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This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect ( d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.

CONTEXT Very young children are said to be a vulnerable group for exposure to trauma, and for a psychopathological response (e.g., PTSD) after a risk-exposure. The specific assessment of young children is necessary to enable them to be enrolled in an appropriate care pathway. OBJECTIVE The objective was to identify the instruments available in the English language for the assessment of posttraumatic symptoms in very young children (from 0- to 5-year old). DESIGN This article reports on a systematic review, conducted using the search engines Google Scholar, Science Direct, PsycArticles, and PubMed. RESULTS Nine instruments are available to specifically assess traumatic symptomatology in very young children (0-7-year old), five instruments are available for the broader assessment of very young children (1-6-year old), six instruments are available for the assessment of traumatic symptoms in very young children and in older children (2-18-year old), one instrument did not correspond to any category. These 21 tools are adapted to different ages, built according to different objectives, and do not rely on the same diagnostic algorithm. CONCLUSION Future research should compare the instruments quantitatively to identify those most specific and sensitive to the assessment of trauma symptoms in young children.

Patients with complex medical conditions may have a medical history that includes multiple negative/traumatic experiences with the health care system over the course of their diagnosis and treatment. The BITTEN (Betrayal history by health-related institutions; Indicator for health care engagement; Trauma symptoms related to health care; Trust in health care providers; Expectation of patient; Needs of patient) model posits that health care providers can recognize and respond in a way that encourages resisting patient retraumatization. We present a hypothetical case study applying the BITTEN model as a patient-centered framework to include in a standard visit. Increased awareness of the patient’s risk for institutional betrayal, trauma, and overall negative past health care experiences can help the NP better understand the patient’s current and future health care needs and expectations.

Southeast Asian (SEA) refugee children tend to have numerous mental health problems such as trauma symptoms, depression, and low self-esteem. Yet, many SEA refugee children do not receive the couns...

Women in resource-constrained, postdisaster, urban enclaves, such as Haiti’s Cité Soleil, are at risk for nonpartner sexual violence (NPSV) by multiple perpetrators, and subsequently, psychological trauma and sexually transmitted infections (STIs), including HIV/AIDS. These biopsychosocial risks suggest that NPSV victims may benefit from an adapted evidence-based intervention for sexually transmitted infection (EBI-STI) that includes a trauma component. Yet there is a dearth of knowledge on trauma symptoms experienced by victims in Haiti. We administered a Haitian Kreyòl version of Trauma Symptom Checklist (TSC-40), including its subscales (depression, dissociation, anxiety, sexual problems, sleep disturbance, sexual abuse trauma) to women in Cité Soleil, comparing victims’ scores ( n = 54) with those of nonvictims ( n = 179). After controlling for child sexual abuse, arrest, transactional sex, and sociodemographics, being a victim was associated with higher scores on the full TSC-40, and subscales of anxiety and sexual abuse trauma index. These increased scores of victims underscore the need to incorporate trauma in adaptation of EBI-STI for Haitian NPSV victims like our sample.

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Using a sample of 107 clinical couples in which both had experienced childhood trauma, the study investigated if and to what extent each spouse’s trauma symptoms and relationship satisfaction were ...

The histories of incarcerated women exhibit a multitude of personality issues including psychopathy, trauma, and interpersonal dependency. Two studies were undertaken to better understand these iss...

Objective: The present study examined the protective role of partner support in reducing daily experiential avoidance (EA) associated with trauma symptoms in a sample of 154 couples during pregnancy. Background: Although psychological distress during pregnancy may hinder the developing bond between parents and infants after birth, high quality intimate partner support has the potential to enhance psychological wellbeing during pregnancy, particularly in the context of trauma. Specifically, partner support might mitigate the impact of trauma symptoms on maladaptive coping strategies such as EA by enabling individuals to safely encounter their distress. Method: Participants completed a semi-structured clinical interview of support and a PTSD symptom inventory, followed by home surveys of EA over 14 days. We examined growth trajectories of EA over 14 days using latent trajectory modeling within a dyadic framework. Results: Trauma symptom severity was associated with higher levels of EA across the 2 weeks; however, among women, the impact of trauma symptoms on EA was no longer significant when support from a partner was above average quality or higher. Findings also revealed partner effects; to the extent that women reported higher levels of trauma symptoms, their partners had higher levels of EA. Conclusion: Findings highlight the protective role of high quality support from intimate partners and suggest that trauma-related interventions targeting partner support processes, especially those implemented during pregnancy, might enhance recovery and prevent further distress and dysfunction among pregnant women experiencing trauma symptoms.

Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.

Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion (such as hair cortisol concentrations; HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.

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 ( Mage = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-months 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.

While there has been great deal of research conducted on the effects of child sexual abuse (CSA) on trauma symptoms in children and adults, there is less knowledge on the effects on trauma symptoms in female older adult CSA survivors. The aim of this study was to investigate current symptoms of trauma in adult female survivors of child sexual abuse across each successive decade, beginning with eighteen year olds. This retrospective, anonymous online study gathered a sample of 223 adult female survivors of CSA (38 of whom were aged 50-59 (17%), and 20 of whom were 60+ years of age (9%)), and surveyed their trauma history and their current symptomology. In our sample, the survivors with the most severe trauma symptoms were between 18 and 29 years old. Each subsequent decade reported fewer trauma symptoms, with respondents in the 60+ age group reporting the lowest trauma symptom severity. While a cross-sectional study does not allow us to evaluate individuals' experiences over time, these results suggest that the negative impacts of CSA may abate over the life course. Future research should consider these questions longitudinally to explore whether these results are related to survivorship (those with worse outcomes dying younger) and whether these effects endure as female older adults experience physical and mental challenges in later life.

Objectives To assess symptoms of post-traumatic stress disorder (PTSD) in children with severe epilepsy and the associations of trauma symptoms across age, comorbid symptoms, epilepsy-specific factors, parental resources, and psychopathology. Methods Fifty children with severe epilepsy across three different age groups (0–5 yrs., 6–12 yrs., 13–18 yrs.) were assessed with developmental-sensitive and standardized PTSD assessment tools when hospitalized at the tertiary epilepsy center Filadelfia, Denmark. The Diagnostic Infant and Preschool Assessment (DIPA), the Darryl test, and the ITQ questionnaire were used to assess the three age groups, respectively. Results Twenty-two percent of the overall sample met the criteria for PTSD, with a prevalence of symptoms increasing with age (6%, 28%, and 40%). Comorbid psychiatric symptoms in preschoolers were present in 81% of the children witnessing a high level of distress in this group. Behavioral difficulties were elevated across all three age groups, and 40% of the children with trauma symptoms had a parent with concurrent psychopathology. Conclusion To the authors’ knowledge, this study is the first to assess trauma symptoms with standardized tests in children with more complicated epilepsies. Trauma symptoms in the group are high; however, there is a need for larger scale studies and research into trauma symptoms in children with more severe epilepsy than those assessable with the included assessment tools. The trauma perspective in severe childhood epilepsy might further clarify the complex associations of biological and contextual variables that affect the children’s life quality and enable better preventative treatment options for this group.

Background Police officers are frequently exposed to distressing and dangerous situations, increasing their risk of posttraumatic stress disorder (PTSD) and complex PTSD (C-PTSD). Research examining C-PTSD in police officers is sparse, particularly examination of the occupational risk factors for trauma symptoms. Aims This study aimed to examine the prevalence and risk factors for PTSD and C-PTSD in UK police officers. Methods A cross-sectional study was conducted using psychological health surveillance data from the UK National Police Wellbeing Service. Police officers were either from high-risk areas of work or had been referred for screening by occupational health practitioners regarding psychological distress. The primary outcome for this study was a positive screening of either PTSD or C-PTSD, measured using the International Trauma Questionnaire. A range of occupational, clinical and lifestyle factors was examined to establish their role as potential risk factors for PTSD and C-PTSD. Results In total, 2444 UK police officers were included, with 89% from high-risk areas of work. A prevalence of 3% for PTSD and 2% for C-PTSD was found in police officers from high-risk areas of work. Higher work stress and lower manager support were found to increase the odds of C-PTSD but not PTSD. Higher personal trauma history increased the risk for PTSD and C-PTSD equally. Conclusions Work-related occupational factors increased the odds of PTSD and C-PTSD in police officers, which could be important risk factors for trauma symptoms within police officers. Efforts should be made to improve the working environment of police officers to help improve their psychological well-being.

Nurse practitioners regularly treat primary care patients with trauma histories. By incorporating trauma-informed care into practice, nurse practitioners can enhance the provision of clinical care and, ultimately, improve patient health outcomes. This brief report demonstrates how to actively incorporate the principles and practices of the 4R framework of trauma-informed care into primary care to realize the prevalence of trauma, recognize patients’ trauma signs and symptoms, and respond to patients in a manner that resists retraumatization. Through early identification of trauma symptoms and referral to appropriate follow-up treatment, nurse practitioners can significantly improve the life course of their trauma survivor patients.

Police officers are frequently exposed to traumatic events and therefore are at elevated risk of developing post-traumatic stress disorder (PTSD) and other mental health conditions. While evidence-based treatments for PTSD such as prolonged exposure therapy demonstrate effectiveness, residual symptoms and relapse remain problematic outcomes. Improvements in outcomes may be enhanced by modifying psychotherapy processes based upon recent neuroscientific findings. The present study explored incorporating memory reconsolidation principles into evidence-based exposure therapy for PTSD to create memory reconsolidation therapy (MRT). MRT incorporates memory recall followed by a wait period to make memories liable for modification. Using a case series design, three police officers diagnosed with PTSD participated in a maximum of twelve 90-min sessions of MRT and recorded weekly self-report measures of trauma symptoms and psychological distress. Results indicated participants experienced significantly reduced psychological distress with gains maintained over a 3-month follow-up. A significant reliable reduction in trauma symptoms by post-therapy was identified in two of the three cases with the third narrowly missing the clinically significant cut-off. These significant changes were maintained over the 3-month follow-up in one participant, while the maintenance of these improvements in trauma symptoms approached significance in the other two participants. These findings provide preliminary evidence to justify larger future studies to test the efficacy of MRT with police officers experiencing PTSD.

Background In this study, the first to examine psychometrics of a Haitian Kreyol version of the Trauma Symptom Checklist-40 (TSC-40), we investigated trauma symptoms in survivors of Haiti's 2010 earthquake who reside in Haiti's Cite Soleil slum, a violent neighborhood where non-partner sexual violence (NPSV) is rampant and whose residents are historically underrepresented in research. Methods 233 women and 280 men 18 years or older completed the TSC-40. Differential Item Function (DIF) analysis was performed on the TSC-40 responses for women and men. We examined symptom counts by gender, between NPSV victims and non-victims, and by interaction between gender and NPSV experience. Results We identified a reduced pool of 17-items that exhibited no gender bias. This 17-item index showed acceptable internal consistency reliability (α = 0.87). Employing this index, average symptom counts for women ( x ¯ = 11.3) did not differ from men ( x ¯ = 11.1). Average symptom counts for NPSV victims was greater ( x ¯ = 12.5) than for non-victims ( x ¯ = 10.7). The gender by experience of NPSV interaction indicated that women victims had the highest symptom counts ( x ¯ = 14.0). Limitations We used non-probability sampling, and data were from self-reports collected in a cross-sectional survey. Conclusions Observed differences in trauma burden are likely to be misleading if instruments are administered without regard to DIF. We contribute a Haitian Kreyol Trauma Symptom 17-item index, which offers clinicians/practitioners in Haiti the opportunity to use a valid and reliable measure of enduring trauma symptoms validated in Haiti.

The purpose of this study was to create a reliable, quick and easy to administer screening measure of violence exposure and trauma for children from infancy through age 7. In a sample of 6,676 children, caregivers completing a 22-item screener reported nearly one out of five youth had been exposed as witness or victim to at least one kind of violence. For trauma, caregivers reported that their children had trouble going to sleep at least sometimes (15.83%), had cried or had a tantrum to exhaustion (15.61%) and had difficulty concentrating or focusing (15.55%). Analyses showed reliable internal consistency for violence exposure (.74) and trauma (.85) scales. Factor analyses revealed a single trauma factor and two violence exposure factors, witnessing and victimization. These data provide support for a brief screening measure for trauma and violence exposure in children from birth through age seven that can be administered by minimally trained staff in public systems and community-based agencies who can then refer children and families to necessary assessment and treatment services.

This investigation evaluated trauma-focused cognitive behavioral therapy (T-F CBT) with detained male adolescents with serious offending behaviors. One hundred and seventeen youth with trauma symptoms participated in an average of twelve T-F CBT individual sessions. Trauma symptoms were assessed prior to and following treatment using the Trauma Symptom Checklist for Children (TSCC) and a paired sample t-test was used to analyze changes from pre- to posttest. Trauma symptoms in five of the six scales (i.e., anger, depression, anxiety, posttraumatic stress, dissociation) were significantly reduced following treatment. T-F CBT may be effective in reducing general trauma symptoms among detained adolescents; assessing and treating trauma symptoms are recommended as standard protocol in the juvenile justice system; and T-F CBT may be effective without caregiver participation.

A first-line screening instrument, the Preschool Inventory of Trauma Symptoms (PITS), was developed to assess trauma symptoms with a diverse sample of 150 toddlers and preschoolers ( M = 2.49 years; SD = 1.12). Items reflected the current trauma literature, assessment measures, and diagnostic criteria for very young children. A principal component analysis produced a 34-item, four-factor model: Arousal and Hyper-Reactivity, Fearful Attachment, Intrusion and Re-Experiencing, and Avoidance and Negative Cognition and Mood. One validity scale, Response Style, was also developed. All scales significantly correlated ( r = .45 to .81; p < .01) with preestablished trauma measures and demonstrated adequate internal consistency (α = .68 − .87). A receiver operating characteristics curve analysis identified a cut-score with good discrimination ability (.88), sensitivity (.81), and specificity (.81). In a preliminary pilot study, PITS also was found to be sensitive to trauma symptom change following participation in an evidence-based trauma informed treatment program. A copy of the PITS is included in the Appendix for free use by qualified professionals.

This exploratory study assessed the association between agency and life satisfaction, as well as the potential for life satisfaction, in its turn, to alleviate trauma symptoms and reduce negative emotion in a group of children exposed to war and military violence in Palestine. Two hundred and fifty Palestinian children, who had been recruited at primary schools in urban and rural areas, and refugee camps, completed the Multilevel Student’s Life Satisfaction Scale, Children’s Hope Scale (CHS), Children’s Impact of Event Scale (CRIES) and Positive and Negative Affect Scales. We performed structural equation modelling to evaluate the effects of agency on negative emotions and trauma symptoms via life satisfaction. The participants appeared to play an agentic role in mobilizing their own life satisfaction, and the more satisfied they were with their lives, the less they suffered from trauma symptoms. In terms of clinical practice, we advocate more active and participatory approaches to fostering children’s agency, a complex construct in need of further investigation via mixed-method quanti-qualitative and ethnographic studies.

Background Gulf War Illness (GWI) is a chronic, multi-symptomatic disorder affecting an estimated 25–32% of the returning military veterans of the 1990–1991 Persian Gulf War. GWI presents with a wide range of symptoms including fatigue, muscle pain, cognitive problems, insomnia, rashes and gastrointestinal issues and continues to be a poorly understood illness. This heterogeneity of GWI symptom presentation complicates diagnosis as well as the identification of effective treatments. Defining subgroups of the illness may help alleviate these complications. Our aim is to determine if GWI can be divided into distinct subgroups based on PTSD symptom presentation. Methods Veterans diagnosed with GWI (n = 47) and healthy sedentary veteran controls (n = 52) were recruited through the Miami Affairs (VA) Medical Health Center. Symptoms were assessed via the RAND short form health survey (36), the multidimensional fatigue inventory, and the Davidson trauma scale. Hierarchal regression modeling was performed on measures of health and fatigue with PTSD symptoms as a covariate. This was followed by univariate analyses conducted with two separate GWI groups based on a cut-point of 70 for their total Davidson Trauma Scale value and performing heteroscedastic t-tests across all measures. Results Overall analyses returned two symptom-based subgroups differing significantly across all health and trauma symptoms. These subgroups supported PTSD symptomatology as a means to subgroup veterans. Hierarchical models showed that GWI and levels of PTSD symptoms both impact measures of physical, social, and emotional consequences of poor health (ΔR2 = 0.055–0.316). However, GWI appeared to contribute more to fatigue measures. Cut-point analysis retained worse health outcomes across all measures for GWI with PTSD symptoms compared to those without PTSD symptoms, and healthy controls. Significant differences were observed in mental and emotional measures. Conclusions Therefore, this research supports the idea that comorbid GWI and PTSD symptoms lead to worse health outcomes, while demonstrating how GWI and PTSD symptoms may uniquely contribute to clinical presentation.

The present study investigated psychometric properties of a French translation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003) in a large sample of university students (N = 1,350). A confirmatory factor analysis supported the single-factor structure of the MSI-BPD, and its configural, metric and scalar invariance across gender was established. Internal consistency was high (tetrachoric α = .88; Ω = .88). MSI-BPD scores were significantly correlated to depressive symptoms (r = .57), trauma symptoms (r = .40), negative consequences of substance use (r = .25), and frequency of drug use (r = .11). Finally, 9.5% of the sample reached the clinical cutoff, which is similar to the pooled prevalence for BPD reported in a recent meta-analysis of university students. The present study showed that the French translation of the MSI-BPD is a psychometrically sound screening tool for BPD in both men and women.

Objective Children in foster care (CFC) may be at higher risk for developmental problems. This study sought to determine (1) the percentage of CFC with developmental problems seen at an integrated primary care clinic and (2) whether the presence of various risk factors was associated with increased odds of developmental problems in general and across developmental domains. Method This cross-sectional study used the Ages and Stages Questionnaire, Third Edition, demographic, and health-related data retrieved from electronic health records. The study included 796 children aged 1 to 66 months seen at an integrated primary care clinic exclusively serving CFC. Frequencies and percentages of children with developmental problems were calculated, and relationships between developmental status and potential risk factors were accessed using χ2 and bivariate logistic regression analyses. Results Overall, 68.5% had scores indicative of developmental concern (DC), and 39.8% had scores indicating developmental delay (DD). After adjusting for other risk factors, analysis suggested that being male (odds ratio [OR] 2.169, 95% confidence interval [CI] 1.595-2.950) and exhibiting trauma symptoms (OR 1.51, 95% CI 0.993-2.295) were associated with higher odds of exhibiting DC, whereas being in a kinship placement (OR 0.55, 95% CI 0.359-0.842) was associated with lower odds. Odds were higher for exhibiting DD for children who were male (OR 1.716, 95% CI 1.278-2.303), born prematurely (OR 2.165, 95% CI 1.438-3.259), experienced physical abuse (OR 1.541, 95% CI 1.040-2.283), and presented trauma symptoms (OR 1.441, 95% CI 0.975-2.130). Conclusion The findings suggest that early screening is vital for CFC to identify developmental impairment so that appropriate education and interventions can be offered.

Background There is a need for effective, low-cost, readily available measures for reducing trauma symptoms so that people exposed to potentially traumatic events can receive help more quickly. A previous study reported that performing an intervention including a visuospatial task shortly after a reminder of a series of unpleasant film clips seen 24 hours earlier reduced the number of intrusive memories over the following week. Objective This study reports a follow-up and extension of the earlier promising finding. The prediction was that participants performing the visuospatial task immediately after the reminder would report fewer intrusions compared to three other groups who 1) performed no task, and novel conditions who 2) performed the task before the reminder, and 3) performed the task 90 minutes after the reminder. Method A trauma-analogue method was used, where students (N = 200) watched a series of short films with unpleasant material. Over the following week, they were asked to write down any intrusive memories they experienced in a diary. On the second day they returned to the lab and saw static reminders of the films. They were then randomly allocated to condition, recorded intrusive memories over the following days and returned to the lab for final testing on Day 8. Results A total of 49 participants did not report any intrusions and were excluded from the analyses. Two more participants were excluded as outliers, leaving a final sample of n = 149. Despite using largely the same materials as the original study there were no significant differences in the number of intrusive memories between the four groups post intervention. Conclusions Possible explanations include the effect not being as robust as expected, a low number of intrusions across groups, baseline differences in attention, and minor but potentially important differences in procedure between this and the original study., HIGHLIGHTS This study followed up James et al.’s (2015) finding that playing a visuospatially demanding game reduced negative intrusive memories.As we did not find a similar pattern of findings the intervention may be less promising than assumed and sensitive to changes in set-up.

Background Although the child welfare field has initiated efforts to use standardized screening for trauma and behavioral health needs, research has rarely examined whether these screenings have influenced permanency outcomes. Objective Using data from three states' federal demonstration projects, we examined whether receipt of trauma and behavioral health screening and results of screening were associated with placement stability (i.e., fewer placements). Our inquiry focused on whether similar patterns of statistical associations would be observed in three distinct state settings. Participants and setting Samples comprised children in out-of-home care in three states newly implementing trauma and behavioral health screening. The states included a South Central state, New England state, and a Central Midwestern state. Results In all three states, findings showed children who received screening had a higher number of placements (i.e., placement instability). Likewise, all three states found that children whose screening results indicated greater need, such as higher number of trauma symptoms or lower behavioral health functioning, were more likely to experience a higher number of placements (i.e., placement instability). Conclusion Despite differences in screening tools and state-specific approaches, findings suggest that early screenings may provide important information that could be used to identify children's needs, make appropriate service referrals, establish well-matched placements, and support resource parents and birth parents toward better permanency outcomes. Regardless of potential benefits of early screening, it may be underutilized in the field. Future research is needed to replicate these findings and continue to build an evidence base for trauma and behavioral health screening.

Background and PurposeThere are very limited brief, validated, open access screening tools for trauma symptoms in adolescent populations. This study aimed to test two brief tools used with adults in primary care settings for use with adolescents.MethodsYouth (n = 77) completed the Posttraumatic Stress Disorder (PTSD) Checklist (PCLC-2), the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV; PC-PTSD), and the PTSD Reaction Index for DSM-5 (reference tool). Sensitivities and specificities were analyzed.ResultsThe PCLC-2 and PC-PTSD demonstrated high sensitivity and specificity with adolescents when using lower cutoff scores than those recommended for adults.ConclusionsThe PC-PTSD and PCLC-2 have the potential to be used as brief screens with adolescents. Additional research is needed to further examine their validity with larger, diverse youth samples in primary care and school-based settings.

Children’s exposure to intimate partner violence (IPV) and child abuse (CA) is strongly related to later psychological problems. Few studies exist on patients in child and adolescent mental health services (CAMHS) who have been singly or doubly exposed to IPV and/or CA. The overall aim of the current study was to compare self-reported psychiatric symptoms, post-trauma impact, and post-traumatic stress disorder (PTSD) diagnoses among CAMHS patients who had been singly or doubly exposed or had reported no family violence (NoFV). We expected to find more severe symptoms in both singly and doubly exposed patients than in the NoFV group and that double exposure was associated with more severe symptoms than single exposure (to IPV or CA). Finally, we expected to find that higher frequencies of exposure to IPV or CA were related to more psychiatric symptoms, greater post-trauma impact, and a higher likelihood of PTSD diagnosis. We compared psychiatric symptoms, post-trauma impact, and PTSD diagnosis in 578 patients aged 9–17 years with NoFV (n = 287), single exposure (n = 162), and double exposure (n = 129). The influence of gender, age, age of onset, frequency, and traumatic interpersonal events outside the family (IPE) were regressed on psychiatric symptoms, post-trauma impact, and PTSD diagnoses. Patients with double exposure had more severe symptoms than the NoFV group, and patients with single exposure had more trauma-related symptoms than the NoFV group. Double exposure was associated with more severe symptoms than single exposure, and frequency (of exposure to IPV and/or CA) and IPE influenced trauma symptoms and psychiatric symptoms, respectively. Exposure to more than one type of violence is associated with more severe symptoms, but other factors such as frequency of violent acts and IPE are important factors to focus on in future studies and clinical assessment.

Objective: As part of a larger community-based, service driven research project, the purpose of this study was to 1) document the clinical needs of sheltered children (i.e., externalizing behavior problems [EBP], trauma symptoms, and developmental status) and 2) examine the effectiveness of time-limited adaptations of Parent Child Interaction Therapy (PCIT) and Child Parent Psychotherapy (CPP). Method: One hundred and forty-four young children (Mage = 3.48, SD = 1.09; 56.9% male; 78.5% Black/African American) and their mothers were recruited from a women's homeless shelter and randomly assigned to a 12-week course of either PCIT or CPP delivered by shelter clinicians on site. Families completed pre and post intervention assessments including mother-reported measures of child EBP and trauma symptoms, and parenting stress. Observational data on maternal verbalizations during a child-led play session were also collected. Results: High rates of clinically elevated EBP (36%), trauma symptoms (47%), and developmental delays (35%) were found. Time-limited PCIT resulted in greater reductions in maternal negative verbalizations and parenting stress, and greater increases in maternal positive verbalizations relative to time-limited CPP. As it relates to child outcomes, both time-limited PCIT and CPP resulted in similar decreases in children's post-traumatic stress symptoms; however, only time-limited PCIT resulted in significant improvements in EBP. Conclusions: Young sheltered children evidenced high levels of EBP, trauma symptoms and developmental delays. Both time-limited PCIT and CPP offered effective trauma interventions. However, PCIT offered a more comprehensive intervention by more effectively targeting EBP and parenting. Implications of these findings for clinical practice are discussed.

Background: Emergency room personnel are indirectly exposed to many traumas. Few studies have examined secondary traumatic stress in emergency room nurses and only a single study examined emergency room physicians. The extent of vicarious post-traumatic growth, i.e., the growth associated with such trauma, has also hitherto not been examined in emergency room personnel. Objective: Our first goal was to examine secondary traumatization in both emergency room nurses and physicians. Our second goal was to examine vicarious post-traumatic growth in emergency room personnel. Finally, we also address the association (linear and curvilinear) between secondary traumatization and vicarious traumatic growth. Methods: A questionnaire comprising demographic variables, secondary traumatic stress and vicarious post-traumatic growth was administered electronically to a sample of emergency room personnel from the Wolfson Hospital, Holon, Israel. Results: There were no differences between nurses and physicians in overall secondary trauma or vicarious post-traumatic growth levels. For physicians, there was both a linear and a curvilinear association between secondary trauma and vicarious post-traumatic growth; for nurses, there was no overall association. Further sub-group analyses revealed that emergency room nurses with low workload, in conjunction with low work experience, did show a linear association. Conclusion: Results indicate that while vicarious post-traumatic growth is linked to secondary traumatic stress for emergency room physicians, it is not so for nurses. Theoretical implications concerning the role of trauma symptoms in vicarious post-traumatic growth are discussed. Clinical implications are raised regarding the identification of excessive secondary traumatic stress levels and the need for interventions to both decrease stress levels, and to increase vicarious post-traumatic growth levels., HIGHLIGHTS • Emergency room physicians and nurses have same level of secondary trauma and vicarious post-traumatic growth. • In physicians these variables were linked; in nurses they were not. • Different sources for growth in physicians and nurses are discussed.

Background Interpersonal trauma (IPT) is one of the most commonly reported types of traumatic experiences and has the greatest likelihood of resulting in a diagnosis of posttraumatic stress disorder (PTSD). Relative to other types of trauma, victims of IPT report greater trauma-specific rumination, whereby they focus on negative consequences of the trauma on their life. Theoretical and empirical work suggest trauma-specific rumination leads to elevated posttraumatic stress symptoms (PTSS); however, there has been a dearth of research examining how trauma type may impact this association. Therefore, the current longitudinal study examined how the experience of IPT moderates the relationship between trauma-specific rumination and later PTSS. Method Participants (N = 204) enrolled in a clinical trial completed self-report measures of trauma experience, trauma-specific rumination, and PTSS at baseline and 1-month follow-up appointments. Results Results revealed that IPT moderated the relationship between baseline rumination and 1-month trauma symptoms, even after covarying for participant age and sex, treatment condition, negative affect, and number of previously experienced traumas. Further, this moderation effect was specific to the PTSD numbing cluster. Limitations Major limitations include measurement of PTSS via PCL-C rather than the PCL-5, as well as a limited sample size, precluding moderation analyses of other trauma types. Conclusions The current study provides novel findings demonstrating specificity of index trauma type in the longitudinal relationship between rumination and PTSS. Future work is needed to examine how IPT impacts the development of pathways between rumination and PTSS.

Background: Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. Methods: This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. Results: Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. Conclusion: Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.

Background Adult substance use contributes to high rates of child maltreatment, adverse parenting, and poor child well-being outcomes. The Children’s Bureau in the Administration for Children and Families, U.S. Department of Health and Human Services funded the Regional Partnership Grant (RPG) program to improve safety, well-being, and permanency outcomes for children at risk of or in out-of-home placements because of caregivers’ substance use. Objective This study estimates the effect of the RPG program on adult parenting and recovery outcomes, as well as child safety, permanency, and well-being outcomes. Participants and setting This study included samples from three RPG projects funded in 2014. A total of 437 families were included in the evaluation: 198 enrolled in RPG and 239 in the comparison group. Methods Outcomes included both administrative data and standardized instruments collected at program entry and exit. Impacts were calculated by comparing regression-adjusted differences between RPG participants and a well-matched comparison group. Results The RPG program showed two favorable and statistically significant impacts on adult outcomes: reduced trauma symptoms (ES = −0.25, p = 0.02), and depressive symptoms (ES = −0.25, p = 0.03). In addition, children enrolled in RPG had reduced behavior problems (ES = −0.31, p = 0.02) and reduced executive functioning deficits (ES = −0.31, p = 0.04). There were no significant impacts observed for child safety and permanency outcomes. Conclusions The RPG approach has produced several favorable impacts on key mental health needs of caregivers and children, establishing foundational evidence of program effectiveness. Additional evaluation research is necessary to understand the effectiveness on additional outcomes with a larger, more generalizable sample.

This study aimed to investigate the relationship between chronotype preference/sleep problems and symptom severity of children with Attention Deficit Hyperactivity Disorder (ADHD) during the COVID-19 outbreak and to assess the chronotype preference/sleep problems that may play a mediating role in the relationship between the reactions to trauma and severity of ADHD symptoms. The sample of this single-center cross-sectional study consisted of 76 children with ADHD and their parents. Trauma symptoms were evaluated with the Children's Impact of Event Scale (CRIES-8); sleep habits were assessed using the Children's Sleep Habits Questionnaire (CSHQ); and chronotype was assessed using the Children's Chronotype Questionnaire (CCQ). There were significant differences in CRIES-8 and CSHQ scores between the eveningness type group and the non-eveningness type group. The CRIES-8 scores of children with ADHD were related to the CCQ and CSHQ scores and severity of ADHD symptoms. In mediation analyses, sleep problems were found to be the full mediating factor in the relationship between CRIES-8 scores and severity of ADHD symptoms and the relationship between CCQ scores and the severity of ADHD symptoms. Our findings indicate that chronotype plays an important role on the negative effects of home confinement of ADHD children during the COVID-19 outbreak. The role of the full mediator of sleep problems in the path from cognition to the behavior of young ADHD and non-ADHD children confined to the home environment during the pandemic period requires further assessment.

Background The trauma experienced as a paramedic can have a devastating psychological impact on both professionals and students in training, and increases the risk of developing post-traumatic stress disorder (PTSD). Paramedics are often placed in high-risk situations involving multiple or sustained trauma and also experience high levels of occupational stress, which can produce adverse psychological and physiological responses. Despite these risks, understanding trauma and its various manifestations in paramedicine has not been well documented. Methods This narrative review describes the history and changes in diagnostic criteria, and contrasts the methods of measuring PTSD symptomology with the current criteria. Results PTSD was first defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) in 1980, however the diagnostic criteria and associated measurement tools failed to reflect the repeated and vicarious traumatic events experienced by paramedics. Currently, the majority of the measurement tools used to assess post-traumatic stress are still aligned with superseded diagnostic criteria and many only classify the symptoms of PTSD as present or absent with little consideration given to symptom severity. Consequently, these existing measurements of PTSD are out dated and inefficient in their ability to identify and measure PTSD using the revised criteria. Conclusion The development of a more specific measurement tool, which reflects the DSM-5 diagnostic criteria of trauma-related stressors within this population, will allow for a more comprehensive measurement of symptoms. Future research undertaken in this specific field will also help to inform education and training programs to assist with the negative impacts of trauma and aid in management and treatment of PTSD in paramedics.

Much correlational research has reported on the relationship that exists between clinically verified trauma symptoms in returning soldiers and self-reports of distress in their civilian partners. Subclinical trauma, despite being much more prevalent in returning military personnel, however has rarely been examined in relation to civilian partners’ psychological functioning; the role of mediating variables has also been scarcely considered. This study aimed to fill this gap. A sample of (N=26) soldiers that had returned from a tour of duty in the last three years completed questionnaires assessing: (a) military variables (e.g., total tours of duty, exposure to active combat) and (b) subclinical trauma symptoms. Soldiers’ civilian partners completed questionnaires assessing: (c) problem focused (PF) and disengaged (DS) coping behaviours, and (d) psychological distress. Civilian partners of returning soldiers experiencing greater subclinical trauma used fewer PF coping behaviours, thus resulting in elevated distress scores. These findings provide a clearly definable target for clinical intervention; by increasing the use of PF coping behaviours, civilian partners of trauma affected military husbands might be relatively protected against psychological distress.

Poor maternal mental health, including depression and high stress levels, can negatively impact many domains of child development, particularly among low-income, ethnic minority families experiencing multiple stressors. Low-income minority mothers, particularly Hispanic mothers, are also at increased risk of experiencing exposure to community violence and other types of trauma. However, studies exploring the additional impact of maternal trauma symptoms on children’s functioning are rare. This study aims to address this gap by examining the impact of maternal trauma symptoms on young children’s functioning in a low-income, predominantly Hispanic sample through the mechanisms of maternal depressive symptoms, and mother’s experiences of parenting stress and strain. The sample consisted of 158 biological mothers (58% Hispanic, 13% African American, 5.7% White American) who were participating in community-based mental health treatment for their children (MAGE = 3.7, SD = 1.2). Mothers completed questionnaires providing information on their children’s behaviors and their own mental health and stress levels at intake. Path analysis indicated that there was a significant indirect effect of maternal trauma symptoms on children’s behavior problems through maternal depressive symptoms and maternal stress in the parent-child relationship (β = 0.09, p

Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.

Child maltreatment can lead to a unique set of trauma stress among young children that can be challenging to measure. The purpose of this review was to review measures of maltreatment-related trauma outcomes (trauma-related symptoms and post-traumatic stress disorders) in very young children (ages 0–6) and to examine research trends in how and if child development is accounted for in this area of measurement. A systematic search strategy was used to identify articles in two databases, CINAHL and PsychInfo. Articles were eligible for inclusion in the review if they measured trauma symptoms in children ages 0–6, were quantitative research reports of studies conducted in North America, and were published in English. The search resulted in 74 articles meeting prespecified inclusion criteria. Results suggested that recognition of the ways maltreatment trauma affects child development and the importance of developmental sensitivity in assessing trauma symptoms has grown in recent years. However, many research studies did not use developmental frameworks and applied adult-oriented trauma symptom frameworks in measurement and treatment. Behavioral symptoms were the primary outcome of interest for this age group. There was also incongruity and lack of consensus about diagnostic tools for post-traumatic stress disorders in young children. Further research is needed to resolve theoretical and empirical controversies related to measurement and diagnosis of trauma symptomatology in young children.

Background: Prescription drug–related overdose deaths have increased dramatically in recent years. Women in the justice system experience high rates of drug use, victimization, trauma symptoms, and other health problems and would appear to be at high risk for nonmedical use of prescription drugs (NMUPD). This study will be among the first to describe prevalence and correlates of NMUPD among this population. Methods: This cross-sectional study collected data from 406 victimized women on probation and parole between 2010 and 2012. In a multiple logistic regression model, we differentiated women who reported past-year NMUPD from those who did not using demographic, health, other drug use, substance use treatment, and trauma symptom severity variables. Results: Past-year NMUPD was reported by 26.8% ( n = 109) of the overall sample. Women reporting NMUPD were significantly younger and more likely to be white. Past-year use of alcohol (adjusted odds ratio [AOR]: 3.3; 95% confidence interval [CI]: 1.8–6.1), marijuana (AOR: 3.6; 95% CI: 1.8–7.0), methamphetamines (AOR: 6.1; 95% CI: 1.7–21.3), and heroin (AOR: 8.4; 95% CI: 2.0–35.2) were significantly associated with NMUPD. Additionally, each unit increase in the measure assessing bodily pain was associated with a 40% increase (AOR: 1.4; 95% CI: 1.1–1.7) in the odds of NMUPD. Finally, meeting diagnostic criteria for posttraumatic stress disorder almost doubled (AOR: 1.9; 95% CI: 1.1–3.4) the odds of reporting past-year NMUPD. Conclusions: Victimized women on probation and parole report high rates of NMUPD, and this behavior intersects with other complex social, behavioral, psychological, and physical needs. The authors recommend increased access to trauma-informed correctional care among women in the justice system.

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with women’s trauma symptoms. Participants were 95 women recruited from domestic violence shelters. Women reported on their trauma symptoms, the frequency of IPV victimization, the use of a weapon during IPV, and police involvement over the year following shelter departure. Police involvement in IPV was associated with higher levels of reexperiencing trauma symptoms 1 year after shelter departure, even after controlling for baseline trauma symptoms, the frequency of IPV, and the use of a weapon during IPV. Women’s race and ethnicity did not moderate the results. These findings suggest police involvement in IPV incidents may be associated with higher levels of trauma symptoms experienced by women. Further investigation into law enforcement practices and policies to help reduce women’s distress is needed.

Background: Posttraumatic stress disorder (PTSD) is associated with abnormal hippocampal activity; however, the functional connectivity (FC) of the hippocampus with other brain regions in PTSD and its relations with symptoms warrants further attention. We investigated subregional hippocampal FC in PTSD during a resting state compared with a trauma-exposed control (TEC) group. Based on extant research, we targeted the FCs of the anterior and posterior hippocampal subregions with the amygdala, medial prefrontal cortex (mPFC), and the posterior cingulate (PCC). Methods: Resting-state functional magnetic resonance images were acquired from 11 individuals with PTSD and 13 trauma-exposed controls. Anterior and posterior hippocampal FC was compared between groups. Within the PTSD and TEC groups, subregional hippocampal FC was correlated with scores on the Clinician-Administered PTSD Scale (CAPS) at time of scan and 4 months post-scan. Results: Those with PTSD had significantly greater FC compared with the TEC group between the left posterior hippocampus and the bilateral PCC (g’s > .96). Direct contrasts of the Fisher z-transformed coefficients indicated that the correlations between CAPS scores 4 months post scan and the FC between the left hippocampal head and the right PCC (z = − 2.07, p = .039) as well as the FC between the right hippocampal tail and the right mPFC (z = − 2.19, p= .029) were significantly greater in the PTSD group compared to the TEC group. Conclusions: These results support between-group differences in posterior hippocampal FC and different relations with PTSD future symptoms, underscoring associations with the anterior and posterior hippocampus. These findings enrich our understanding of PTSD pathophysiology and provide support for future investigations of imaging biomarkers predictive of disease progression. Keywords: Posttraumatic stress disorder, Functional magnetic resonance imaging, Hippocampus, Trauma symptoms, Resting state connectivity

Purpose Physical and psychological challenges can arise from paediatric injury, which can impact child health outcomes. Evidence-based resources to promote recovery are limited. The low cost, portable Cellie Coping Kit for Children with Injury provides evidence-based strategies to help children manage injury-related challenges. This study aimed to describe intervention feasibility and explore initial outcomes (learning, quality of life [QOL], and trauma symptoms). Methods Three independent pilot studies were conducted. Child-parent dyads (n = 61) participated in the intervention; ~36% completed a 4-week follow-up assessment. Results Results suggested that the intervention was feasible (e.g., 95% of parents would recommend the intervention; >85% reported that it was easy to use). Over 70% of participants reported learning new skills. No statistically significant differences were detected for children's QOL or trauma symptoms preintervention to postintervention. Conclusion Preliminary research suggests that the Cellie Coping Kit for Children with Injuries is a feasible, low-cost, preventive intervention, which may provide families with strategies to promote recovery from paediatric injury. Future research, including a randomized controlled trial, ought to further examine targeted long-term intervention outcomes.

Eye Movement Integration (EMI) is a neurobiological therapeutic technique that aims to reduce trauma symptoms by utilizing specific eye movements. This article contributes to the understand...

Background A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. Methods A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. Results Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. Limitations Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. Conclusions Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.

Victimization has been associated with increased depression, anxiety, anger, and delinquency; yet, research on adolescent victimization has largely relied on variable-centered approaches to examine associations with singular outcomes. With secondary data from the Developmental Victimization Survey, we utilized latent profile analysis to identify subgroups of youth, ages 12–17, based on clusters of internalizing and externalizing behaviors. We also examined how the behavioral outcome clusters were associated with different forms of victimization. Four behavioral subscales were included within the latent profile analysis and a four-class model had the best fit. Youth in Class 3 (high depression, anxiety, anger, and delinquency) were significantly more likely to have experienced peer/sibling victimization and to have experienced indirect victimization than youth in Class 2 (high depression, anxiety, and anger). The study findings indicate that certain types of victimization have greater consequences on mental health and that the unique clustering of symptoms is at least partially accounted for by the types of victimization experienced.

Five randomized controlled trials have shown that child-parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = -.13, p = .018, and hyperarousal, β = -.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, βrange = .15 to .33, and for those who participated in fewer treatment sessions, βrange = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = -.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.