Child & Adolescent Trauma

Mentalization-Based Training Program for Child Care Workers in Residential Settings Abstract Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis Abstract This study examined the benefit of psychosocial interventions on functional impairment in youth exposed to mass trauma. A random effects meta-analysis was used to estimate the overall effect in 15 intervention trials identified through a literature review. The moderator analysis examined how the effect of intervention differed across types of populations receiving the intervention (targeted or non-targeted samples), characteristics of intervention delivery (individual or group application and number of sessions), and the context of intervention administration (country income level). The results revealed a significant small effect on functional impairment (Hedges' g = 0.33; 95%CI = (0.16; 0.50); p = 0.0011). None of the moderators explained the heterogeneity in intervention effect, perhaps due to the small number of trials. The effect of the interventions on functional impairment and on posttraumatic stress were positively correlated. The current analysis provides preliminary evidence that interventions can improve functioning in youth exposed to mass trauma, but the mechanisms, moderators, and duration of benefit are yet unknown.

Using the PAI-A to Classify Juvenile Offenders by Adjudicated Offenses Abstract To improve understanding and treatment of criminal behavior, researchers have developed typologies of juvenile offenders, primarily focusing on personality traits and criminal history to classify according to type of offense committed. Existing literature has examined underlying personality characteristics found in different subcategories of criminal offenses in juveniles; however, few studies have employed the Personality Assessment Inventory-Adolescent (PAI-A), instead choosing the MMPI-A. A typical classification model of juvenile offenses categorizes offenses into: Interpersonal, Property, and Drug/Alcohol-related charges, to further study within-group differences. The current study examines how personality profiles, examined by the PAI-A, can classify offenders into these offense-type groups. Personality profiles of participants were obtained through pre-sentencing psychological evaluations of 142 juvenile offenders ages 14 to 17. Binary logistic regressions were conducted using PAI-A Clinical, Treatment Consideration, and Interpersonal scales to predict offense-type group classifications. Results yielded statistically significant full models for all offense-type groups, with an average overall accuracy rate of 76.3%. Overall, results suggest that the PAI-A has good predictive power to classify juvenile offender types, and may be more effective in classifying certain types of offenders than the MMPI-A. Notably, Interpersonal and Treatment consideration scales were stronger predictors of offense-type than Clinical scales. This model of juvenile offender classification holds promise for more effective treatment, management, and prediction of behavior for juvenile offenders.

An Exploratory Trial of Cognitive-Behavioral vs Client-Centered Therapies for Child-Mother Dyads Bereaved from Terrorism Abstract The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4–17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers' PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children's were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.

Contemporary Risk Assessment Tools: Should We Use Them for Sexually Abusive Children Ages 4 to 12 Years? Abstract Empirical findings are reported on an age group of sexually abusive youth (4–12 years) not commonly studied. Findings are from major studies employing the ecologically framed MEGA♪ risk assessment tool: MEGA♪Combined Samples Studies (N = 3901 [1979–2017] (Miccio-Fonseca Journal of Child Sexual Abuse: Special Issue on Risk Assessment of Sexually Abusive Youth, 2018a, Journal of Child and Adolescent Trauma, 2018b) and MEGA♪Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female, ages 4–19 with coarse sexual improprieties and/or sexually abusive youth, including youth with low intellectual functioning. Findings provided normative data, with cut-off scores according to age and gender, establishing four (calibrated) risk levels: Low, Moderate, High, and Very-High. The fourth risk level, Very-High Risk, sets MEGA♪ apart from other risk assessment tools by the ability to assess those few most seriously concerning and/or dangerous youth, whereas other risk tools (with three risk levels) do not make this differentiation.

Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure Abstract Although nightmares are frequently endorsed symptoms in children who have experienced trauma, limited research has been conducted on how nightmares vary with different forms of trauma exposure. Our goal was to assess the relationship between nightmares, trauma exposure, and symptoms of Posttraumatic Stress Disorder (PTSD) in youth. A total of 4440 trauma exposed treatment-seeking youth (ages 7 to 18) were administered the UCLA PTSD Reaction Index. Different trauma types, total traumas experienced, and PTSD symptoms were analyzed with correlations and a logistic regression in relation to nightmare frequency. Overall, 33.1% of participants reported experiencing clinically-significant nightmares. 79.1% of the sample experienced more than one trauma type, with an average of 3.06 trauma types endorsed. A binary logistic regression demonstrated the odds of reporting clinically-significant nightmares increased by 1.3 times for every additional type of trauma experienced. Lastly, nightmares were positively correlated with all PTSD criterion. The current study provides prevalence rates of trauma exposure and nightmares in a large, statewide sample of treatment-seeking youth. Each new trauma type experienced resulted in a greater likelihood of endorsing clinically-significant nightmares. This study provides useful information related to assessing and addressing nightmares in youth who have experienced trauma.

What Are We Missing? How Language Impacts Trauma Narratives Abstract The potential for the development of psychopathology in aolescent refugees and asylees is high due to the trauma inherent in their experience. Yet, psychopathology rooted in trauma has proven amenable to treatment. Nonetheless, as most clinicians are monolingual, the language difference between clinician and client may be a barrier of desensitization and processing typically characteristic of trauma therapy. Thus, this study aimed to describe qualitative differences in speech production among native and non-native narratives using Linguistic Inquiry and Word Count (LIWC) processing software (Pennebaker et al. 2015) to understand if the current best practice will function similarly in these populations. We compared 10 adolescent immigrants (50% male) who narrated events that provoked their migration to the U.S. in their second language (L2; i.e., English) to 10 age- and gender-matched adolescents narrating in their first language (L1; i.e., Spanish). Results revealed L1 narratives were significantly higher in their use of/talk about anger, cognitive processes, discrepancy, tentativeness, perceptual processes, ingestion, relativity, time, work, and home. L2 narratives were higher in their use of/talk about positive emotions, death, causation, health, motion, space, and fillers. Findings have implications for the efficacy of treatments using discourse to ameliorate symptoms related to trauma in non-native languages.

Erratum to: Family Enrichment Adventure Therapy: A Mixed Methods Study Examining the Impact of Trauma-Informed Adventure Therapy on Children and Families Affected by Abuse

Meeting Complex Needs Through Community Collaboration: a Case Study Abstract This case study focuses on complex trauma in a refugee family. It explores the barriers faced while supporting a family presenting with complex and multifaceted needs. It reviews the roles, processes and participation of practitioners from Service Coordination (case management) and Treatment (therapeutic intervention) perspectives. This case study also examines the gaps in existing services for new immigrant and refugee populations within a community and provides recommendations for closing these gaps.

Correlates of Adolescent Ambiguity in Defining their Experience of Sexual Victimization in Two Large-Scale Croatian Samples Abstract Adolescents are at increased risk for sexual victimization compared to other age groups and sexual abuse in adolescence is associated with negative health outcomes in adulthood. Sexual experiences are often conceptualized as either consensual or coercive so little is known about adolescents who are unsure whether their negative experience constitutes sexual abuse. The present study used two samples (n = 2235, n = 1253) of Croatian adolescents to explore the psychosocial characteristics and sexualized behaviors associated with difficulty in defining negative sexual experiences. Multivariate findings suggested that, when compared to non-victimized peers, adolescents who reported sexual victimization were characterized by a higher probability of sexualized behaviors. This was not true when comparing individuals who reported an ambiguous sexual experience to non-victimized peers. However, both groups differed from non-victimized participants in reporting hostile/aggressive family environment. More research on the mechanisms underlying adolescents' difficulty in labeling sexual victimization is needed for sexual abuse education and prevention.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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6948891480

alsfakia@gmail.com