Youth Trauma Research Articles

Racial, ethnic, and neighborhood income disparities in childhood posttraumatic stress and grief: Exploring indirect effects through trauma exposure and bereavement.

Previous findings suggest that experiences with systems of oppression that disproportionately affect individuals based on race and neighborhood residency (e.g., systemic racism, neighborhood income disadvantage [NID]) can be associated with higher odds of developing psychological problems following traumatic events. Although race/ethnicity and NID residency are often associated, they are separate concepts that play unique roles in mental health outcomes among youth. Residents of Black, Latinx, and income-disadvantaged communities also have an increased risk of exposure to polyvictimization and the loss of multiple loved ones. Studies have not carefully delineated the potential relations between race/ethnicity and NID residency, polyvictimization, accumulated losses, and trauma and grief outcomes in youth. We examined mediation models to investigate whether polyvictimization, the loss of multiple loved ones, and exposure to violent death were potential mechanisms through which race/ethnicity and NID would predict trauma and grief outcomes in youth. Participants (N = 429) included Black (19.9%), Latinx (36.0%), and White (27.3%) children and adolescents who were assessed through a routine baseline assessment at a trauma and grief outpatient clinic. Black youth reported significantly elevated posttraumatic stress and maladaptive grief symptoms through higher polyvictimization and violent death exposure relative to White youth, βs = .06-.12, ps <.001. Latinx identity and NID were positively and directly associated with specific domains of maladaptive grief reactions, βs = .10-.17, ps < .001. If replicated longitudinally, these findings suggest that polyvictimization and violent death exposure may be mechanisms through which Black youth develop more severe traumatic stress and grief reactions.

6.35 Behavioral and Neural Mechanisms of Trauma Symptomatology in Youth With Autism Spectrum Disorder

Previous research has demonstrated that youth with autism spectrum disorders (ASD) are more likely to experience adverse childhood experiences (ACEs) and may be at greater risk for developing PTSD following such events. Our research aimed to utilize the longitudinal ABCD study to assess the prevalence and underlying mechanisms of increased risk of ACEs, trauma, and PTSD in youth with ASD. Youth with ASD (n = 196) were identified and a typically developing control (CTL) group was established using nearest neighbor propensity score matching on age, sex, MRI scanner, IQ, and socioeconomic status (SES). Using data from the Family Environment Scales, K-SADS, Family History, Short Social Responsiveness Scale, Youth Life Events Scale, and Longitudinal Parent Demographics Survey, we compared the relationship between ACEs and PTSD symptoms between groups using negative binomial regression and moderation analyses of functional connectivity (FC) MRI measures provided by the ABCD consortium seeded in the amygdala. Youth with ASD had significantly more ACEs compared to CTL peers and met DSM-5 criteria for PTSD (per K-SADS-5) at nearly twice the rate (9.9%) of their CTL peers (5.2%, p = 0.020). Poor social skills were associated with more PTSD in CTL compared to ASD and externalizing and internalizing behaviors predicted PTSD above and beyond ACEs differently for the two groups. More positive right amygdala FC with the visual, auditory and sensory-motor hand networks predicted more PTSD symptoms in ASD youth with high ACEs (visual & auditory) or all levels of ACEs (SM hand). This is the first study to examine the prevalence of PTSD in a community sample of youth with ASD who did not come to study attention through clinical interactions and confirmed the higher rate of PTSD in ASD. Alterations in FC in the ASD group suggest underlying ASD-related abnormalities may be risk factors for development of PTSD and that youth with ASD respond differently to ACEs and/or develop different compensatory mechanisms. The differential expression of internalizing and externalizing behaviors associated with PTSD underlines the importance of assessing for ACEs and post-traumatic symptoms in youth with ASD as these youth may have greater difficulty mounting appropriate resiliency responses and therefore need further intervention.

Delivering Trauma-Informed Care in the Juvenile Justice Setting

Youth taken from the home and placed in emergency shelter, secure detention, and residential set-tings are exposed to new sources of trauma and danger that may re-activate severe stress symptoms leading to re-traumatization. A juvenile justice center planned a trauma-informed, system-focused in-tervention that included recommended elements: appropriate assessments of trauma symptoms, evi-dence-based programs and treatments to build resilience skills in youth and families, staff training, community collaboration and partnerships, and a safe environment to reduce the risk of re-traumatization. The purpose of this study was to describe the implementation over two years of the trauma-informed, system-focused intervention in the juvenile justice center and associated effects on youth trauma symptoms. Current and past traumatic event exposure, change in youth participants’ emotional regulation, effects of an evidence-based, trauma-informed therapeutic intervention on youth participants’ stress symptoms, and quality of the organizational trauma-informed care plan were assessed. Although efforts to improve participant emotional regulation and post-traumatic stress symptoms did not demonstrate significant differences, efforts to screen for trauma exposure at intake provided important information about participant multiple traumas to assist with the therapeutic pro-cess. Efforts in changing organizational culture and policy did result in minor self-reported facility envi-ronmental improvements. For the practitioner, even when an intervention is well planned, results are not always positive in actual practice.

The Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) Program Questionnaire Validation Study (PQVS)

The Prevent Alcohol and Risk-related Trauma in Youth (P.A.R.T.Y.) program is an immersive hospital-based education program designed to reduce trauma in adolescents. The efficacy of the program in reducing risk-taking attitudes and preventing traumatic injuries has been proven through various methodologies. However, there is currently no study that has investigated the efficacy of the program using a validated, multi-domain questionnaire. This study outlines the design of the P.A.R.T.Y. Program Questionnaire (PPQ) and validates it through examining its construct and criterion validity as well as its internal consistency. Its capacity to risk-stratify participants was compared against the RT-18, a robust, 18-item risk-profiling instrument. The PPQ and the RT-18 were completed by New South Wales school students (N = 458) aged 15 to 18. The PPQ was designed in consultation with relevant field experts to optimise engagement and sensitivity. Examination of the construct validity of the PPQ was performed through exploratory factor analysis which demonstrated the presence of two underlying factors which aligned with the constructed two-scenario questionnaire format. The PPQ was shown to be internally consistent with a Cronbach's alpha of 0.77. Individual scenarios were shown to be internally consistent as well (α = 0.69, α = 0.66). The PPQ also identified high risk and low risk participants effectively as demonstrated by comparison against the risk stratification performed with the RT-18 (p-value < 0.001). This suggests the PPQ demonstrates criterion validity. Hence, the PPQ is an effective and valid tool for assessing risk-taking attitudes in adolescent populations.

Medical Trauma in LGBTQIA Youth: Adapting Trauma-Informed Affirming Clinical Practices.

Lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual (LGBTQIA) youth are more likely than cisgender heterosexual youth to experience traumatic stress across all social systems, including within family, school, and health care settings. LGBTQIA youth may be particularly susceptible to traumatic stressors associated with medical illness or injury and health care, due to both to higher baseline levels of stress and adversity and unique identity-linked stressors pervasive across systems of care. Pediatric providers can greatly impact mental health in their LGBTQIA patients by providing trauma-informed care that is affirming of gender and sexual identities. This article presents foundational concepts pertaining to medical trauma and practice priorities for pediatric providers, who are uniquely positioned to mitigate medical traumatic stress experienced by LGBTQIA youth. [Pediatr Ann. 2021;50(9):e379-e383.].

Process, practices, and outcomes of trauma-focused services in a statewide treatment foster care program

Many youth in treatment foster care (TFC) have been exposed to traumatic life events that are associated with negative health outcomes, yet few studies have examined how TFC programs are addressing the needs of trauma-exposed youth. This study used clinical data from 542 youth enrolled in TFC services within a statewide publicly funded mental health system from 2008 to 2018 to explore (a) how many youth receive trauma treatment, including youth diagnosed with PTSD, (b) to what extent common elements for youth trauma treatment are among the interventions employed during months when trauma was included as a treatment focus, and (c) clinician-reported trauma treatment progress. Only 34% of all youth in TFC, and 56% of youth diagnosed with PTSD, received treatment with any focus on trauma during the first six months of TFC. Therapists used a variety of therapeutic strategies during months when trauma was treated, some of which were consistent with the evidence-base for youth traumatic stress. Therapists reported 36% of youth with some trauma treatment focus made, at most, minimal improvement on trauma concerns during this time. Considerations for research and clinical practice in trauma-focused treatment foster care services are discussed.

Implementation of a Trauma-Informed Suicide Prevention Intervention for Youth Presenting to the Emergency Department in Crisis

ABSTRACT Given the increasing number of children presenting to the emergency department (ED) in psychiatric crisis, our tertiary children’s hospital ED adopted SAFETY-Acute/Family Intervention for Suicide Prevention (SAFETY-A), an evidence-based practice for suicide prevention. Because of the relationship between trauma and suicide among youth, this study piloted the feasibility of combining SAFETY-A and a standardized approach to the detection and response to trauma in youth, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) within a busy ED setting. Over a three-month period, 30 youth with low to moderate risk for suicide received SAFETY-A+CPM in the ED. 62% of respondents reported trauma exposure, with the majority endorsing moderate or severe traumatic stress symptoms. Twenty-nine of the 30 youth were able to be safely discharged home with follow-up care. Fifteen youth were provided referrals/linkages with new providers, 5 of which were to trauma-focused assessment and treatment as indicated by the CPM-PTS. Overall, crisis workers found that offering SAFETY-A +CPM was “more rewarding” than traditional crisis evaluations and that using trauma-specific data identified with the CPM-PTS was quite helpful. Post-intervention surveys with parents indicated a favorable experience, comfort with maintaining safety, and overall satisfaction with the ED intervention. Clinical and system barriers identified over the course of the pilot are critical to address for sustained delivery. Overall, SAFETY-A was able to be delivered to fidelity and blended with the CPM-PTS.

Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness.

Homeless youth experience high rates of suicidal ideation and attempts, yet limited research has examined predictors of treatment engagement among this population. Suicidal homeless youth (N = 150) between the ages of 18 and 24years were recruited from a drop-in center in Columbus, Ohio. Participants were randomly assigned to Cognitive Therapy for Suicide Prevention + treatment as usual through a local drop-in center (CTSP + TAU) (N = 75) or TAU alone (N = 75), and treatment attendance among those assigned to CTSP + TAU was examined in this study. As expected, among youth engaged in CTSP + TAU, those with a history of intimate partner violence (IPV) showed decreased odds of treatment attendance. Additionally, youth randomized into CTSP + TAU with higher acquired capability for suicide (ACS) scores and those identifying as Black were more likely to attend treatment sessions. Findings suggest that effective treatment implementation must consider youth's trauma history, demographics and severity of suicidal ideation and behaviors.

Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms

ABSTRACT Objective We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias. Methods Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians (N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales. Results Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present. Conclusions Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.

Psychometric Evaluation of the Caregiver Version of the Child PTSD Symptom Scale in a Recently Immigrated, Spanish Speaking Population

In recent years, there has been a large increase in the number of youth and families emigrating from Central America to the United States to escape extreme violence and crime victimization. As a result, the rate of trauma-exposure and trauma-related distress among this population is alarmingly high and necessitates representation of this population in psychological research, particularly related to trauma symptom measurement. The broad aim of the current study was to examine the psychometric performance of caregiver-reported data on one such instrument intended to measure youth trauma symptoms. Specifically, we sought to document the psychometric performance of the Child PTSD Symptoms Scale (CPSS) with recently immigrated Spanish-Speaking youth and caregivers from Central America by examining the convergent, divergent, and concurrent validity of the caregiver-report form. Overall, the measure showed psychometric promise as it broadly demonstrated adequate concurrent and convergent. Results also suggested that further research is needed to better understand how to reduce the comorbidity that is often depicted in caregiver reports, which can lead to poor discriminant validity. Regardless, current findings suggest the appropriateness of incorporating caregiver reports of youth trauma in Spanish-speaking, recently immigrated youth.

The Urban Youth Trauma Center: A Trauma-Informed Continuum for Addressing Community Violence Among Youth.

Contemporary community violence has escalated into a national public health crisis with urban youth, particularly ethnic minorities, suffering disproportionate negative impacts. The Urban Youth Trauma Center (UYTC) promotes a trauma-informed continuum of prevention-to-intervention services that combines community-based and clinic-based manualized protocols designed to reduce and prevent community violence for youth and families. Based on a socio-ecological model, UYTC has the main goals of addressing community violence and related traumatic stress as well as co-occurring conditions of substance abuse and disruptive behavior problems in urban youth by: (1) raising public awareness; (2) disseminating specialized trauma-informed training; and (3) mobilizing service system coalitions. UYTC employs this evidence-based yet flexible structure for disseminating, implementing, and evaluating trauma-informed training as a means of contributing to the reduction and prevention of community violence for low-income urban minority youth and families who bear the biggest burden of this current crisis.

Trauma-focused cognitive-behavioral therapy (TF-CBT) for interpersonal trauma in transitional-aged youth.

Posttraumatic stress disorder (PTSD) following interpersonal trauma in transitional-aged youth (TAY), aged 15 to 25, is highly prevalent; however, evidence-based interventions have rarely been studied. A single-group pre-/posttest study was conducted at headspace Sunshine, Melbourne, Australia, evaluating the feasibility, acceptability, safety, tolerability, and potential clinical effectiveness of trauma-focused cognitive-behavioral therapy (TF-CBT). An intent-to-treat analysis was conducted for N = 20 participants (65% female, n = 13) who attended a mean of 15 TF-CBT sessions over 25 weeks. At the end of treatment, only 1 of the 16 participants with a baseline PTSD diagnosis still met diagnostic criteria. Significant improvements were also noted for self-report measures of PTSD (d = -.83), anxiety (d = -.74), and depression (d = -.76). A minority of participants reported a brief exacerbation in symptoms of PTSD (n = 8) and anxiety and depression (n = 5) during stabilization and directly before and/or after the trauma-narration phase. However, all symptoms resolved at the end of treatment. The majority of participants (85%, n = 17) rated the intervention as helpful. Regardless of the expected temporary symptom exacerbation, the results indicated that TF-CBT was safe, tolerable, and acceptable. Transitional-aged youth is an emerging area of research. With limited research available on this age group to inform evidence-based practice, it is recommended that a randomized controlled trial is conducted to determine if TF-CBT (Cohen et al., 2017) can be effectively translated to this underresearched age group. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Role of Low Self-Control as a Mediator between Trauma and Antisociality/Criminality in Youth.

Trauma exposure and low self-control are robustly associated with youth antisocial/criminal problems, but the interrelation of these constructs is unclear when taking into account both traumatic events and reactions. The objective of the present study is to examine self-control mediation effects related to trauma and juvenile delinquency, conduct disorder, crime seriousness, and aggression outcomes. The sample consisted of N = 388 male youth from Portugal (age, M = 16.01 years, SD = 1.03, age range = 13–18 years). Path analysis procedures revealed that self-control partially mediates the relation between trauma events and the examined outcomes and fully mediates the relation between trauma reactions and the examined outcomes. Research on youth trauma should examine both trauma events and trauma reactions because they have differential effects on low self-control and antisocial/criminal outcomes.

Supplemental Material for Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) for Interpersonal Trauma in Transitional-Aged Youth

Supplemental Material for Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) for Interpersonal Trauma in Transitional-Aged Youth

Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care.

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.

Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.

Planning for Youth Emotional Health in Unruly Environments: Bringing a Trauma Informed Community Building Lens to Therapeutic Planning

Planning in the context of emotion is an important but underemphasized aspect of planning practice. Planning literature has traditionally viewed issues of trauma through the lens of therapeutic planning. Two strands of scholarship emerging from the field of public health can enhance our understanding of planning for the emotional health of youth. Trauma Informed Community Building (TICB) focuses on community building strategies that counteract contemporary trauma found in challenging environments. Scholarship documenting the impact of youth trauma, referred to as Adverse Childhood Experience (ACE’s) emphasizes the need to support emotional health for youth. The paper presents a case study of the I Am My Brother’s Keeper (I Am MBK) program, implemented in Columbus, OH, as a model of trauma informed youth community development. I Am MBK illustrates the importance of supporting the emotional health of youth as a form of planning for emotion. Findings from the I Am MBK case illustrate how trauma informed practice can strengthen our existing concept of therapeutic planning, by supporting the emotional health of youth through empowerment, radical acceptance, creation of safe spaces, advocacy, relationship building, mind/body practices and experiential learning. The I Am MBK case improved the emotional health of youth but could not counteract other systemic or structural policy challenges in the community. The case demonstrates the importance of aligning planning for emotional health with reforming systems and structures in alignment with Schweitzer’s three obligations of restorative healing.

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Childhood trauma and amygdala nuclei volumes in youth at risk for mental illness.

Adults with significant childhood trauma and/or serious mental illness may exhibit persistent structural brain changes within limbic structures, including the amygdala. Little is known about the structure of the amygdala prior to the onset of SMI, despite the relatively high prevalence of trauma in at-risk youth. Data were gathered from the Canadian Psychiatric Risk and Outcome study. A total of 182 youth with a mean age of 18.3 years completed T1-weighted MRI scans along with clinical assessments that included questionnaires on symptoms of depression and anxiety. Participants also completed the Childhood Trauma and Abuse Scale. We used a novel subfield-specific amygdala segmentation workflow as a part of FreeSurfer 6.0 to examine amygdala structure. Participants with higher trauma scores were more likely to have smaller amygdala volumes, particularly within the basal regions. Among various types of childhood trauma, sexual and physical abuse had the largest effects on amygdala subregions. Abuse-related differences in the right basal region mediated the severity of depression and anxiety symptoms, even though no participants met criteria for clinical diagnosis at the time of assessment. The experience of physical or sexual abuse may leave detectable structural alterations in key regions of the amygdala, potentially mediating the risk of psychopathology in trauma-exposed youth.

Assessing trauma and related distress in refugee youth and their caregivers: should we be concerned about iatrogenic effects?

Assessment of potentially traumatic events and related psychological symptoms in refugee youth is common in epidemiological and intervention research. The objective of this study is to characterize reactions to assessments of trauma exposure and psychological symptoms, including traumatic stress, in refugee youth and their caregivers. Eighty-eight Somali youth and their caregivers participated in a screening and baseline interview for a psychological intervention in three refugee camps in Ethiopia. Participants were asked about their levels of distress prior to, immediately after, and approximately two weeks after completing the interview. Other quantitative and qualitative questions inquired about specific reactions to interview questions and procedures. Children and caregivers became increasingly relaxed over the course of the interview, on average. Few children (5.3%) or caregivers (6.5%) who reported being relaxed at the beginning of the interview became upset by the end of the interview. Some children and caregivers reported that certain assessment questions were upsetting and that feeling upset interfered with their activities. Despite some participants reporting persistent negative reactions, most reported liking and benefitting from the interview. While the majority of refugee youth and their caregivers reported positive experiences associated with completing trauma-related assessments, some reported negative reactions. Researchers and practitioners must consider the necessity, risks, and benefits of including questions about potentially traumatic events and related symptoms that are particularly upsetting in screening, survey research, and clinical assessment. When included, it is important that researchers and practitioners monitor negative reactions to these assessments and connect participants who become distressed with appropriate services.