Feasibility and psychometric properties of the UCLA PTSD reaction index for DSM-5 in japanese youth: A multi-site study

Psychometric Properties of the Parent-Report Version of the UCLA PTSD Reaction Index for DSM-5

The UCLA PTSD Reaction Index for DSM-5 (RI-5) is a developmentally appropriate and well recognized screening tool for the assessment of Post-Traumatic Stress Disorder (PTSD) in children and adolescents. The children/adolescent self-report version of the RI-5 has been thoroughly studied in very recent years, showing adequate psychometric properties. Despite such results, the utility of the parent/caregiver-report version, which also integrates the RI-5 system, remains to be explored. As such, the present study aimed to test the general psychometric properties of the parent/caregiver-report version of RI-5, based on a sample of 457 children and adolescents, aged between 7 and 17 years, exposed to at least one potentially traumatic experience, and their respective primary caregivers. The RI-5 total score and categories revealed good internal consistency reliability. The total number of traumas reported emerged as a significant predictor of the RI-5 total score. The RI-5 total score proved to be significantly correlated with more internalizing and externalizing problems, but correlation coefficients were below .70, serving as an indicator of discriminant validity. The four-factor structure of the RI-5 was supported through confirmatory factor analysis. In conclusion, the present study provided preliminary evidence supporting the utility of the parent/caregiver-report version of the RI-5 for research purposes and for clinical assessment and treatment, anchored on a multiple informant perspective of child psychopathology.

Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth

BACKGROUND

The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology.

OBJECTIVE

Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning.

PARTICIPANTS AND SETTING

We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents.

METHODS

Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure).

RESULTS

Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02).

CONCLUSIONS

Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.

A Bayesian Structural Equation Modeling Factor Analysis of the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 in a Polyvictimized Sample of Adolescents

The revised criteria for posttraumatic stress disorder (PTSD) in the fifth edition of the Diagnostic and Statistical Manual necessitated the development of new screening tools for youth, one of the most widely used of which is the UCLA Posttraumatic Stress Disorder Reaction Index for DSM-5 (RI-5). Thus far, the few studies that have investigated the RI-5's factor structure have supported a four-factor model. However, to date this research has been limited to youth with histories of exposure to single-event traumatic stressors, a significant limitation as evidence suggests many trauma-exposed youth report exposure to multiple types of traumatic stressors, or polyvictimization. It is imperative to determine the generalizability of previous factor models to specific populations which they are purported to represent. We investigated whether the RI-5's four-factor model replicated in a sample of 455 polyvictimized justice-involved adolescents. Initial confirmatory factor analysis demonstrated that the four-factor model did not converge. Therefore, we utilized Bayesian Structural Equations Modeling (BSEM) to determine why the previously proposed factor structure did not converge. The BSEM model suggested that the global factor structure was acceptable and did not require addition or subtraction of any factor or cross-factor loadings. However, small and moderate residual covariances resulted in model misspecification, suggesting there may be additional associations not captured by the current DSM-5 model for polyvictimized youth. Future work should continue examining the RI-5's factor structure in order to better understand whether the current results are unique and how measurements assessing DSM-5 PTSD symptom criteria perform in diverse trauma-exposed youth populations.

The Effect of Theraplay on Prolonged Grief and Post-Traumatic Stress Disorder in Bereaved Siblings of Children with Cancer: A Preliminary Study

Background: Death of any of siblings is an overwhelming, severe, and prolonged challenge in children development process and is a major risk factor for psychiatric disorders in childhood and later. Interventions for bereaved families following a child’s death have been examined over the last several decades. However, no effective treatment for bereavement siblings prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD) has been found yet. Objectives: The study aimed at determining the effect of Theraplay on the symptoms of prolonged grief (PG) and post-traumatic stress disorder (PTSD) in siblings of a deceased child with cancer. Methods: In this preliminary study, a multiple baseline single-subject design with a follow-up period was used. The statistical population included siblings and mothers of children aged 6-10 years who had been under treatment at Mahak Child Cancer Hospital and died 1or 2 years ago. From this population, 4 mother-child pairs were selected as the study sample by convenience sampling. Each mother-child pair participated in 15 Theraplay sessions once a week (45-minute section). Assessments were performed using the inventory of prolonged grief for children (IPG-C) and the University of California at Los Angeles Posttraumatic Stress disorder reaction index for DSM-5 (UCLA PTSD-RI) at baseline, intervention sessions and follow-up stages. Visual analysis of graphic displays of level, reliable change index (RCI) and clinical significance were used to analyze the data. Data analysis and drawing graphs were performed in Microsoft Excel 2016. Results: Results of visual and quantitative analysis of data showed that PG symptoms decreased in all 4 participants during the treatment and follow-up. Also, according to the results, Theraplay intervention significantly reduced PTSD in all participants. Conclusions: Theraplay appears to be effective in reducing PG and PTSD in bereaved siblings. However, the reduction rate varied in different subjects. According to the findings, Theraplay helped subjects accept grief and loss and this method can be used to help the mental health of other bereaved children.

The UCLA PTSD Reaction Index for DSM-5 Brief Form: A Screening Tool for Trauma-Exposed Youths

OBJECTIVE

Children and adolescents who experience potentially traumatic events are at risk for developing posttraumatic stress disorder (PTSD). Although psychometrically sound measures are now available to assess these youths, brief tools are currently needed for screening purposes. Two studies were conducted to develop and validate the UCLA PTSD Reaction Index for DSM-5-Brief Form (RI-5-BF).

METHOD

Study 1 used item response theory models to derive the RI-5-BF from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 486 trauma-exposed youths (mean age = 13.32 years, SD = 2.90) recruited through a practice research network. Study 2 used receiver operating characteristic analyses and diagnostic efficiency statistics to assess the discriminant-groups validity and clinical utility of the RI-5-BF in identifying children at different levels of PTSD risk using a sample of 41 treatment-seeking youths (mean age = 12.44 years, SD = 2.99).

RESULTS

In study 1, item response theory models identified the 11 most informative items across their respective subscales. The RI-5-BF exhibited excellent internal consistency in both studies (α > .93). In study 2, receiver operating characteristic analyses indicated that an RI-5-BF score of 21 maximized sensitivity and specificity. Moreover, diagnostic likelihood ratios across multiple levels of scores provided support for the measure's clinical utility in identifying different levels of PTSD risk.

CONCLUSION

These findings provide support for both the psychometric properties of the RI-5-BF as a brief screening measure for PTSD in children and adolescents and its utility for identifying youths meriting further assessment and consideration for treatment.

Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed

OBJECTIVES

Few studies have investigated pharmacologic treatment for pediatric post-traumatic stress disorder (PTSD). Prazosin, an alpha-1 adrenergic receptor antagonist, has been studied and demonstrated to be efficacious in an adult population for PTSD related sleep disturbances; however, in the pediatric population, data is limited to case reports and retrospective case series. This study prospectively assessed the safety and effects of Prazosin on PTSD symptoms in a pediatric sample.

METHODS

Since 2016, 18 patients with PSTD under the age of 15 admitted in a child and adolescent psychiatric unit were challenged with prazosin as part of a treatment protocol. PTSD symptoms and adverse effects were collected weekly and prospectively assessed each month with validated clinical scales. All data were retrospectively analyzed. This treatment protocol and the evaluation of clinical data were approved by our Ethical committee for research on preexisting data at the University Teaching Hospital of Rouen.

RESULTS

Among the 18 patients (10 girls and 8 boys), 13 (72%) had experienced sexual abuse and 5 (28%) family violence. After 1 month of treatment with a mean prazosin dose of 2.16 ( ± 0.6) mg/day, the CGI-S score significantly decreased from 5.3 ( ± 0.9) to 2.9 ( ± 0.7) (improvement of 43%). The mean total UCLA-PTSD-RI score significantly decreased 11.4 points ( ± 5.4) during the first week and 37.9 ( ± 16) during the first month, leading to an improvement of 20% and 67%, respectively. The improvement was significant irrespective of trauma exposure or sex. No adverse effects were reported except for one patient (hypotension).

CONCLUSION

Consistent with prior case reports and retrospective reviews, our retrospective analysis of data prospectively and systematically assessed among 18 patients suggests that prazosin is well-tolerated and associated with improvement in symptoms for pediatric PTSD.

Validation of the UCLA PTSD Reaction Index for DSM-5: A Developmentally Informed Assessment Tool for Youth

OBJECTIVE

To describe the test construction procedure and evaluate the internal consistency, criterion-referenced validity, and diagnostic accuracy of the Child/Adolescent Self-Report Version of the UCLA PTSD Reaction Index for DSM-5 (RI-5) across 2 independent samples.

METHOD

Study 1 examined the clarity, developmental appropriateness, acceptability of individual RI-5 items, and internal consistency and criterion-referenced validity of the full test. The study 1 sample included 486 youth recruited from 2 major US cities who completed the RI-5 and a measure of depression. Study 2 evaluated the reliability and diagnostic accuracy of the RI-5 in 41 treatment-seeking youth who completed the RI-5 and a "gold standard" structured diagnostic interview, the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version.

RESULTS

RI-5 total scale scores showed excellent internal consistency in the 2 samples. Study 1 provided evidence of criterion-referenced validity, in that total scale scores correlated positively with depressive symptoms. Study 2 provided evidence of diagnostic accuracy (including discriminant-groups validity). RI-5 total scores discriminated youth with from youth without PTSD as benchmarked against the structured diagnostic interview. Further, receiver operating characteristic analyses using a total score of 35 provided excellent diagnostic classification accuracy (area under the curve 0.94).

CONCLUSION

The developmental appropriateness and diagnostic accuracy of the RI-5 support its utility for clinical assessment, case conceptualization, and treatment planning in different child-serving systems, including schools, juvenile justice, child welfare, and mental health.

The Role of Executive Function in Predicting Children's Outcomes in a Cognitive Behavioral Treatment for Trauma-Related Nightmares and Secondary Sleep Disturbances

Predictors of children's outcomes in trauma-focused interventions are well documented. However, little is known about the role of higher-order cognitive processes, specifically executive function (EF) abilities, in determining children's responses to treatments specifically for trauma-related sleep disturbances. EF is independently related to PTSD reactions, sleep deficits, and nightmares. Furthermore, well-developed EF can be protective; thus, we sought to examine whether higher EF predicted better treatment outcomes for trauma-related sleep disturbances. Twenty-three children aged 5 to 17 presenting with post-traumatic nightmares (PTNs) participated in a cognitive behavioral therapy to address their trauma-related nightmares (CBT-NC). Pre- and post-treatment data were used in analyses. Findings from discriminant function analyses revealed that EF was not a statistically significant predictor of treatment outcomes across indices of nightmare frequency and distress, sleep quality, and PTSD symptomology. However, effect sizes suggested that EF was a moderate predictor of sleep quality outcomes, which has clinical implications. Treatment duration for sleep problems could be related to EF with briefer interventions being more suitable for children with high EF, whereas children with low EF may benefit from longer treatment protocols.

Prevalence, comorbidity and predictors of post-traumatic stress disorder, depression, and anxiety in adolescents following an earthquake

BACKGROUND

This study sought to assess prevalence rate, comorbidity and predictors of Post-Traumatic Stress Disorder (PTSD), depression and anxiety among adolescents affected by the 2016 Aceh Earthquake.

METHODS

A cross-sectional study was conducted six months after the earthquake. The multi-stage random sampling method was applied to a selection of respondents from district schools. A total of 321 students participated in the study. In addition to generating demographic data, a brief PTSD inventory, the Patient Health Questionnaire (PHQ), the Generalized Anxiety Disorder (GAD-7) questionnaire and the Disaster Impact Questionnaire (DIQ) were administered.

RESULTS

Approximately 58.3%, 16.8% and 32.1% of adolescents reported the clinical symptoms of PTSD, depression and anxiety, respectively. The associations and comorbidity between PTSD, depression, and anxiety were statistically significant (p = 0.001). Gender, depression, having directly seen someone injured or trapped, the injury or hospitalization of a member of the nuclear family and being afraid to stay inside a building since the earthquake were demonstrated to be the significant predictors for PTSD. The injury and hospitalization of a member of the nuclear family and feeling stressed after the earthquake were significant predictors for depression. Having been injured, having one's house destroyed; being afraid to stay inside a building and gender were significant predictors for generalized anxiety disorder.

CONCLUSIONS

The prevalence of PTSD in the current study population is relatively high and the fact that a significant number of adolescents were afraid to stay inside a building following the earthquake calls for further investigation and treatments.

UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.