The assessment of developmental trauma in children and adolescents: A systematic review

Exploring networks of complex developmental trauma symptomatology among children and adolescents involved in child welfare

Background

Clinical presentations of child and adolescent psychopathology can vary systematically for boys and girls. While network analysis is increasingly being applied to explore psychopathology in adults, there is a dearth of network studies considering differences in symptoms for boys and girls, particularly in developmental trauma-related symptomatology.

Methods

This study involves rural children (n = 375, 39.47% girls) and adolescents (n = 291, 51.20% girls) involved with child protection services in Ontario, Canada. Caregivers completed the Assessment Checklist for Children or Adolescents within the first 6 months of care. Psychometric network analyses were conducted using subscales for boys and girls. Differences were examined via network comparison permutation tests, moderated network models, and independent t-tests.

Results

Attachment-related interpersonal difficulties were the most central nodes in the child and adolescent networks for both boys and girls. Emotional dysregulation also had high strength centrality for adolescents. While network comparison tests found the overall network structures and global network strength to be invariant between boys and girls for children and adolescents, moderated network models and independent t-tests revealed several differences with regards to the expression of specific symptoms. Among children, girls exhibited more indiscriminate and pseudomature interpersonal behaviors, whereas boys expressed significantly more non-reciprocal interpersonal behaviors and self-injury. Adolescent girls exhibited more behavioral dysregulation and suicide discourse in the moderated network model; t-tests also indicated higher levels of emotional dysregulation, negative self-image, and other items considered clinically important complex trauma symptoms (e.g., distrust of adults, confused belonging).

Discussion

This study supports evidence of differences in the expression of complex trauma symptomatology for boys and girls. Additionally, girls exhibit more symptoms, in general. Consistent with the transdiagnostic conceptualization of the consequences of developmental trauma, findings demonstrate the primacy of attachment-specific difficulties and emotion dysregulation.

Is it 'just' trauma? Use of trauma-informed approaches and multi-agency consultation in mental healthcare of looked after children

This article presents three case studies of patients that a child and adolescent mental health service (CAMHS) have supported and its purpose is to encourage discussion of two key learning points. The first of these is the utility of developmental trauma as an approach for children with mental health presentations. The second centres on the importance of multi-agency working when working with young people, principally those within the UK's local authority care system ('looked after children'), who have had traumatic experiences in order to enhance positive outcomes. We also want to encourage consideration of the implications of developmental trauma for current core CAMHS therapeutic models in an attempt to reach beyond the often held narrative that the trauma formulation implies there is 'just trauma, no mental illness'.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

Assessment tools for complex post traumatic stress disorder: a systematic review

Appropriate screening tools are required to accurately detect complex post traumatic stress disorder (CPTSD). This systematic review aimed to assess and compare measurement tools. A literature search using key words 'complex post traumatic stress disorder', 'PTSD', and 'assessment' was undertaken on Embase and PsychINFO during February 2022 by two reviewers. Inclusion criteria included full text papers between 2002-2022 which evaluated CPTSD using assessment tools. Exclusion criteria included reviews, editorials, meta-analyses, or conference abstracts. Twenty-two papers met selection criteria. Thirteen studies used the International Trauma Questionnaire (ITQ). Two studies each evaluated CPTSD with the International Trauma Interview (ITI) or Symptoms of Trauma Scale (SOTS). The Developmental Trauma Inventory (DTI), Cameron Complex Trauma Interview (CCTI), Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC), Complex Trauma Questionnaire (ComplexTQ), and Scale 8 of the Minnesota Multiphasic Personality Inventory Scale (MMPI) were used by a single study each. The ITQ was the most thoroughly investigated, validated across different populations, and is a convenient questionnaire for screening within the clinical setting. Where self-report measures are inappropriate, the ITI, SOTS, and COPISAC are interview tools which detect CPTSD. However, they require further validation and should be used alongside clinical history and examination.

Psychosocial assessment tools for children and young people aged 5-18 years: A rapid review of the literature

AIM

Schools are a key platform for health promotion and a point of connection to local health-care services, with an almost universal reach across the child and adolescent population. This study sought to determine whether validated psychosocial assessment tools exist for a school-based nursing program that would assist in providing an initial health assessment to identify and understand the needs of children and young people referred to the nurse, with the outcome of appropriate connection to external health and wellbeing services.

METHODS

Rapid evidence assessment methodology was utilised to identify validated tools that could identify psychosocial concerns in children and young people aged 5-18 years. We identified articles from peer-reviewed journals via three electronic bibliographic databases (PubMed, Embase and CINAHL). We then extended the search for evidence through a search of the grey literature.

RESULTS

From 3963 peer-reviewed articles found in the database search, 10 relevant peer-reviewed publications met inclusion criteria. In combination with 12 grey literature sources, 33 tools were identified. These included self-report tools (typically for children aged 11 years and older), parent-report and teacher-report tools. We identified the six most promising psychosocial assessment tools. However, there was limited description about implementation within school-based nursing programs.

CONCLUSIONS

Several tools exist that show promise in assisting school-based nursing programs to conduct preliminary psychosocial assessments for children and young people. The introduction of any tools into practice would require implementation guidance and evaluation, including how and when they should be used, and when referral and follow-up is required.

Compassion and complex interpersonal trauma in adolescence: An early systematic review

BACKGROUND

Whilst childhood trauma has been identified as a transdiagnostic risk factor for poly-psychopathology, compassion-focused interventions have emerged as transdiagnostic treatment modality. However, no previous systematic review has specifically explored the relationship between complex interpersonal trauma and compassion in adolescence. The aim of this early systematic review was to evaluate the existing evidence on the role of compassion in adolescents with complex interpersonal trauma.

METHODS

A systematic search of electronic databases was undertaken to identify cross-sectional and intervention studies that examined the role of compassion in the amelioration of psychopathology in adolescence.

RESULTS

Nine studies, including three intervention studies and six cross-sectional studies, met the inclusion criteria. The findings suggested a mediating role of compassion in trauma-specific and overall psychopathology.

CONCLUSION

Despite the dearth of research, this review suggests that integrating compassion might mediate the relationship between complex trauma and psychopathology in adolescents.

Working Relationally with Adolescents Who Have Experienced Complex Interpersonal Trauma: an Interpretative Phenomenological Analysis

The study explores practitioners' experiences of working with adolescents with complex interpersonal trauma. Five mental health professionals were recruited via purposive and snowball sampling. Semi-structured interviews were conducted, audio-recorded and transcribed. Interpretative phenomenological analysis was employed to identify themes related to the research question. Three superordinate themes emerged: "The distance-relationship dynamic"; "The unknown self"; "Practitioners' presence". Participants reported the fragility of their relationships with clients, enhanced awareness of their professional and personal identity, and highlighted the importance of meeting their clients as persons. Results are discussed within the literature that considers the role of the person of the therapist to foster therapeutic change. Future research could explore the role of therapeutic distance, the interplay between transference-countertransference and attachment dynamics, and the relevance of practitioners' playfulness with traumatised youth. Finally, this study proposes a model of use of self as "compassion-in-action" to express practitioners' 'response-ability' to their clients' trauma as commitment to social justice.

A Systematic Review of the Validity, Reliability, and Clinical Utility of Developmental Trauma Disorder (DTD) Symptom Criteria

Exposure to complex trauma is a prevalent and costly public health concern. Though not yet included in the formal diagnostic systems, developmental trauma disorder (DTD) was proposed to capture the consistent and predictable emotional, behavioral, and neurobiological sequelae observed in children exposed to complex trauma. This systematic review synthesizes and evaluates the existing empirical evidence for DTD as a reliable, valid, distinctive, and clinically useful construct. We identified 21 articles reporting on 17 non-overlapping samples that evaluated DTD symptom criteria using objective, empirical methods (e.g., factor analysis, associations with other diagnostic constructs, associations with trauma exposure type, clinician ratings of utility). Studies were largely supportive of the DTD construct and its clinical utility; however, it will be crucial for this work to be replicated in larger samples, by independent research groups, and with more rigorous methodological and analytic approaches before definitive conclusions can be drawn. Findings from this review, while preliminary, provide a promising empirical foundation for DTD and bring the field closer to improving diagnostic parsimony for children and adolescents affected by complex trauma.

Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence

Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.

The Relationship Between ACEs, Trauma-Related Psychopathology and Resilience in Vulnerable Youth: Implications for Screening and Treatment

This study examined the impact of ACEs in vulnerable adolescents and assessed whether resilience would have a moderating impact on psychological functioning. Participants included 40 youth, aged 12-17 identified as having experienced family violence and who were referred for treatment at the San Diego Center for Counseling (SD-CC). The relationship between ACEs, trauma-related symptomology, and psychological functioning was examined using results from the Child Posttraumatic Stress Scale (CPSS) and the Personality Assessment Inventory for Adolescents (PAI-A). The Child Youth Resiliency Measure was utilized to assess whether resilience buffered against the impact of ACEs. A positive relationship between the number of reported ACEs and trauma-related symptomology was found. There was a dose dependent response: youth endorsing 4 or more ACEs had significantly more psychopathology and showed less resilience as compared to those scoring below 4. The more resilient the sample, the less symptomatology was found. Regression analysis showed that resilience had a protective influence: as ACE distress increased, those high in resilience reported less somatization or depression. These findings support the use of the ACE measure as a screening tool and underscore the importance of assessing resilience in conjunction.

Trauma-informed care for adult survivors of developmental trauma with psychotic and dissociative symptoms: a systematic review of intervention studies

Developmental trauma is associated with an increased risk of psychosis and predicts poor prognosis. Despite this association, little is known about which treatments work best for survivors of developmental trauma with psychosis. We sought to do the first review, to our knowledge, to investigate treatments for people with psychotic and dissociative symptoms who have a history of developmental trauma. We searched MEDLINE, PsychINFO, and Google Scholar for studies reporting psychological and pharmacological treatments of psychotic or dissociative symptoms in adult survivors of developmental trauma. We identified 24 studies, most of which investigated various modalities of psychotherapy with two case reports of pharmacological treatments. There is preliminary evidence in favour of third wave cognitive therapies. However, because of low methodological quality and reporting in most of the studies found, it remains unknown which treatments are most effective in this clinical group. Nonetheless, our findings of potential treatment targets, including emotion regulation, acceptance, interpersonal skills, trauma re-processing, and the integration of dissociated ego states, could guide future work in this area. Methodologically rigorous studies are needed to enable clinicians and patients to collaboratively form evidence-based treatment plans. Our Review is registered with PROSPERO, number CRD42018104533.

Emotional Maltreatment and Adolescent Depression: Mediating Mechanisms and Demographic Considerations in a Child Welfare Sample

Emotional maltreatment is a risk factor for adolescent depression. Yet, it remains unclear whether commissions and omissions of emotional maltreatment (a) confer vulnerability via distinct mechanisms and (b) demonstrate similar risk across adolescent subpopulations. The present, multiwave study examined whether school engagement and peer relationships explain the depressive effects of distinct emotional maltreatment subtypes in an at-risk child welfare sample (N = 657; ages 11-14, Age_Mean  = 12.49). The findings indicated that commission subtypes of emotional maltreatment predicted increasing depressive symptoms via increasing peer relationship problems, especially for girls. Meanwhile, decreasing school engagement was a depressogenic risk pathway for Hispanic adolescents reporting omission subtypes of emotional maltreatment. The results emphasize the importance of distinguish between emotional maltreatment subtypes to identify specific risk pathways for adolescent depression.

Cardiac autonomic functioning and post-traumatic stress: A preliminary study in youth at-risk for PTSD

The identification of robust, psychophysiological markers of trauma-related distress is critical for developing comprehensive, trauma-informed, mental health assessments for youth. Thus, the present study examined the clinical utility of cardiac autonomic balance (CAB) and cardiac autonomic regulation (CAR), two composite indices of the sympathetic and parasympathetic nervous system. We hypothesized that CAB/CAR would more reliably index post-traumatic stress (PTS) responses compared to measuring the parasympathetic (i.e., respiratory sinus arrhythmia; RSA) and sympathetic (i.e., pre-ejection period; PEP) nervous systems in isolation. Our sample was comprised of 88 diverse, low-income youth (40.9% African-American and 36.4% White; 60.5% girls; M_age = 12.05 years; SD_age = 1.57) who are at increased risk for adversity-exposure. RSA and PEP were measured during a 5-minute baseline period and 5-minute parent-child conflict discussion task. Adolescent-caregiver dyads completed a clinician-administered measure of the youth's lifetime trauma-exposure and current PTS. CAB represented the difference between RSA and PEP, while CAR was the summation of RSA and PEP. Analyses revealed that sympathetically-oriented CAB reactivity uniquely (a) indexed PTS, especially in the context of elevated trauma, and (b) distinguished between those with and without PTSD. Findings highlight the translational promise of using physiological markers that account for the balance between the parasympathetic and sympathetic nervous system.

Sporting Activities for Individuals Who Experienced Trauma During Their Youth: A Meta-Study

The purpose of this study was to critically examine the qualitative research on childhood trauma survivors' experiences of sporting activities. A comprehensive search of health and social science databases, manual journal searches, and contact with experts yielded 7,395 records. Full-text screening resulted in a final sample of 16 studies. Meta-study methodology was used as a diagnostic tool to rigorously analyze the theory, methods, and findings of the included studies. Studies with explicit connections between philosophy, theory, and methodology resulted in a more robust and critical contribution to the literature. There was much diversity in terms of methodological approaches and qualitative methods which was important in revealing the multifaceted nature of experiences in sporting activities following trauma. Findings from the reviewed studies indicated that a sense of belonging, psychological escape, embodied experience, and the physical and social environmental are important considerations in the study of sporting activities for trauma survivors.

Trauma-Focused Cognitive Behavioral Therapy With a 6-Year-Old Boy

A considerable minority of children are exposed to prolonged periods of repeated or multiple interpersonal traumas at an early age, yet few interventions exist for this vulnerable population. This current case study presents manualized trauma-focused cognitive behavioral therapy (TF-CBT) with a 6-year-old boy who had been exposed to multiple traumatic events. The boy presented with symptoms of post-traumatic stress disorder (PTSD), depression, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), specific phobia, reactive attachment disorder, and psychosocial malfunction in several domains. After TF-CBT was implemented, he no longer met the criteria of PTSD, depression, ADHD, and specific phobia. He also improved in several domains of psychosocial function. In addition, the mother reported a better quality of the parent–child relationship, and they both demonstrated a better understanding of trauma reactions and how to apply new coping and problem-solving skills. Finally, the young boy showed improvements in academic performance, social interactions, and general emotional and behavioral functioning. This case study adds to the growing literature, highlighting the utility of using TF-CBT to successfully treat symptoms of PTSD and associated psychopathology in young children with a history of complex trauma.

The Relationship Between Adverse Childhood Experiences and Health Care Use in the Manitoba IBD Cohort Study

BACKGROUND

We aimed to determine the prevalence of adverse childhood experiences (ACEs) in persons with inflammatory bowel disease (IBD) and whether having ACEs was associated with health care utilization post-IBD diagnosis.

METHOD

Three hundred forty-five participants from the population-based Manitoba IBD Cohort Study self-reported ACEs (ie, physical abuse, sexual abuse, death of a very close friend or family member, severe illness or injury, upheaval between parents, and any other experience thought to significantly impacts one's life or personality) at a median of 5.3 years following IBD diagnosis. Cohort study data were linked to administrative health databases that captured use of hospitals, physician visits, and prescription drugs; use was classified as IBD-related and non-IBD-related. Mean annual estimates of health care use were produced for the 60-month period following the ACE report. Generalized linear models (GLMs) with generalized estimating equations (GEEs) with and without covariate adjustment were fit to the data.

RESULTS

The prevalence of at least 1 ACE was 74.2%. There was no statistically significant association between having experienced an ACE and health care use. However, unadjusted mean annual non-IBD-related general practitioner visits were significantly higher for participants exposed to physical and sexual abuse than those not exposed. Selected adjusted rates of IBD-related health care use were lower for participants who reported exposure to an upheaval between parents and high perceived trauma from ACEs.

CONCLUSION

The estimated prevalence of at least 1 self-reported ACE in persons with diagnosed IBD was high. Health care use among those who experienced ACEs may reflect the impacts of ACE on health care anxiety.

The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension

Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the "traumatic-dissociative" dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.

Substance use disorder and posttraumatic stress disorder symptomology on behavioral outcomes among juvenile justice youth

BACKGROUND AND OBJECTIVES

Substance use behaviors have been identified as a risk factor that places juveniles at greater risk for engaging in delinquent behaviors and continual contact with the juvenile justice system. Currently, there is lack of research that explores comorbid factors associated with substance use, such as post-traumatic stress disorder (PTSD) symptoms, that could help identify youth who are at greatest risk. The aim of the present study was to examine if PTSD symptomology moderated the relationship between substance use disorder (SUD) symptoms and externalizing behaviors and commission of a violent crime; hypothesizing that risk would be heightened among youth with elevated SUD and PTSD symptomology compared to those with elevated SUD symptoms but lower PTSD symptoms.

METHOD

The study included 194 predominantly male (78.4%), non-White (74.2%) juvenile justice youth between the ages of 9-18 (M = 15.36). Youth provided responses to assess PTSD symptoms, SUD symptoms, and externalizing behaviors. Commission of a violent crime was based on parole officer report.

RESULTS

Findings indicated that SUD symptomology was associated with greater externalizing behaviors at high levels of PTSD symptomology. At low levels of PTSD symptomology, SUD symptoms were inversely associated with externalizing behaviors. An interactive relationship was not observed for commission of violent crimes.

CONCLUSIONS

Findings suggest that the association between SUD symptoms and externalizing behaviors among juvenile offenders may be best explained by the presence of PTSD symptomology.

SCIENTIFIC SIGNIFICANCE

Addressing PTSD rather than SUD symptoms may be a better target for reducing risk for externalizing behaviors among this population of youth (Am J Addict 2019;28:29-35).

Review of Tools for Measuring Exposure to Adversity in Children and Adolescents

Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools.

Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians

This article provides an overview of attachment theory, developmental trauma and trauma-informed care for paediatricians. The impact of difficult or impoverished parent-child relationships on brain development and long-term health is now well known. Recent neuroscience research reveals the adverse neurological impacts of developmental trauma and supports the biological basis of attachment theory. There is also an increasing body of evidence that childhood adversity is common and impacts physical and mental health throughout the life-span. Comprehensive paediatric assessment should include an understanding of attachment difficulties and developmental trauma. Viewing children and their families through a 'trauma-informed lens' can provide critical insights into their clinical presentation and care needs. All paediatricians should be providing and practicing trauma-informed care.

Psychosocial screening and monitoring for children in foster care: Psychometric properties of the Brief Assessment Checklist in a Dutch population study

Children in foster care experience higher levels and rates of psychosocial difficulties than children from the general population. Governments and child welfare services have a responsibility to identify those children in care who have need for therapeutic services. This can be achieved through systematic screening and monitoring of psychosocial difficulties among all children in foster care. However, general screening and assessment measures such as the Strengths and Difficulties Questionnaire (SDQ) and Child Behavior Checklist (CBCL) might not adequately screen for the range of difficulties experienced by foster children. The Brief Assessment Checklists for Children (BAC-C) and Brief Assessment Checklists for Adolescents (BAC-A) are measures designed to screen for and monitor attachment- and trauma-related difficulties among child welfare populations. This article reports psychometric properties of the BAC-C and BAC-A, estimated in a population study of 219 Dutch foster children. The results suggest the BAC-C and BAC-A perform both screening and monitoring functions well. Their screening accuracy, internal reliability and concurrent validity are comparable to those estimated for the SDQ within the same child and adolescent sample. Future research is needed to assess the value of the Brief Assessment Checklists (BAC) compared to other measures and to validate cut-points for the BAC. This study further establishes the BAC-A and BAC-C as valid and useful mental health screening and monitoring measures for use with children and adolescents in foster care.

Reliability and Validity of the Early Trauma Inventory Self Report-Short Form among Korean Adolescents

Objectives:

Experiencing early childhood trauma is related to multiple psychiatric problems in adolescents and adulthood. This study aimed to examine the reliability and validity of the Korean version of the Early Trauma Inventory Self Report-Short Form (ETISR-SF) among Korean adolescents.

Methods:

A total of 86 adolescents aged 12–17 years (mean age 14.50±1.35 years, range 12–17) were assessed using the ETISR-SF. Other instruments, including the Children’s Depression Inventory (CDI), the revised Children’s Manifest Anxiety Scale (RCMAS), and the List of Threatening Experiences Questionnaire (LTE-Q), were used to assess clinical symptoms. After 2 months, 51 of the 86 participants were evaluated using the ETISR-SF to assess test-retest reliability.

Results:

The Cronbach’s coefficient alpha for the ETISR-SF was high (0.803). Adolescents with depressive disorder showed higher ETISR-SF scores compared to healthy controls. The ETISR-SF scores were correlated higher with the scores on the LTE-Q (r=0.485) than with the scores on the CDI or RCMAS (r=0.165 and 0.347, respectively).

Conclusion:

The ETISR-SF was temporally stable, showing acceptable reliability (r=0.776). These findings suggest that the Korean version of the ETISR-SF appears to be a reliable and valid instrument for the measurement of reported childhood trauma.

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

Adolescents exposed to adverse childhood experiences (ACEs) have unique developmental needs that must be addressed by the health, education, and social welfare systems that serve them. Nationwide, over half of adolescents have reportedly been exposed to ACEs. This exposure can have detrimental effects, including increased risk for learning and behavioral issues and suicidal ideation. In response, clinical and community systems need to carefully plan and coordinate services to support adolescents who have been exposed to ACEs, with a particular focus on special populations. We discuss how adolescents' needs can be met, including considering confidentiality concerns and emerging independence; tailoring and testing screening tools for specific use with adolescents; identifying effective multipronged and cross-system trauma-informed interventions; and advocating for improved policies.