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OBJECTIVE To understand how youth PTSD symptoms and externalizing problems emerge and change over time for youth with different profiles of victimization, including polyvictimization. METHOD We conducted a latent class analysis (LCA) to identify empirically derived victimization profiles in a sample of 2,776 youth who participated in an evaluation study. We then conducted growth curve analyses to determine whether these victimization profiles predicted change in the course of PTSD symptoms and externalizing problems over a 1-year time period for youth engaged in a variety of community-based services. RESULTS The LCA revealed three profiles: a low victimization profile defined by relatively low endorsement of victimization across types; a witnessing profile defined by particularly high endorsement of witnessing violence; and a polyvictimization profile defined by high endorsement of multiple types of victimization. We found that overall, despite differing initial levels of PTSD symptoms and externalizing problems, all three groups' symptoms improved over the year, but the polyvictimization class generally showed the steepest decreases, particularly in caregiver-reported PTSD symptoms. CONCLUSION Polyvictimized youth participating in community-based services are at increased risk for developing PTSD and externalizing problems, but symptoms appear to decrease to levels similar to other victimized youth after one year. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background The primary purpose of this study was to examine the place of posttraumatic stress disorder (PTSD) vis-a-vis the external dimensions of general distress and physiological arousal. Methods Using data collected from veterans of the wars in Iraq and Afghanistan (N = 1350), latent variable covariance structure modeling was employed to compare correlations of PTSD symptom clusters and individual PTSD symptoms with general distress and physiological arousal. Results Each PTSD symptom cluster, and 17 of 20 individual PTSD symptoms were more strongly associated with general distress than with physiological arousal. However, moderate to strong associations were also found between physiological arousal and both PTSD clusters and symptoms. Limitations Findings are based on self-reported data elicited from a single sample of veterans with substantial PTSD symptoms. Replication, particularly by clinician interview, is necessary. Generalizability to other traumatized populations is unknown. Conclusions Results offer support, with caveats, for viewing PTSD as a distress disorder. Findings are not consistent with the position that PTSD is a hybrid disorder with some features reflecting hyperarousal and others indicative of general distress. Results have implications for the conceptualization and measurement of PTSD.

Youth exposed to violence, many of whom are from racial/ethnic minority backgrounds, are at high risk for externalizing problems such as aggressive and oppositional behavior, conduct problems, and delinquency. Most interventions target youth with already high levels of such problems, while selective prevention efforts have received less attention. It is important for researchers, policy makers and practitioners to understand how such problems develop and change over time, and how selective prevention may impact externalizing problems. In this study, we examined one-year trajectories of externalizing problems in 883 low-income, ethnic minority youth exposed to violence who participated in randomized controlled trials testing a prevention program for high-risk youth called the Strengthening Families Program. We found three trajectories of externalizing problems: Low Externalizing (43% of the sample had consistently low levels of externalizing symptoms), Persisters (39% of the sample had consistently high levels of externalizing symptoms), and Improvers (18% of the sample had initially high levels of externalizing symptoms that decreased over time). There were demographic differences between the three trajectories with individuals in the Low Externalizing trajectory more likely to be female and younger than those in the other two trajectories and Persisters and Improvers had significantly more problems with baseline internalizing symptoms, family conflict, and parenting behavior compared to the Low Externalizing trajectory. Logistic regressions then tested several predictors of membership in the Persisters trajectory compared to the Improvers trajectory, controlling for all covariates simultaneously. Only baseline parenting behavior and intervention group membership significantly predicted trajectory membership, and these were small and unreliable effects. Thus, children with varying levels of violence exposure, co-occurring emotional/behavioral problems and family issues, and varying demographics (e.g., age and gender) may do equally well over time, but engagement in this type of intervention may increase the likelihood that high levels of externalizing problems are ameliorated over time.

We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6-site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores ≥ 50 on the PTSD Checklist -Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow-ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's α = .87, .92, .95, .95, at assessments 1-4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectories: subjects reporting persistent symptoms (Persisters, 81.9%, n = 388), and subjects reporting improved symptoms (Improvers 18.1%, n = 86). Logistic regression modeling examined baseline predictors of symptom trajectories, adjusting for demographics, installation, and treatment condition. Subjects who reported moderate combat exposure, adjusted odds ratio (OR) = 0.44, 95% CI [0.20, 0.98], or who reported high exposure, OR = 0.39, 95% CI [0.17, 0.87], were less likely to be Improvers. Other baseline clinical problems were not related to symptom trajectories. Findings suggested that most military primary care patients with PTSD experience persistent symptoms, highlighting the importance of improving the effectiveness of their care. Most indicators of clinical status offered little prognostic information beyond the brief assessment of combat exposure.

Implementation issues often interfere with delivery of evidence-based interventions for students exposed to trauma. To improve uptake of evidence-based techniques for such students, a partnership of interventionist scientists, research and development experts, and students created a self-paced, confidential, online curriculum. This article describes the program and results of an open trial in 5 schools that serve primarily ethnic minority youth in urban settings. Fifty-one middle and high school students completed surveys before and after the program, as well as within the program, to assess emotional and behavioral symptoms (depressive, anxiety, posttraumatic stress disorder [PTSD] symptoms and behavior) and purported mechanisms of action (coping, cognitions, emotional self-efficacy). Results indicated the program was feasible and acceptable, with moderate satisfaction. Despite low power in this study, we observed changes in several hypothesized mechanisms of action. In addition, we observed promising improvements in PTSD symptoms, emotional problems, and total behavioral difficulties. These findings offer the promise of using a self-help web-based tool to augment and enhance usual school support services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

To evaluate the feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety.Participants were 74 schoolchildren (Grades 1-5) and their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist) intervention. Parent- and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3 months, and 6 months.Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent- and child-reported posttraumatic stress and child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent- and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment).Findings support the feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic stress. Implications are discussed.

The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) program is designed to help students exposed to traumatic events who are suffering from emotional or behavioral problems. CBITS focuses on three goals: decreasing current symptoms related to trauma exposure, building skills for handling stress and anxiety, and building peer and caregiver support. This new edition provides updates based on two decades of field experience.

The purpose of this study was to examine prevalence, correlates and predictors of mental health in children in New Orleans 15 months post-Hurricane Katrina. Analyses were conducted on 195 children who completed self-reports of hurricane and lifetime trauma exposure, social support, post-traumatic stress disorder (PTSD) symptoms, and depression. Teachers completed the Strengths and Difficulties Questionnaire. Children reported high incidence of PTSD symptoms: 36.9% moderate to severe and 23.6% mild. In multiple regression analyses, gender, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted PTSD. Age, social support, and lifetime trauma exposure, but not hurricane exposure, significantly predicted child depressive symptoms. Teachers reported lower levels of problems and no significant predictors of teacher reports other than age and school. PTSD and depression were significant problems for children 15 months post-Hurricane Katrina. Lifetime trauma exposure was the strongest predictor of both PTSD and depression. Effective and accessible treatment is needed for such children.

Millions of children each year are exposed to violence in their homes, schools, and communities as both witnesses and victims. As a result, evidence-based programs for children and adolescents who have been exposed to traumatic events (CEV-EBPs) have been widely disseminated but rarely evaluated in their real-world applications. One crucial aspect of conducting such evaluations is finding appropriate measures that can be of use both to the practitioner and to the researcher. This review aims to provide guidance to the field by first identifying any gaps in the availability of psychometrically tested measures for certain outcome domains and age ranges and then recommending the measures that are most appropriate for use by both researchers and practitioners. Interviews with content experts in the measurement of trauma symptoms and parent-child relationships were conducted to identify the key outcome domains for measurement that are critical to the evaluation of CEV-EBPs and the criteria for dual-use measures, defined as measures that are useful to both researchers and practitioners. A database of 46 relevant measures was created by compiling measures from existing repositories and conducting a focused literature review. Our review of these measures found that existing repositories had few measures of depression, a major gap that should be addressed. Further, there were few measures for young children ages 0-3 years (n = 15) and only a handful of measures (n = 9) had both a child and parent version of the measure. Overall, although the different repositories that currently exist are helpful, researchers and practitioners would benefit from having a single reputable source (e.g., a centralized repository or item bank) to access when searching for measures to use in evaluating CEV-EBPs. Such a tool would hold promising to narrow the current gap between research and practice in the field of children's exposure to violence.

Given the unprecedented operational tempo of the Afghanistan and Iraq wars and the heavy involvement of the Reserve and National Guard, the stress that military families are exposed to is distinct from stress in earlier conflicts, with little empirical data to inform the impact on non-deployed military caregivers or "home caregivers." The study seeks to examine the experiences of home caregivers during deployments, with a focus on the impact of deployment on the caregiver's well-being. We conducted 50 qualitative interviews and 1,337 survey interviews with home caregivers who experienced at least one deployment. The structured qualitative interview focused on caregiver experiences during deployment. The quantitative data centered on caregiver well-being and household and relationship hassles. The qualitative interview notes were the unit of analysis and traditional methods were used to analyze the data. The quantitative data were analyzed using regression models. The qualitative data revealed key deployment-related household challenges that caregivers experience and the effect of those challenges on caregivers. Multivariate analyses of the quantitative data explored differences in caregivers' emotional well-being, household and relationship hassles. The results showed important component and deployment experience differences. Caregivers affiliated with the National Guard and those with more months of deployment reported significantly poorer emotional well-being, and more household and relationship hassles. Given the important role that maternal well-being has on child and family functioning, it is critical to understand how the stress of deployment is affecting mothers in their daily routines, especially during potentially high stress periods.

Purpose To examine readiness for treatment among adolescents with depression in primary care. Methods This article draws upon data from 184 depressed patients, aged 13 to 17, who participated in the Teen Depression Awareness Project. Adolescents were screened assessed along a number of domains at baseline and 6 months. Results Seventy-eight percent of the depressed teens acknowledged they had a problem with depression, yet only 25% were currently getting any sort of counseling or treatment for depression. A total of 40.8% of depressed adolescents were “ready” to get care, whereas 26.6% were “unsure” and 32.1% were “not ready.” Significant differences among these groups were observed for race/ethnicity and household income. Adolescents in the ready group also had more depressive symptoms and lower MHI-5 scores. Being in the ready group versus being “unsure” was a significant predictor of service use at the 6-month follow-up, as was the average number of days impaired and overall mental health functioning. Race, gender, and age were not significant predictors of readiness, yet average number of depressive symptoms was significantly associated with greater readiness. Conclusions Because teens in primary care settings are not seeking mental health treatments even when depression is detected, providers should be mindful that adolescents may be at different stages of recognition and readiness for treatment. Teens who are less ready for care may need follow-up primary care visits or consultation to help them become more active in seeking care.

Using a sample of adult survivors of physical trauma requiring hospitalization (N = 677), we examined the relationship of aspects of alexithymia and anxiety sensitivity to symptoms of posttraumatic distress (PTD). At the bivariate level, both aspects of alexithymia and anxiety sensitivity were positively associated with acute PTD symptomatology, but anxiety sensitivity was more strongly related to PTD symptoms. At the multivariate level, both anxiety sensitivity and aspects of alexithymia made unique and independent contributions to both total PTD symptoms and the majority of PTD symptom clusters. At the facet level, anxiety sensitivity–physical concerns and anxiety sensitivity–psychological concerns, and the alexithymic dimension of difficulty identifying feelings, were uniquely associated with acute PTD symptoms. Findings are discussed in terms of potential clinical implications. Shortly after a trauma, individuals often begin to show disrupted emotional experiences: intense trauma-related emotions on the one hand, and emotional numbing or restriction on the other (DSM-IV ; American Psychiatric Association [APA], 1994). Given that the emotional avoidance and numbing symptoms characteristic of the posttraumatic stress disorder (PTSD) suggest problems with affect regulation (Stone, 1993), and that cognitive factors are thought to contribute to the development and maintenance of PTSD (e.g., Ehlers & Clark, 2000; Foa, Steketee, & Rothbaum, 1989), numerous studies have linked both alexithymia and anxiety sensitivity to PTSD. Yet, no study to date has examined all three together. Anxiety sensitivity is a trait-like cognitive characteristic that is defined as the fear of anxiety-related bodily sensations (Reiss & McNally, 1985). Insofar as individuals with high anxiety sensitivity fear that these symptoms may have dire consequences (McNally, This research was supported by grants R01MH56122 and R01MH071636 from the National Institute of Mental Health and R01AA014246 from the National Institute on Alcohol Abuse and Alcoholism. The views expressed are those of the authors and do not necessarily reflect those of the sponsors or RAND. We express appreciation to Drs. Howard Belzberg, Henry Cryer, Gudata Hinika, Peter Meade, and Vivek Shetty for facilitating data collection. We thank the RAND Survey Research Group and Harris Interactive for their assistance with data collection. We gratefully acknowledge the generosity of the trauma survivors who participated in this study.

Although Latinos have been a rapidly growing population in the US, little is known about how mental health symptoms may present in Latino children especially in the context of those living in poverty and exposed to violence. We explored the level of violence exposure and trauma symptoms in Latino youth and the relationship of these factors with English language fluency. During 2000–2002, 1,601, Latino students from seven middle schools participated in a school-based screening to identify students with exposure to community violence and symptoms of Posttraumatic Stress Disorder (PTSD). The students completed a self-report instrument, in either Spanish or English, that combined a modified version of the Life Events Scale and the Child PTSD Symptom Scale (CPSS). Bivariate analyses and multivariate regression models showed that youth with higher English language fluency reported greater violence exposure and PTSD symptoms than those with lower fluency. No difference was found in functioning by English language fluency. English language fluency appears to be related to violence exposure and PTSD symptoms in these Latino youth. We discuss the importance of school-based programs especially designed to serve Latino students of varying English language fluency.

Accurate assessment of attitudes about intimate partner violence is important for evaluation of prevention and early intervention programs. Assessment of attitudes about cross-gender interactions is particularly susceptible to bias because it requires specifying the gender of the perpetrator and the victim. As it is likely that respondents will tend to identify with the same-gender actor, items and scales assessing attitudes about intimate partner violence may not have equivalent measurement properties for male and female respondents. This article examines data from 2,575 high school students who participated in a teen-dating violence intervention study. The majority of participants were Latino (91%), and the sample was nearly evenly split with respect to gender (51% female). Items from two scales (boy-on-girl violence, 4 items; girl-on-boy violence, 5 items) reflecting teens' attitudes about dating violence were calibrated with the graded item response theory (IRT) model and evaluated for differential item functioning (DIF) by gender. A total of three items, two from the girl-on-boy violence scale and one from the boy-on-girl violence scale, were identified as functioning differently for girls and boys. In all cases where DIF was detected, the item's attitudinal statement was easier to accept for the gender group that was portrayed as victim rather than perpetrator. For both scales, accounting for the identified DIF influenced inferences about the magnitude of mean differences in attitudes between boys and girls. These results support the use of IRT scores that account for DIF to minimize measurement error and improve inferences about gender differences in attitudes about dating violence.

This study examined the relationship between acculturation, gender stereotypes, and recent aversive and fearful dating experiences, and attitudes about dating violence in dating, urban Latina/o youth (N = 442). All participants completed self-administered surveys at school. Relative to girls, boys held more attitudes accepting of dating violence. Females reported less belief in stereotyped gender roles (i.e., more belief in gender role egalitarianism) than males. Adolescents with higher levels of Spanish language media use were more likely to endorse traditional rather than egalitarian gender roles. Hierarchical regression analyses revealed that gender was an important predictor of dating violence attitudes even after other variables were controlled. Implications for dating violence interventions and future directions for research are explored.

Traumatic childhood events can have a significant impact on overall child functioning. Early identification and intervention could offer significant benefits for children's mental health and educational trajectories, but how to effectively identify young children is a challenge. In this paper, we describe screening for exposure to traumatic events and associated symptoms of posttraumatic stress, and examine differences by child gender and grade level. A total of 402 elementary school children in grades 1-5 participated across four elementary schools. We describe modified administration procedures of screening instruments for these young children. Children who endorsed exposure to one or more traumatic events were individually assessed for posttraumatic stress symptom severity. Thirty-four percent (n=138) of children screened experienced one or more traumatic events, and 75.4% of those exposed to at least one traumatic event endorsed moderate levels or higher of posttraumatic stress symptoms. Internal consistency of the symptom self-report instrument was adequate for children of all grade levels. Posttraumatic stress symptom severity increased for children exposed to more types of events. No gender/grade differences were found in symptom severity. Findings suggest that young children are impacted by traumatic events in relatively high numbers, that they can reliably report their posttraumatic stress symptoms, and that a large portion of those exposed to trauma experience significant distress. These results highlight the importance of early screening and identification of these children to curtail potential risk for future academic, social, and psychological maladjustment.

To examine the emotional and behavioral impact of terrorism on children across the country, telephone interviews were conducted with a national probability sample of 395 parents of 5- to 18-year-old children from November 9 to 28, 2001. Parents reported on child emotional and behavioral reactions to terrorism, parent-child discussions about terrorism, and terrorism-related school activities. Thirty percent of parents reported more than 4 terrorism-related emotional or behavioral reactions in their child. Latinos and parents with lower household incomes reported greater terrorism-related reactions in children. Thirty-eight percent of parents reported talking with their child about terrorism for 1 hr or more in the week prior to the interview. Topics of terrorism-related parent-child discussions included the child's fears for his or her own safety, taking precautions against anthrax, and avoiding large gathering places. Children's emotional and behavioral reactions were positively associated with the freque...

This 3-wave longitudinal study examined the natural course of posttraumatic stress disorder symptoms using data collected from young adult survivors of community violence. Three key findings emerged. 1. Mean levels of distress for each symptom cluster decreased over time, with reexperiencing decreasing most rapidly. 2. Cross-lagged panel analysis revealed that hyperarousal strongly influences, but is not generally influenced by, other symptoms clusters. 3. Trajectory analysis demonstrated that respondents for whom hyperarousal was the most pronounced baseline symptom showed lower overall symptom improvement relative to trauma exposed counterparts for whom hyperarousal was a less prominent early symptom. Implications for theory, research, and clinical practice are discussed.

Relative to violence among adult intimate partners, violence among adolescent dating partners remains an understudied phenomenon. In this review, we assess the state of the research literature on teen dating violence. Our review reveals that the broad range of estimates produced by major national data sources and single studies make conclusions about the prevalence of teen dating violence premature. Similarly, our review of what is known about risk factors reveals inconsistency among studies. We assess published evaluations of adolescent dating violence prevention programs and discuss their findings and limitations. Finally, we discuss challenges to researchers in this area and suggest that additional investment in high-quality basic research is needed to inform the development of sound theory and effective prevention and intervention programs.

Trauma exposure and related symptoms interfere with adult adherence to drug treatment. Whether these findings hold true for adolescents is unknown. We examined trauma exposure, PTSD symptoms, and psychosocial functioning among 212 adolescents upon admission to long-term residential drug treatment and examined retention in treatment at 6 months. Seventy-one percent reported lifetime trauma exposure, and 29% of the trauma-exposed met criteria for current PTSD. Trauma-exposed adolescents reported more behavioral problems, with gender differences apparent. We divided the sample into three groups: no trauma exposure (21%), trauma-exposed without PTSD (59%), and trauma-exposed with PTSD (20%). Survival analysis showed that trauma-exposed adolescents without PTSD left treatment sooner than the nonexposed. Need for attention to trauma in substance abuse treatment programs is discussed.

Emerging as one of the most significant health issues facing American youth today, child and adolescent exposure to community violence has generated much interest across multiple disciplines. Most research to date has focused on documenting the prevalence of community violence and the emotional and behavioral ramifications. This paper provides an overview of the current literature regarding prevalence of youth exposure to community violence, and identifies those areas where further research is warranted. In addition to examining overall rates of community violence exposure, this paper reviews the prevalence of different types of community violence, such as weapon use, physical aggression, and crime-related events. Predictors of community violence exposure, including gender, age, race, socioeconomic status, behavior patterns, and geography, are discussed.

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.

Acute reactions to trauma are examined in 267 individuals severely injured via community violence. Respondents were interviewed about pretrauma, peritraumatic, and acute posttraumatic factors. A series of bivariate and multivariate analyses were conducted. We found few factors related to peritraumatic dissociation (PD): only injury severity and neuroticism emerged as multivariate predictors and the effects were small. PD was strongly related to acute PTSD symptoms, and partially mediated the relationship between other factors and acute PTSD and general distress symptoms. Different patterns of predictors emerged for acute PTSD symptoms vis-à-vis general distress symptoms. Future research on predictors of PD is indicated to develop prevention and early intervention programs.

This article reports results from 3 studies conducted to develop and validate a modified version of the self-administered form of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ; C. R. Marmar, D. S. Weiss, & T. J. Metzler, 1997). The objective was to develop an instrument suitable for use with persons from diverse ethnic and socioeconomic backgrounds. In Study 1, the original PDEQ was administered to a small sample (N = 15) recruited from among men admitted to the hospital for physical injuries stemming from exposure to community violence. Results led to modifications aimed at improving the utility of the instrument. In Study 2, the modified PDEQ was subjected to structural equation modeling and item response theory analyses to assess its psychometric properties in a larger, primarily male, sample of community violence survivors (N = 284). In Study 3, the reliability and validity of the modified instrument were further assessed in a sample of female survivors of sexual assault (N = 90). Results attest to the psychometric properties as well as the reliability and validity of the modified 8-item PDEQ.

This study investigated the efficacy of an intervention program (the Depression Prevention Program for Children), which was successful overall in preventing depressive symptoms in 5th and 6th grade children, for a subset of those children-those whose parents have divorced. The 12-week program taught cognitive and social problem solving skills to children in group sessions conducted in their middle schools. There were 59 children in the treatment group-thirty-one (31) children from intact families and 28 children whose parents were divorced. The children completed the Children's Depression Inventory at pretest, posttest, and at 6-month intervals after completion for a 2-year period. The program was effective in preventing depressive symptoms in both groups. However, there was a significant group × time interaction, indicating that for children of divorce, the effectiveness may begin to diminish over time. These findings are discussed in terms of the various factors which might influence the respon...

The present article reports on the development and validation of a self-report measure of posttraumatic stress disorder (PTSD), the Posttraumatic Diagnostic Scale (PTDS), that yields both a PTSD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994; DSM-IV) criteria and a measure of PTSD symptom severity. Two-hundred forty-eight participants who had experienced a wide variety of traumas (e.g., accident, fire, natural disaster, assault, combat) were administered the PTSD module of the Structured Clinical Interview (SCID; Spitzer, Williams, Gibbons, & First, 1990), the PTDS, and scales measuring trauma-related psychopathology. The PTDS demonstrated high internal consistency and test-retest reliability, high diagnostic agreement with SCID, and good sensitivity and specificity. The satisfactory validity of the PTDS was further supported by its high correlations with other measures of trauma-related psychopathology. Therefore, the PTDS appears to be a useful tool for screening and assessing current PTSD in clinical and research settings.

A model of cognitive-behavioral treatment for posttraumatic stress disorder (PTSD) in rape survivors is presented. Emotional processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A combination therapy that includes education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring is presented. The case example of a young female rape survivor is described in detail, including her assessments before and after therapy. In this case, issues of prior substance dependence and intense shame and guilt are highlighted. The therapy was successful in reducing the client's symptoms of PTSD as well as her depressive symptoms, and these gains were maintained at a 1-year follow-up assessment. © 1997 John Wiley & Sons, Inc.

To develop prevention and intervention programs for children exposed to violence, it is necessary to understand what factors might help alleviate the negative effects of violence exposure. In this study, we sought to test whether relationships exist between certain protective factors and subsequent adjustment and to examine whether violence re-exposure contributed to changes in outcomes over time. The analyses revealed that caregiver reports of both child self-control and the quality of the parent–child relationship were related to changes in child posttraumatic stress disorder (PTSD) symptoms and behavior problems. Furthermore, children experiencing more categories of violence re-exposure had increased behavior problems at follow-up compared to those without re-exposure. These findings advance our understanding of the relationship between these protective factors and outcomes for children exposed to violence and suggest that intervening to bolster these protective factors could improve outcomes.

The potential negative consequences of exposure to traumatic events on the academic success and mental health of children and adolescents are well documented, particularly the development of posttraumatic stress disorder. Providing school-based interventions for students who are experiencing trauma symptoms has great potential to meet unmet mental health needs, build resilience, and support students’ academic success. The current chapter provides an overview of the effect of trauma on students, and describes the development and core components of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS. The chapter also summarizes the research evidence and implementation experiences with CBITS, and highlights future directions for research and practice for supporting students exposed to traumatic events.

Despite the proven efficacy of exposure techniques for the treatment of Post-Traumatic Stress Disorder, some obstacles can arise that interfere with successful implementation of exposure-based therapy. In this paper, the theory behind exposure therapy for PTSD is reviewed and basic implementation procedures are detailed. The ways in which three obstacles to treatment (extreme anger, emotional numbing, and overwhelming anxiety) can impede progress in therapy are discussed in terms of theory and case examples. Specific suggestions for circumventing these obstacles are offered, including modifying the exposure techniques and augmenting exposure by using stress inoculation techniques or cognitive therapy.

The study explores whether and how lifetime violence exposure is related to a set of negative symptoms: child internalizing and externalizing behavior problems, child trauma symptoms, and parenting stress. Using a large sample of violence-exposed children recruited to participate in intervention research, the study employs different methods of measuring that exposure. These include total frequency of all lifetime exposure, total frequency of lifetime exposure by broad category (i.e., assault, maltreatment, sexual abuse, and witnessing violence), and polyvictimization defined as exposure to multiple violence categories. The results indicate that only polyvictimization, constructed as a dichotomous variable indicating two or more categories of lifetime exposure, emerged as a consistent predictor of negative symptoms. The total lifetime frequency of all violence exposure was not associated with negative symptoms, after controlling for the influence of polyvictimization. Likewise, in the presence of a dichotomous polyvictimization indicator the total lifetime frequency of exposure to a particular violence category was unrelated to symptoms overall, with the exception of trauma symptoms and experiences of sexual abuse. Taken together, these findings suggest that total lifetime exposure is not particularly important to negative symptoms, nor is any particular category of exposure after controlling for polyvictimization, with the single exception of sexual abuse and trauma symptoms. Instead, it is the mix of exposure experiences that predict negative impacts on children in this sample. Further research is needed to continue to explore and test these issues.

This paper describes the development and preliminary efficacy of a program designed to prevent depressive symptoms in at-risk 10-13 year-olds, and relates the findings to the current understanding of childhood depression. The treatment targets depressive symptoms and related difficulties such as conduct problems, low academic achievement, low social competence, and poor peer relations, by proactively teaching cognitive techniques. Children were identified as 'at-risk' based on depressive symptoms and their reports of parental conflict. Sixty-nine children participated in treatment groups and were compared to 73 children in control groups. Depressive symptoms were significantly reduced and classroom behavior was significantly improved in the treatment group as compared to controls at post-test. Six-month follow-up showed continued reduction in depressive symptoms, as well as significantly fewer externalizing conduct problems, as compared to controls. The reduction in symptoms was most pronounced in the children who were most at risk.

Reports the results of a longitudinal study of youth from military families and their caregivers concerning their emotional well-being and how well they are coping with servicemembers' extended deployments.

This chapter contains a review of what is known about the stressors that service members experience during deployment, and what aspects of that deployment may contribute to emotional changes for families. The review specifically synthesizes research on deployment and child well-being, including the impact on child academic and mental health outcomes, in conflicts prior to Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) as well as during OEF and OIF. Findings from a study to expand our understanding of how OEF/OIF has affected children are summarized, with particular attention to experiences for children from Active and Reserve Component families. The information in this chapter can therefore help to guide efforts already underway to support military families.

Although schools can improve children's access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6-18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers.

New Orleans school children participated in an assessment and field trial of two interventions 15 months after Hurricane Katrina. Children (N = 195) reported on hurricane exposure, lifetime trauma exposure, peer and parent support, posttraumatic stress disorder (PTSD), and depressive symptoms. Teachers reported on behavior. At baseline, 60.5% screened positive for PTSD symptoms and were offered a group intervention at school or individual treatment at a mental health clinic. Uptake of the mental health care was uneven across intervention groups, with 98% beginning the school intervention, compared to 37% beginning at the clinic. Both treatments led to significant symptom reduction of PTSD symptoms, but many still had elevated PTSD symptoms at posttreatment. Implications for future postdisaster mental health work are discussed.

OBJECTIVE: Although studies have begun to explore the impact of the current wars on child well-being, none have examined how children are doing across social, emotional, and academic domains. In this study, we describe the health and well-being of children from military families from the perspectives of the child and nondeployed parent. We also assessed the experience of deployment for children and how it varies according to deployment length and military service component. PARTICIPANTS AND METHODS. Data from a computer-assisted telephone interview with military children, aged 11 to 17 years, and nondeployed caregivers (n = 1507) were used to assess child well-being and difficulties with deployment. Multivariate regression analyses assessed the association between family characteristics, deployment histories, and child outcomes. RESULTS: After controlling for family and service-member characteristics, children in this study had more emotional difficulties compared with national samples. Older youth and girls of all ages reported significantly more school-, family-, and peer-related difficulties with parental deployment (P < .01). Length of parental deployment and poorer nondeployed caregiver mental health were significantly associated with a greater number of challenges for children both during deployment and deployed-parent reintegration (P < .01). Family characteristics (eg, living in rented housing) were also associated with difficulties with deployment. CONCLUSIONS: Families that experienced more total months of parental deployment may benefit from targeted support to deal with stressors that emerge over time. Also, families in which caregivers experience poorer mental health may benefit from programs that support the caregiver and child.

OBJECTIVE: This study aimed to determine the impact of teen depression on peer, family, school, and physical functioning and the burden on parents. METHODS: Patients participated in a longitudinal study of teens with and without probable depression, drawn from 11 primary care offices in Los Angeles, California, and Washington, DC. A total of 4856 teens completed full screening assessments; 4713 were eligible for the study, and 187 (4.0%) met the criteria for probable depression and were invited to participate, as were teens who were not depressed. A total of 184 baseline assessments for teens with probable depression and 184 for nondepressed teens were completed, as were 339 (90%) parent interviews. Follow-up interviews were conducted with 328 teens (89%) and 302 parents (82%). Measures included teen reports of peer and parent support, 2 measures of school functioning, grades, physical health, and days of impairment. Parent reports included peer, school, and family functioning and subjective and objective burdens on parents. RESULTS: Teens with depression and their parents reported more impairment in all areas, compared with teens without depression at baseline, and reported more coexisting emotional and behavioral problems. Both depression and coexisting problems were related to impairment. There was a lasting impact of depressive symptoms on most measures of peer, family, and school functioning 6 months later, but controlling for coexisting baseline emotional and behavioral problems attenuated this relationship for some measures. CONCLUSION: Improvements in teen depression might have benefits that extend beyond clinical symptoms, improving peer, family, and school functioning over time.

Project Fleur-de-lis™ (PFDL) was established to provide a tiered approach to triage and treat children experiencing trauma symptoms after Hurricane Katrina. PFDL provides school screening in schools in New Orleans and three tiers of evidence-based treatment (EBT) to disaster-exposed children. Utilizing a public health approach to meet the various needs of students referred to the program, some stemming from the disaster itself, some related to prior exposure to violence, and some relating to preexisting conditions and educational delays. The National Institute of Mental Health (NIMH) is funding a research project conducted in collaboration with PFDL, to examine two evidence-based practices for child PTSD in order to guide child treatment decisions after future disaster situations. The present paper describes the need for mental health services for children following disaster, the structure and purpose of PFDL, design of the NIMH project, two case descriptions of children treated within the project, and preliminary lessons learned.

This study examines the cross-lagged relationships between posttraumatic distress symptoms and physical functioning, using a sample of 413 persons who were hospitalized for injuries resulting from community violence. Posttraumatic distress was assessed at one week, 3-months and 12-months post injury, and posttraumatic physical functioning was assessed at 3-months and 12-months. Structural equation modeling was used to assess the prospective relationship between posttraumatic distress symptoms and physical functioning while controlling for demographic characteristics and objective measures of injury severity. Results indicate that posttraumatic distress and physical functioning are reciprocally related. Individuals with high levels of psychological distress at one week post trauma have worse physical functioning at 3-months. Psychological distress at 3-months was not significantly associated with subsequent change in physical functioning at 12-months. Individuals with poor physical functioning at 3-months had higher than expected levels of psychological distress at 12-months. These findings demonstrate a reciprocal relationship between physical and mental health following traumatic injury. Interventions targeting physical recovery may influence subsequent mental health and therapies aimed at improving early mental health may also have long term benefits for physical recovery.

Substance use and related problems were assessed in a sample of primary care patients (n = 450) ages 13-21 who screened positive for depression at a clinic visit. Patients were classified as having no substance use (n = 248), non-problematic use (substance use without reported school, work, social, or family problems, n = 90), or use that reportedly caused problems in at least one area (n = 112). In logistic regression models, older age, externalizing symptoms, and not being African American were significantly associated with non-problematic use; older age, male gender, externalizing symptoms, Caucasian/White ethnicity/race, and more friends were associated with problematic use. Odds ratios were similar for patients reporting non-problematic and problematic use, suggesting that, in the presence of depression, any substance use merits evaluation and monitoring to determine treatment needs and to prevent escalation of dysfunction.

Objectives This research explores the relationship between hypothesized protective factors and outcomes for children investigated for maltreatment. Methods Using data from the National Survey on Child and Adolescent Well-Being (NSCAW), we ran logistic regression models to examine the relationship between hypothesized protective factors (social competence, adaptive functioning skills, and peer relationships) and outcomes (externalizing behavior, internalizing behavior, reading competence). Results For each hypothesized protective factor, we found variation in individual scores and sample mean scores at the lower end of the scales, indicating that these children fare worse than most children. However, many children experienced large changes in their individual scores over time suggesting that children can and do improve on these hypothesized protective factors. In examining the relationship between hypothesized protective factors and outcomes, children with higher levels of social competence were significantly more likely to be in the normal range for both externalizing and internalizing behaviors. Children with higher mean adaptive functioning skills were more likely to be in the normal range for both externalizing behavior and reading competence. The positive nature of the child's peer relationships was also related to externalizing behavior and reading competence. Conclusions Overall, our analyses support the idea that social competence, adaptive functioning skills, and peer relationships are related to outcomes for children investigated for maltreatment. While further research is needed to establish a causal link, this work identifies three individual-level hypothesized protective factors as potential sources of variation in outcomes. Practice implications To prevent or alleviate the harmful consequences maltreatment, it is necessary to understand factors that help children move beyond poor outcomes. Our analyses suggest that a strong relationship exists between a child's social competence, adaptive functioning skills and positive peer relationships and select outcomes three years after being investigated for maltreatment. With these individual-level protective factors related to more positive outcomes, it suggests that intervening to increase protective factors could improve outcomes for maltreated and at-risk children.

Little is known about youths' experiences in residential adolescent treatment programs. To better understand the experiences of youth in such programs, the authors conducted a longitudinal qualitative study of 10 juvenile probationers in an adolescent therapeutic community (TC) treatment setting. Seven boys and three girls were recruited into the study upon their entry into the TC. Ages ranged from 14 to 17 years old; six youths were Hispanic, three were White, and one was African-American. Each participant completed between two and six audio-recorded interviews over the course of two years. We report on youth experiences in the TC as well as after discharge or drop out. Three issues were most salient in these interviews--the positive and negative influence of peers, youth appreciation of the family counseling component, and the need for improved methods to prevent running away from the program. Regarding running away, half of the youth in our sample who ran away regretted it, suggesting that with more focused intervention some of them might have been retained in the program.

Despite efficacious treatments for depression in youth, current data indicate low rates of care. To better understand reasons for these low rates of care, we examined treatment preferences for depression treatment. Adolescents (N=444) who screened positive for depression at a primary care visit completed measures of predisposing, enabling, and need characteristics thought to be related to help seeking. Results indicated a strong tendency for adolescents to prefer active treatment (72%) versus watchful waiting (28%), and for youth to prefer counseling (50%) versus medication (22%). Female gender, prior treatment experience, and current depression and anxiety were related to preference for active treatment over watchful waiting. In multivariable analyses, female gender and current anxiety symptoms remained significant predictors of preference for active treatment. Ethnicity, attitudes about depression care, prior treatment experience, and anxiety symptoms were related to preference for medication over counseling. In multivariable analyses, those with negative attitudes about depression treatment generally, with positive attitudes about treatment via medication, or with current anxiety symptoms were more likely to prefer medication. Youth preference for counseling over medication may contribute to low adherence to medication treatment and underscores the importance of patient education aimed at promoting positive expectations for treatments.

Purpose Given the high rate of dating violence between teens and associated deleterious outcomes, the need for effective prevention and early intervention programs is clear. Break the Cycle's Ending Violence curriculum, a three-class-session prevention program focused on legal issues, is evaluated here for its impact on Latino/a youth. Methods Tracks within large urban high schools that had at least 80% Latino/a students were randomized to immediate or delayed curriculum. Classrooms were randomly selected within tracks and individual student outcomes were assessed pre- and postintervention and six months later. Results Students in intervention classrooms showed improved knowledge, less acceptance of female-on-male aggression, and enhanced perception of the helpfulness and likelihood of seeking assistance from a number of sources immediately after the program. Improved knowledge and perceived helpfulness of an attorney were maintained six months later. There were no differences in recent abusive/fearful dating experiences or violence victimization or perpetration. Conclusions The Ending Violence curriculum has an impact on teen norms, knowledge, and help-seeking proclivities that may aid in early intervention for dating violence among Latino/a students.

Objective To pilot-test a school mental health program for Latino immigrant students who have been exposed to community violence. Method In this quasi-experimental study conducted from January through June 2000, 198 students in third through eighth grade with trauma-related depression and/or posttraumatic stress disorder symptoms were compared after receiving an intervention or being on a waitlist. The intervention consisted of a manual-based, eight-session, group cognitive-behavioral therapy (CBT) delivered in Spanish by bilingual, bicultural school social workers. Parents and teachers were eligible to receive psychoeducation and support services. Results Students in the intervention group ( n = 152) had significantly greater improvement in posttraumatic stress disorder and depressive symptoms compared with those on the waitlist ( n = 47) at 3-month follow-up, adjusting for relevant covariates. Conclusions A collaborative research team of school clinicians, educators, and researchers developed this trauma-focused CBT program for Latino immigrant students and their families. This pilot test demonstrated that this program for traumatized youths, designed for delivery on school campuses by school clinicians, can be implemented and evaluated in the school setting and is associated with a modest decline in trauma-related mental health problems.

Many recent immigrant children are at risk for violence exposure and related psychological distress resulting from experiences before, during, and after immigration. This study examines the rates of violence exposure and associated symptoms among recent immigrant children in Los Angeles.1,004 recent immigrant schoolchildren (aged 8-15 years) were surveyed about their prior exposure to violence and symptoms of posttraumatic stress disorder (PTSD) and depression. Participants included children whose native language was Spanish, Korean, Russian, or Western Armenian.Participants reported high levels of violence exposure, both personal victimization and witnessing violence, in the previous year and in their lifetimes. Thirty-two percent of children reported PTSD symptoms in the clinical range, and 16% reported depressive symptoms in the clinical range. Although boys and older children were more likely to have experienced violence, girls reported more PTSD and depressive symptoms. Linear multiple regressions revealed that PTSD symptoms were predicted by both recent and lifetime violence exposure (p values.001 and p.05, respectively), when depressive symptoms and gender were controlled. On the other hand, depressive symptoms were predicted by recent victimization only (p.001) when PTSD and gender were controlled.These findings document the need for interventions addressing the psychological sequelae of violence exposure in immigrant children.

In recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment.

We assembled a team of researchers who designed and conducted a telephone survey of a nationally representative sample of U.S. households three to five days after the attacks. The purpose of the survey was to determine the immediate reactions of adults to the events and their perceptions of their children's reactions. Our primary goal was to learn whether people around the country experienced symptoms of stress at rates anywhere near those of people who lived within close proximity. In addition, we hoped to learn something about how people coped with their reactions.