Parent–Child Discordance and Child Trauma Symptomatology Throughout Therapy: Correlates and Treatment Response

Children and their caregivers often disagree when reporting on child behavioural and emotional difficulties. But how does parent–child discordance relate to outcomes, particularly among children undergoing trauma therapy? This study examined parent–child discordance in relation to children’s trauma symptoms and therapy outcomes. Participants included 96 trauma-exposed children and their caregivers, who received Trauma-Focused Cognitive Behavioural Therapy. Discordance was calculated using absolute difference scores between child- and parent- reported psychological symptoms. Parent–child discordance, calculated at pre-therapy, post-therapy, and at a six-month follow-up, predicted the severity of children’s posttraumatic stress, dissociation, and internalizing and externalizing difficulties at each respective time-point. Pre-therapy discordance predicted improvements in externalizing behaviours after therapy and at follow-up. Improvements in discordance predicted improvements in trauma-specific symptoms over the course of treatment and at follow-up. The findings underscore how changes in parent–child discordance are related to child trauma symptoms and treatment response. Clinical implications and future directions are discussed.     

Modeling psychiatric patients' treatment decision making

Decision-making processes of psychiatric inpatients were assessed at admission and prior to discharge, and compared to hospital staff members using a paired comparison paradigm in which subjects chose between hypothetical antipsychotic medications. Multidimensional analyses of binary choice matrices revealed that all subjects based decisions on the risks and benefits of medication, and weighted risks and benefits in roughly equal proportions. Hospital staff demonstrated greater internal consistency in their decisions than the inpatient sample at both time points. For newly admitted inpatients, severity of psychiatric symptoms and nonverbal intelligence were related to internal consistency of decision making, and behavioral indices of medication compliance predicted relative weighting of risks and benefits. For predischarge and comparison samples, verbal intelligence and treatment preferences predicted both outcome measures. Reliance on verbal reports of decision making may be misleading when assessing competence in acutely impaired psychiatric patients.     

Do Not Make their Trauma Your Trauma: Coping with Burnout as a Family Law Attorney

In the field of family law, attorneys frequently expose themselves to highly emotional and traumatized clients. Litigation is by nature a high‐stress occupation, demanding a high level of intellectual and emotional engagement from the contesting lawyers. Adding the burden of inherently distressing content to litigation can impair a lawyer's functioning. The effects are often referred to as “secondary trauma.” This Note proposes that state bar associations should take a more active role in providing mental health support to prevent burnout in family law attorneys by (1) offering voluntary classes to educate attorneys about the dangers of, and ways to cope with, the burnout that comes with working with traumatized clients in family law and (2) organizing support groups among local family law communities.

Key Points for the Family Court Community:
• Claims against family law practitioners account for the third highest percentage of all malpractice claims against lawyers.
• Burnout is a serious problem for family law attorneys.
• Programs sponsored by state bar associations are available and need to be expanded.
• The American Bar Association's Model Rules require that a lawyer shall not represent a client or, where representation has commenced, shall withdraw from the representation of a client if the lawyer's physical or mental condition materially impairs the lawyer's ability to represent the client.
• The unique nature of family law, centered on relationships and emotions, puts family law attorneys at a higher risk for experiencing the effects of secondary trauma than other areas of law.
• Lawyers at risk for secondary trauma can avoid its effects by educating themselves about such effects.

     

Short-term effects of restorative justice conferences on post-traumatic stress symptoms among robbery and burglary victims: a randomized controlled trial

Objectives

To examine the impact of face-to-face restorative justice conference (RJC) meetings led by police officers between crime victims and their offenders on victims’ post-traumatic stress symptoms.

Methods

Two trials conducted in London randomly assigned burglary or robbery cases with consenting victims and offenders to either a face-to-face restorative justice conference (RJC) in addition to conventional justice treatment or conventional treatment without a RJC. Post-traumatic stress symptoms (PTSS) were measured with the Impact of Event Scale-Revised (IES-R) within 1 month of treatment for 192 victims. We assessed the prevalence and severity of PTSS scores following treatment, using independent sample t tests and chi square statistics. We further measured the magnitude of the differences between the groups, using effect size analyses.

Results

Analyses show that PTSS scores are significantly lower among victims assigned to RJC in addition to criminal justice processing through the courts than to customary criminal justice processing alone. There are overall 49 % fewer victims with clinical levels of PTSS, and possible PTSD (IES-R?≥?25). Main treatment effects are significant (t?=?2.069; p?Conclusions Findings suggest that restorative justice conferences reduce clinical levels of PTSS and possibly PTSD in a short-term follow-up assessment. Future research should include longer follow-up, larger and more stratified samples, and financial data to account for the cost benefit implications of RJ conferences compared to ordinary PTSS treatments.     

Malingered Posttraumatic Stress Disorder (PTSD) and the Effect of Direct Versus Indirect Trauma Exposure on Symptom Profiles and Detectability

Posttraumatic stress disorder (PTSD) is arguably prone to malingering due to its subjective and heterogeneous nature. Various factors can influence PTSD symptom profiles including trauma type and trauma exposure. However, it is unknown whether trauma exposure influences malingered PTSD symptom profiles. We used a malingering simulation design with trauma type controlled to compare (1) PTSD symptom profiles (Posttraumatic Stress Checliklist-5; PCL-5) at the syndrome, symptom cluster, and individual symptom levels and (2) symptom validity profiles (Structured Inventory of Malingered Symptomatology; SIMS) at the overall and subscale level, as a function of direct and indirect trauma exposure. Seventy-three participants were randomly assigned to either the direct (“witnessed” trauma) or indirect (“learned about” trauma) condition. Participants were coached about symptoms and instructed to simulate PTSD. PCL-5 profile analyses revealed that simulators in the direct exposure group reported greater overall PTSD severity. Significant differences were found on cluster D (changes in cognition and mood) and individual symptoms including intrusive thoughts, amnesia, difficulty experiencing positive emotions, and risk-taking. No differences were identified for any other symptom scores nor for the symptom validity profile, except for the SIMS total score (direct: M?=?33.0, SD?=?12.8, indirect: M?=?26.5, SD?=?13.9, t(71)?=?2.06, p?=?.043, d?=?.48). These findings indicate that trauma exposure can influence malingered PTSD profiles at the syndrome, symptom cluster, and individual symptom levels (small effects), but, with one exception for a summary score, it does not produce a detectable difference on symptom validity testing. This study may provide insight for clinicians into the how malingered PTSD profiles can manifest as a result of direct and indirect trauma exposure; however, further research is strongly indicated.     

Victimization and Poly-Victimization in Adolescent Outpatients from Mental Health Centers: A Case-Control Study

The aims of the present study were to establish interpersonal victimization rates in a clinical sample and to analyze this sample’s risk of victimization relative to the general population. The sample was composed of 472 adolescents (12–17 years of age): 118 outpatients from public mental health centers and 354 students who were matched by age and sex. Following previous studies, this research defined poly-victimization as four or more victimization types occurring during the previous year. The clinical group was more likely to report sexual victimization (OR = 9.540), conventional crime (OR = 3.120), caregiver victimization (OR = 3.469), witnessing and indirect victimization (OR = 3.466), electronic victimization (OR = 2.809), and poly-victimization (OR = 4.319) compared with the control group. Clinical samples present an increased risk of interpersonal poly-victimization compared with the general population. The influence of poly-victimization on mental health should be considered in the evaluation and treatment of adolescent outpatients.     

Betrayal trauma: associations with psychological and physical symptoms in young adults

Betrayal trauma, or trauma perpetrated by someone with whom a victim is close, is strongly associated with a range of negative psychological and physical health outcomes. However, few studies have examined associations between different forms of trauma and emotional and physical symptoms. The present study compared betrayal trauma to other forms of trauma as predictors of young adults' psychological and physical symptoms, and explored potential mediators. A total of 185 university undergraduate students completed the Brief Betrayal Trauma Survey, the Trauma Symptom Checklist, the Toronto Alexithymia Scale, and the Pennebaker Inventory of Limbic Languidness. For each set of symptoms, simultaneous multiple regressions assessed the relative contributions of low versus high betrayal trauma to psychological and physical health reports. Structural equation models examined traumatic stress symptoms and alexithymia as mediators of the relationship between betrayal trauma and physical health symptoms. A total of 151 participants (82%) reported exposure to at least 1 of 11 forms of trauma queried (M = 2.08, SD = 1.94); 96 participants (51.9%) reported at least 1 betrayal trauma. Traumas characterized by high betrayal predicted alexithymia, anxiety, depression, dissociation, physical health complaints, and the number of days students reported being sick during the past month, whereas other traumas did not. Structural equation modeling revealed that traumatic stress symptoms and alexithymia mediated the association between betrayal trauma and physical health complaints. These results indicate that betrayal trauma is associated with young adults' physical and mental health difficulties to a greater extent than are other forms of trauma. Results may inform assessment, intervention, and prevention efforts.     

Promoting awareness and prevention of child sexual victimization using the Red Flag/Green Flag program: An evaluation with follow-up

This study describes an evaluation of a school-based sexual abuse awareness and prevention program that featured the “Red Flag/Green Flag People” coloring book and included presentation of a film (“Better Safe than Sorry II”) and discussion of hypothetical and actual experiences involving inappropriate physical touching. Children, parents, and teachers from two experimental schools participated in the program and were compared to similar groups from a control school. Outcomes were evaluated using pre-post (2-month) assessment questionnaires. Among the findings obtained, experimental group children reported learning more about the differences between good and bad touching, and being more likely to both report instances of sexual victimization and utilize program-specific preventive skills, relative to controls. Parents exposed to program materials acknowledged greater improvements in knowledge about program goals and more positive communication at home about abuse. Although no significant differences were obtained for teachers, the ratings for one experimental group were consistently higher than those of the other groups. Staff volunteers evaluated the program as overwhelmingly positive and without adverse effects. Still, some children from all groups reported being touched inappropriately. Some of these improvements were also noted for the experimental group at 6-month follow-up assessment. The findings were discussed in the context of conceptual, clinical, training, and empirical considerations.     

Childhood Maltreatment Experiences and Child Abuse Potential: Temperamental Sensitivity as Moderator?

This study aimed to examine the relationship between negative experiences in childhood (physical-, sexual-, and emotional abuse and emotional neglect) and the risk for an individual to become a perpetrator of child maltreatment in adulthood. Participants were 337 female college students who completed self-report measures of childhood trauma and temperament. Risk for child abuse was assessed with the Child Abuse Potential Inventory. Results showed experiences of emotional neglect significantly predicted higher child abuse potential. Additionally it was shown that experiences of physical abuse significantly predicted higher child abuse potential but only in those individuals with high temperamental orienting sensitivity. These results underline the potentially damaging long-term effects of emotional neglect in childhood and indicate temperamental sensitivity may moderate the relationship between being abused as a child and being at risk for maltreating one’s own offspring.     

Criminal Recidivism After Forensic Psychiatric Treatment. A Multicenter Study on the Role of Pretreatment,Treatment-Related,and Follow-Up Variables

This study examined associations between criminal recidivism after discharge from forensic treatment and variables related to either the time before the current forensic treatment, or the current forensic treatment, or the follow-up after discharge. Participants were treated in 12 forensic clinics according to section 63 of the German penal code. A patient was classified as a criminal recidivist when the patient or the aftercare reported that the patient was delinquent at follow-up. Patients without criminal recidivism were patients for which both perspectives (patient and aftercare) reported no delinquency at follow-up. Mann–Whitney U-tests and Fisher's exact tests were performed. Data to classify patients were available for N = 249 patients. Fifteen patients (6%) were classified as criminal recidivists. The follow-up was M = 12.58 (SD = 1.84) months, and the criminal acts occurred M = 6.00 (SD = 5.55) months after discharge. Differences between patients with and without criminal recidivism were found in pretreatment (young age at first crime, early onset of mental disorder, previous forensic treatments), treatment-related (disorder due to psychoactive substance use, gradual release abuses, outbreaks, assaults against staff, criminal act during treatment, type of discharge, outcome ratings), as well as follow-up variables (no specified housing situation, not being abstinent from psychoactive substances, inpatient readmission, course of outpatient treatment, course of mental disorder) (all p < 0.05). To conclude, it is important to consider variables related to the time before the current treatment, treatment-related variables, and variables related to the follow-up to identify the patients at risk of criminal recidivism after discharge from forensic treatment.     

Adolescents’ Perceptions of Family Violence Risks

Nearly one-third (28.4 %) of adolescents experience some form of physical assault in the home. A survey of 176 adolescents documents optimistic bias; adolescents believe they are less likely than others to become victims of family violence. Elements of the Health Belief Model, perceived susceptibility and perceived severity, predicted optimistic bias. The study also considers the impact vicarious experience through the media on adolescent risk perception.     

Managing an on-the-spot lottery in reentry services

Objectives

Describe the authors?? experiences in designing and conducting a randomized field experiment of a community-based, reentry program for ex-offenders.

Methods

Two surveys: one with reentry clients not involved in our outcome evaluation, and a follow-up survey of participants who underwent randomization in order to participate in the outcome study. Qualitative input from program staff and clients were also recorded, supplemented with observations of the authors.

Results

Having a research staff member located at the program site proved to be a key advantage for monitoring frustrations voiced by program staff and prospective clients, thereby allowing for the modification of the selection procedures over time to minimize resistance. Ultimately, the simplest approach proved to be the most acceptable. The importance of certain procedural justice themes were suggested by the survey results and the observed acceptability of our on-the-spot lottery approach to randomization.

Conclusions

The survey results (and our onsite experiences) provided unequivocal evidence that randomization was unpopular, but that resistance can be partially mitigated by adhering to basic principles of procedural justice.     

Pilot Study of a Group-Based Psychosocial Trauma Recovery Program in Secure Accommodation in Scotland

The current study is the first to implement and evaluate a group-based trauma-specific program for adolescents in a secure accommodation facility in Scotland. A randomized control and qualitative pilot study compared an intervention group (n = 10), who received Teaching Recovery Techniques, to a waitlist control group (n = 7). Measures included subjective units of disturbance (SUDs), standardized trauma symptom questionnaires, and analysis of behavior monitoring logs. Adolescent interviews (n = 10) and a presenter focus group (n = 4) assessed program experience and views on future development. Sessions were videoed and analyzed for program adherence. Analysis involved MANOVA, and a quasi-qualitative thematic approach for participant views. Adolescents reported high SUDs and a range of trauma symptoms. A large effect size was found for reduced SUDs (d = 1.10) and positive trends were identified for symptoms and behavior change in the intervention group. Program adaptations included smaller groups, the use of visual materials and liaison with care staff to facilitate generalization. Recommendations are made for program development and large scale evaluation.     

Trauma,Psychiatric, Substance Use,and Thought Disorders Among Youth in the Juvenile Justice System and How to Deal with Them

The personal stories that youth in juvenile facilities report to their counselors are heartbreaking because they are filled with accounts of excessive trauma resulting from neglect, physical, sexual, and emotional violence perpetrated on these children. Perry found that trauma develops from severe neglect, abuse, and living in terrorizing environments. Trauma changes the neural processing ability within the child's developing brain which can lead to hypervigilance and dysfunctional behavior. ¹ Widom found that children who had been abused or neglected as children have 30% higher arrests as a juvenile and as an adult for a violent offense. ²      

Predictors of suicidal ideation, suicide attempts, and self-harm without lethal intent in a community corrections sample

Purpose

Little published research data exist about suicidal ideation and self-harm behavior in community corrections and we seek to fill this void.

Aims

To examine the effects of drug dependence, depression, anxiety, psychopathy, fracture, and child trauma on suicidal ideation, suicide attempts, and self-harm without lethal intent in community corrections.

Methods

The Semi-Structured Assessment for the Genetics of Alcoholism Revised (SSAGA II) and the screening version of the Hare Psychopathy Checklist (PCL:SV) were administered. Separate binary logistic regression analyses were used to predict lifetime suicidal ideation, suicide attempt, and self-harm behavior.

Results

Prevalences of suicidal ideation, suicide attempt, and self-harm without lethal intent were 41%, 19%, and 14%. Suicidal ideation was predicted by drug dependence, elevated PCL:SV Factor 2 score, and Caucasian race. Suicidal ideation and attempt were both predicted by fractures, depression, and child trauma. Self-harm was predicted by fractures, panic, PCL:SV score, and child trauma.

Conclusions

Child trauma and multiple fractures are potent predictors for suicidal ideation, suicide attempts, and self-harm without lethal intent in this community corrections sample. Depression predicted suicidal ideation and attempts, while panic predicted self-harm without lethal intent. Psychopathy was also an important predictor of suicidal ideation and self-harm behaviors without lethal intent.     

Maternal Childhood Sexual Trauma and Child Conduct Problems

This study examines multiple pathways by which maternal childhood sexual trauma may be related to the behavioral development of children. Propensity score matching procedures were used to create matched groups (total n?=?204) of mothers who retroactively did and did not self-report childhood sexual trauma in a longitudinal sample of families living in poor, rural communities. Using structural equation modeling, maternal characteristics and behaviors were examined as potential mediators of the relationship between maternal histories of childhood sexual trauma and children’s conduct problems. After controlling for numerous socio-demographic factors, analyses indicate that maternal depressive symptoms, intimate partner violence, and maternal parenting were significant mediators and highlight the lasting impact of childhood sexual trauma on victims and their children.     

Trauma Symptoms of Former Intimate Stalking Victims

Abstract

One-hundred-eighty-seven female victims stalked by former intimate partners were interviewed about their victimization experiences. To identify psychological symptoms experienced by the victims, Briere and Runtz's (1989) Trauma Symptom Checklist (TSC-33) was utilized in the interview. Individual items were combined to form five distinct scales as developed and validated by Briere and Runtz (1989). Findings reveal that the highest mean scores for the sample were on the items included in the Sleep Disturbance scale. In addition, overall TSC-33 scores and the Dissociation, Anxiety, Depression, and Post-Sexual Assault Trauma-hypothesized (PSAT-h) scale scores varied by whether or not victims had experienced violence during their former relationship with the stalker and by whether or not violence occurred during the stalking. The absence or presence of verbal threats of violence during the stalking, however, did not have an independent effect on most emotional symptoms when controlling for violence during stalking.     

Trauma Systems Therapy in Residential Settings: Improving Emotion Regulation and the Social Environment of Traumatized Children and Youth in Congregate Care

Although abundant evidence exists indicating the prevalence of trauma exposure among youth in residential care, few models exist for creating trauma-informed milieu treatment. This article outlines the problem and describes the implementation of Trauma Systems Therapy (TST) in three residential centers. TST is unique in emphasizing youth emotions and behaviors as well as the role a distressed or threatening social environment may play in keeping a traumatized youth in a dysregulated state. This dual emphasis makes TST specifically appropriate to implementation in congregate care, focusing assessment and intervention strategies on both clinical treatment and the functioning of the therapeutic milieu itself. Data are reported on incidents of the use of physical restraint; numbers of disrupted foster care placements following discharge from residential treatment; and scores on psychometric measures of children’s functioning and emotion regulation capacity. Knowledge gained through TST implementation in these three residential centers has important implications for developing a model of trauma-informed congregate care.     

Factor similarity of the Conflict Tactics Scales across samples,spouses, and sites: Issues and implications

Wide variations in prevalence estimates of marital aggression point to the absence of a uniform and adequate definition of marital aggression. To focus on the construct validity of Straus' (1979) Conflict Tactics Scales, the most frequently used measure of marital aggression, two studies were conducted. Based on responses to the Conflict Tactics Scales, two consistent factors (viz. Physical and Psychological Aggression) emerged in separate samples of 187 couples seeking therapy for marital problems, and 398 nonclinic couples in beginning marriages. The factor structure was consistent across clinic and nonclinic samples, sex, geographical sites, time, and socioeconomic status. Implications for the measurement of interspousal physical aggression are raised (e.g., mild, moderate, and severe aggression load on the same factor) and appropriate directions for further research on the construct validity of the Conflict Tactics Scales are suggested (e.g., conducting similar factor analyses on aggressive couples).