Who Reports What? A Comparison of Child and Caregivers\xb4 Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics

Ane-Marthe Solheim Skar,Tine K Jensen,Anna Naterstad Harpviken

doi:10.1007/s10802-021-00788-y

Abstract

Identifying trauma-related symptoms is important for treatment planning at child and adolescent mental health services (CAMHS), and routine trauma screening may be a first step to ensure appropriate treatment. Studies with community samples have found modest agreement between children’s and caregivers´ report of exposure to potentially traumatizing events (PTEs). However, studies from clinical populations are scarce and the evidence base for screening recommendations is insufficient. The current study explores child and caregiver agreement on the child’s exposure to PTEs and its relationship with the child’s post-traumatic stress symptoms (PTSS) and functional impairment. The sample consist of 6653 caregiver-child dyads referred to Norwegian CAMHS between 2012–2017. The children were 6 to 18 years of age (M = 12.03, SD = 3.14) and 47% were boys and 45% were girls (8% missing). Children reported significantly more exposure to accidents or illness, community violence, and sexual abuse than their caregiver, but there were no differences for reports of domestic violence. Kappa results were fair to moderate, with the highest agreement rate for reports of sexual abuse, followed by domestic violence, community violence, and lowest agreement for accidents or illnesses. There were higher agreement rates among caregivers and older children, and caregivers and girls. In general, the child had higher PTSS and functional impairment scores when child exposure to PTEs were reported by both the caregiver and the child. Both children and caregivers should be included in trauma screening procedures at CAMHS to collect a more complete picture of the child’s experiences and treatment needs.

Highlights

Studies show that trauma exposed children are amazingly resilient and that there is considerable recovery the first weeks after experiencing trauma (e.g. Miller-Graff & Howell, 2015)
This study indicates that disagreement is common in the acute aftermath of trauma, yet it is a lack of knowledge as to whether this is the case for children with longer lasting difficulties referred to child and adolescent mental health services (CAMHS) for treatment
This study investigated agreement between caregivers and children aged 6–18 years in their reports of the child’s exposure to potentially traumatizing events (PTEs) and associated posttraumatic stress symptoms (PTSS) and functional impairment based on routine screening at Norwegian CAMHS

Summary

Introduction

Studies show that trauma exposed children are amazingly resilient and that there is considerable recovery the first weeks after experiencing trauma (e.g. Miller-Graff & Howell, 2015). Trauma is a significant risk factor for mental illness among children, including somatic problems, depression, anxiety, alcohol misuse, conduct disorder, self-harm, posttraumatic stress disorder (PTSD), and functional impairment (Alsic et al, 2014; Lewis et al, 2019; McLaughlin et al, 2012). In Norway, for instance, 10% of referrals to CAMHS in 2017 were related to “serious reactions after trauma, crises, or catastrophes” (Directorate of Health, 2018). After implementing routine screening of all newly referred cases, it was discovered that in 79% of 10,157 screened cases, exposure to PTEs was reported, pointing to a potential gap between the number of referrals related to PTEs and the actual number of children potentially in need of trauma focused treatment (Skar et al, 2019).

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Conclusion