as anxiety and affective problems (r = .44-.72) and low to medium correlations with externalizing symptoms (r = .21-.36). The ROC-curve analysis has proven a good accuracy (AUC = .81; n = 106).Discussion and conclusion: This study demonstrates the psychometric accuracy of the KJTS in a Dutch clinical population. The KJTS reflects adequately the dimensionality of PTSD as described in the DSM-5, with a good fit for selfreports, an acceptable fit for caregiver reports, excellent reliability and sufficient validity. Limitations are described. The outcomes support the use of the KJTS in research and clinical practice for screening and monitoring of PTSS.

Cognitive therapy for PTSD following multiple-trauma exposure in children and adolescents: a case series

BACKGROUND

Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

AIMS

To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre-post effect size.

METHOD

Nine children and adolescents (aged 8-17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

RESULTS

No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

CONCLUSIONS

These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

Voice hearing in young people with posttraumatic stress disorder (PTSD) following multiple trauma exposure

Background: PTSD is comorbid with a number of other mental health difficulties and the link between voice hearing and PTSD has been explored in adult samples.Objective: To compare the trauma history, symptomatology, and cognitive phenotypes of children and adolescents with a PTSD diagnosis following exposure to multiple traumatic events presenting with voice hearing with those who do not report hearing voices.Methods: Participants (n = 120) were aged 8-17 years and had PTSD following exposure to multiple traumas. Three primary analyses were conducted, comparing PTSD symptom severity, prevalence of sexual trauma, and level of negative post-traumatic cognitions between the voice hearing and non-voice hearing groups. Participants were allocated to the voice hearing group if they reported hearing voices in the past two weeks. A range of mental health and cognitive-behavioural factors were considered in exploratory secondary analyses. All analyses were pre-registered.Results: The voice hearing group (n = 50, 41.7%) scored higher than the non-voice hearing group (n = 70, 58.3%) for negative post-traumatic cognitions, but not PTSD symptom severity or prevalence of sexual trauma. In secondary analyses, the voice hearing group had more sensory-based and fragmented memories and higher scores for panic symptoms than the non-voice hearing group. When participants whose voices were not distinguishable from intrusions or flashbacks were removed from the voice hearing group in a sensitivity analysis, the voice hearing group (n = 29, 24.2%) scored higher on negative post-traumatic cognitions and trauma memory quality, with similar effect sizes to the original analysis.Conclusions: Voice hearing is common among youth exposed to multiple traumas with PTSD and is related to cognitive mechanisms proposed to underpin PTSD (appraisals, memory quality) and more panic symptoms. Further research should seek to investigate the underlying mechanisms and directionality for these relationships.

Characteristics of complex posttraumatic stress disorder (PTSD) in young people with PTSD following multiple trauma exposure

BACKGROUND

Complex PTSD (CPTSD) is a relatively new diagnosis. The objective of the present study was to investigate how trauma characteristics, comorbid psychopathology and cognitive and social factors experienced by children and adolescents with a posttraumatic stress disorder (PTSD) diagnosis following exposure to multiple traumatic events differs between those who meet the criteria for CPTSD and those who do not.

METHOD

The present research used baseline data from the DECRYPT trial (BMJ Open, 2021, 11, e047600). Participants (n = 120) were aged 8-17 years and had exposure to multiple traumas and a PTSD diagnosis. The data collected comprised self-report and parent/caregiver-report questionnaires and interviews. Three primary analyses were conducted, comparing number of trauma types, prevalence of sexual trauma and prevalence of intrafamilial abuse between the CPTSD and PTSD-only groups. A range of comorbid psychopathology and cognitive and social factors were compared between the groups in an exploratory secondary analysis. All analyses were preregistered.

RESULTS

The CPTSD group (n = 72, 60%) had a significantly higher frequency of sexual trauma than the PTSD-only group (n = 48, 40%). The groups did not significantly differ on number of trauma types or prevalence of intrafamilial abuse. From the secondary analysis, the CPTSD group were found to have significantly higher scores on measures of negative post-traumatic cognitions, depression and panic. These results were replicated in correlation analyses using a continuous measure of CPTSD symptoms.

CONCLUSIONS

A large proportion of youth exposed to multiple traumatic events met criteria for CPTSD. Sexual trauma appears to be related to CPTSD symptoms. Youth with CPTSD appear to have greater severity of comorbid depression and panic symptoms, as well as more negative post-traumatic cognitions. Further investigation could focus on the directionality and mechanisms for these associations.

The prevalence, latent structure and psychosocial and cognitive correlates of complex post-traumatic stress disorder in an adolescent community sample

Complex PTSD has received growing attention in recent years. However, the validity, prevalence and risk factors of this diagnosis remain unclear. This study examined PTSD presentations in adolescents using diagnostic criteria and latent class analysis (LCA). It then explored the role of demographics factors, trauma history factors, psychopathology factors and cognitive factors in predicting different PTSD presentations. A cross-sectional data comprising self-report measures of 342 community adolescents (12-15 years) were collected and analysed. 2.3 %, 5.6 % and 10 % of adolescents met the criteria for PTSD, CPTSD and disturbances in self-organisation (DSO) respectively. A three-class model (healthy class, CPTSD class and DSO class) were generated from LCA. Adolescents with CPTSD were most likely to be female and endorsed the most overall trauma types, interpersonal trauma types, depression, anxiety and maladaptive cognitive processes, followed by adolescents with DSO and subsequently healthy adolescents. CPTSD appeared to be a more common presentation than PTSD among community adolescents. The relatively high prevalence of DSO is noteworthy and suggests that DSO is not necessarily accompanied by PTSD. Given the strong associations between CPTSD and cognitive processes implicated in PTSD, CPTSD as a construct might be conceptually similar to PTSD.

DECRYPT trial: study protocol for a phase II randomised controlled trial of cognitive therapy for post-traumatic stress disorder (PTSD) in youth exposed to multiple traumatic stressors

BACKGROUND

Post-traumatic stress disorder (PTSD) is a distressing and disabling condition that affects significant numbers of children and adolescents. Youth exposed to multiple traumas (eg, abuse, domestic violence) are at particular risk of developing PTSD. Cognitive therapy for PTSD (CT-PTSD), derived from adult work, is a theoretically informed, disorder-specific form of trauma-focused cognitive-behavioural therapy. While efficacious for child and adolescent single-event trauma samples, its effectiveness in routine settings with more complex, multiple trauma-exposed youth has not been established. The Delivery of Cognitive Therapy for Young People after Trauma randomised controlled trial (RCT) examines the effectiveness of CT-PTSD for treating PTSD following multiple trauma exposure in children and young people in comparison with treatment as usual (TAU).

METHODS/DESIGN

This protocol describes a two-arm, patient-level, single blind, superiority RCT comparing CT-PTSD (n=60) with TAU (n=60) in children and young people aged 8-17 years with a diagnosis of PTSD following multiple trauma exposure. The primary outcome is PTSD severity assessed using the Children's Revised Impact of Event Scale (8-item version) at post-treatment (ie, approximately 5 months post-randomisation). Secondary outcomes include structured interview assessment for PTSD, complex PTSD symptoms, depression and anxiety, overall functioning and parent-rated mental health. Mid-treatment and 11-month and 29-month post-randomisation assessments will also be completed. Process-outcome evaluation will consider which mechanisms underpin or moderate recovery. Qualitative interviews with the young people, their families and their therapists will be undertaken. Cost-effectiveness of CT-PTSD relative to TAU will be also be assessed.

ETHICS AND DISSEMINATION

This trial protocol has been approved by a UK Health Research Authority Research Ethics Committee (East of England-Cambridge South, 16/EE/0233). Findings will be disseminated broadly via peer-reviewed empirical journal articles, conference presentations and clinical workshops.

TRIAL REGISTRATION

ISRCTN12077707. Registered 24 October 2016 (http://www.isrctn.com/ISRCTN12077707). Trial recruitment commenced on 1 February 2017. It is anticipated that recruitment will continue until June 2021, with 11-month assessments being concluded in May 2022.

A Measure of Safety Behaviors for Use with Young People: Subtle Avoidance Measure for Youth

Objective: Safety behaviors have been found to undermine successful exposure in the treatment of anxiety disorders for both adults and children. Although reliable measures of safety behaviors have been developed for use with adults, no such measure has been developed specifically for pediatric populations. In light of this limitation, the current study aimed to develop and validate a measure of the use of safety behaviors suitable for children: The Subtle Avoidance Measure for Youth (SAMY).Methods: Clinical (n = 174) and community (n = 138) young people, aged 7-13 years, provided data.Results: Both exploratory and confirmatory factor analyses supported a three-factor solution of the SAMY, which reflected checking behaviors, behaviors related to image management, and behaviors related to physical protection. The SAMY and its subscales demonstrated strong internal consistency, test-retest reliability, construct validity, and the ability to discriminate between clinical and community participants.Conclusions: Given its solid psychometric properties, the SAMY will prove useful for both research and clinical work with anxious young people.