Interparental conflict trajectories across various child residence arrangements when parents live apart.

In Norway, as in most Western countries, a growing proportion of parents living apart choose shared residence for their children. The aim of this study was to investigate trajectories of five interparental conflict dimensions across four child residence arrangement groups (and three combination groups) to improve understanding of different conflict trajectories when parents live apart. We used data from the Dynamics of Family Conflict study. Families (N = 1136) were recruited from 37 family counseling centers across Norway. Parents answered questionnaires in three waves: Wave 1 (December 2017 through August 2019); Wave 2 (November 2019 through January 2021); and Wave 3 (April through May 2021). Mixed effects analyses indicated that (a) for all conflict dimensions, there was less conflict and more cooperation over time across all residence arrangements; (b) except for children's involvement in conflict, the conflict dimensions did not develop differently over time between residence arrangements; (c) families with arrangements in which one parent had minority time (1%-14% and 15%-34%) were more likely to report children being involved in their parents' arguments over time than the 35%-49% and 50/50 residence groups; (d) for families with high relational risk pattern, children's involvement in conflict did not decline in either a high (1-34%) or a low degree (35%-49%) of sharing; and (e) families with a violent risk pattern and low degree of sharing (1%-34%) had the steepest decrease in conflict frequency/intensity over time. Even with an average decrease in destructive conflict dimensions over time, the findings point to the need for providing support for parents with complex needs, particularly for parents with a high relational risk pattern.

The impact of school closure and social isolation on children in vulnerable families during COVID-19: a focus on children's reactions.

For children the consequences of the COVID-19 public health measures may have long-term effects into adulthood. By exploring children's reactions more broadly, we are better placed to understanding the breadth of implications of home school and social isolation under COVID-19. The present study explored how COVID-19 related variables, namely, home school experience, child perceived family stress and instability, screen time use, missing friends and worry about virus infection are associated with children's emotional, somatic/cognitive and worry reactions, respectively. A total of 442 children (M = 11.43 years, SD = 2.59) from the longitudinal FamilieForSK-study participated and a series of hierarchical linear regression models were applied controlling for background variables including children's psychological vulnerability. Results showed significant associations between all COVID-19 related predictors, except screen time use, and the three outcomes. Family stress and instability had the strongest effects with standardised betas ranging from .356 to .555 and collectively, predictors explained between 20.7 and 44.1% of variance in outcomes. Furthermore, several associations were moderated by age and older children were more negatively impacted (i.e., higher level of reported reactions). The present study provides more conclusive evidence of the effects of home school and social isolation under COVID-19 on children. It also exemplifies the importance of focusing on children's reactions more broadly, as there was evidence that children on average had fewer emotional reactions compared to before the pandemic.

The importance of the DSM-5 posttraumatic stress disorder symptoms of cognitions and mood in traumatized children and adolescents: two network approaches.

BACKGROUND: The aim of this study is to provide a better understanding of the central symptoms of DSM-5 posttraumatic stress disorder (PTSD) in children and adolescents from the perspective of the child and its caregiver. Identifying core symptoms of PTSD can help clinicians to understand what may be relevant targets for treatment. PTSD may present itself differently in children and adolescents compared to adults, and no study so far has investigated the DSM-5 PTSD conceptualization using network analysis. METHODS: The network structure of DSM-5 PTSD was investigated in a clinical sample of n = 475 self-reports of children and adolescents and n = 424 caregiver-reports using (a) regularized partial correlation models and (b) a Bayesian approach computing directed acyclic graphs (DAGs). RESULTS: (a) The 20 DSM-5 PTSD symptoms were positively connected within the self-report and the caregiver-report sample. The most central symptoms were negative trauma-related cognitions and persistent negative emotional state for the self-report and negative trauma-related cognitions, intrusive thoughts or memories and exaggerated startle response for the caregiver-report. (b) Similarly, symptoms in the negative alterations in cognitions and mood cluster (NACM) have emerged as key drivers of other symptoms in traumatized children and adolescents. CONCLUSIONS: As the symptoms in the DSM-5 NACM cluster were central in our regularized partial correlation networks and also appeared to be the driving forces in the DAGs, these might represent important symptoms within PTSD symptomatology and may offer key targets in PTSD treatment for children and adolescents.

Cost-Effectiveness Analysis of Trauma-Focused Cognitive Behavioral Therapy: A Randomized Control Trial among Norwegian Youth.

Traumatic events by young people can adversely affect their psychological and social well-being when left untreated. This can result in high costs for society. In this study, we aimed to evaluate whether trauma-focused cognitive behavioral therapy (TF-CBT) is a cost-effective alternative to therapy as usual (TAU). Individual-level data were collected from 2008 to 2013, as part of a randomized control trial in Norwegian youth, 10-18 years of age, presenting with symptoms of posttraumatic stress (N = 156). Health outcomes, costs, and patient and family characteristics were recorded. Health-related quality of life (HRQoL) was measured with the 16D instrument, and quality-adjusted life-years (QALYs) were derived; total costs included the costs of therapy, and last we calculated the incremental cost-effectiveness ratio (ratio of differences in costs and QALYs gained). We performed nonparametric bootstrapping and used the results to draw a cost-effectiveness acceptability curve depicting the probability that TF-CBT is cost-effective. HRQoL increased in both treatment groups, whereas no significant differences in QALYs were observed. Resource use measured in minutes per session was significantly higher in the TF-CBT group; however, total minutes of therapy and costs were not significantly different between the two groups. In addition, use of resources, such as psychological counseling services, welfare services, and medication, was lower in the TF-CBT group posttreatment. The likelihood of TF-CBT being cost-effective varied from 91% to 96%. TF-CBT is likely to be a cost-effective alternative to standard treatment and should be recommended as the guideline treatment for youth with posttraumatic stress disorder.

Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents.

In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar's tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.

Change in post-traumatic cognitions mediates treatment effects for traumatized youth-A randomized controlled trial.

Posttraumatic stress symptoms (PTSS) are associated with serious impairments in psychological, social, and academic functioning in youth. The aim of this study was to investigate whether changes in posttraumatic cognitions mediate treatment effects. Participants were multitraumatized youth (N = 156, mean age = 15.1 years, range = 10-18; 79.5% girls) randomly assigned to receive trauma-focused cognitive-behavioral therapy (TF-CBT) or treatment-as-usual (TAU). Mixed-effects models were applied to investigate the impact of treatment conditions on posttraumatic cognitions. Mediation analyses were applied to examine whether changes in posttraumatic cognitions mediated the relationship between treatment conditions and outcome in posttraumatic stress symptoms, depressive symptoms, and general mental health. Participants receiving TF-CBT reported significantly lower levels of negative posttraumatic cognitions at the end of treatment compared to participants in TAU. Change in posttraumatic cognitions mediated the treatment effect difference found for PTSS. When the overall change in cognition was divided into early and late changes, it was only the late change that significantly mediated the PTSS treatment effect. A mediation effect of posttraumatic cognitions was also found for the treatment effect difference in depressive symptoms and in general mental health symptoms. Traumatized youth report having many negative posttraumatic cognitions and changes in negative cognitions plays a key role for treatment outcome. (PsycINFO Database Record

A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth.

The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, χ(2)(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States.

Longitudinal Covid-19 effects on child mental health: vulnerability and age dependent trajectories.

BACKGROUND: Few longitudinal studies have investigated the extended long-term impact of the Covid-19 pandemic for children's and adolescents' mental health, and a lack of uniform findings suggest heterogeneity in the impact of the pandemic. METHODS: This study investigated child and adolescent mental health symptoms across four occasions (pre-pandemic, initial lockdown, second lockdown, and society post reopening) using data from the Dynamics of Family Conflict study. Child and adolescent depressive vulnerability, age, and sex were explored as trajectory moderators. Children and adolescents (N = 381, Mage = 13.65, SD = 1.74) self-reported their anxiety, depression, and externalizing symptoms. Mixed effects analyses were performed to investigate trajectories across measurement occasions and interaction terms between occasion and moderator variables were included to better understand the heterogeneity in the impact of the pandemic. RESULTS: Children and adolescents reported increases in anxiety symptoms at the second lockdown (t(523) = -3.66, p < .01) and when society had reopened (t(522) = -4.90, p < .001). An increase in depression symptoms was seen when society had reopened relative to the three previous measurement occasions (ps < 0.01). Depressive vulnerability moderated the trajectory for anxiety symptoms (F(3,498) = 3.05, p = .028), while age moderated the trajectory for depression symptoms (F(3,532) = 2.97, p = .031). CONCLUSION: The delayed and negative impact on children's and adolescents' mental health underscores the need for continued monitoring, and implementation of support systems to help and mitigate further deterioration.

Effects of Covid-19 lockdown on parental functioning in vulnerable families.

Objective: The aim of this study was to increase the knowledge about how the initial Covid-19 lockdown influenced parental functioning in vulnerable families. Background: The Covid-19 pandemic has caused major changes to family life. Using a natural experiment design can potentially adjudicate on former inconclusive findings about the effects of lockdown on parental functioning in vulnerable families. Method: Responses from parents in a sample of potentially vulnerable families in Norway were divided into a lockdown group if participating at baseline and during the initial Covid-19 lockdown (n = 820 responses) or into a control group if participating at baseline and before lockdown (n = 1368 responses). Mixed model regression analyses were used to mimic a wait-list design investigating direct lockdown effects on mental health, parenting stress, and three aspects of interparental conflicts, as well as moderation effects. Results: The lockdown group showed significantly higher levels of parenting stress compared with the control group, but no aversive lockdown effect on mental health or destructive conflicts were found. In fact, decreased levels of verbal aggression and child involvement in conflict were found during lockdown among parents living apart. Pre-existing financial problems and conflict levels, age of youngest child, and parent gender did not moderate the lockdown effects. Conclusion: The initial lockdown did not seem to adversely affect parental functioning, beyond increased parenting stress. Caution should be taken when generalizing the findings as child effects and long-term lockdown effects were not investigated.

Agreement between child and parent reports of children's reactions to interparental conflict.

Children's perception of interparental conflict is still a relatively unexplored research area. The aim of this study was twofold. First, we wanted to gain more knowledge about the relationship between child and parent reports of children's reactions to interparental conflict across three dimensions: Emotional Reactions, Involvement Reactions, and Avoidance Reactions. Second, we sought to clarify whether disagreement between child and parent reports was related to the interparental conflict severity. The sample consisted of 377 dyads/triads of mothers, fathers, and 11-year-old children (53.2% girls) recruited from the Norwegian Mother, Father, and Child Cohort Study. Paired sample t-tests and correlation analyses were used to investigate the absolute and relative agreement between child and both parents' perceptions. Polynomial regression analyses with response surface plots were used to investigate whether absolute agreement between child and mother and father reports, respectively, was related to the interparental conflict severity. Overall, children reported significantly higher levels of Emotional, Involvement, and Avoidance Reactions than did both parents, and the correlations between the reports were low to moderate. The absolute agreement between child and parent reports was related to the severity of interparental conflict for Emotional and Avoidance Reactions in the sense that larger discrepancy was related to less interparental conflict severity. The findings indicate that parents do not fully grasp children's reactions related to interparental conflict. However, contrary to our hypothesis, when interparental conflict was more severe, parents' responses were more similar to children's responses. The importance of acknowledging children's self-reported reactions is discussed along with clinical implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived social support and posttraumatic stress symptoms in children and youth in therapy: A parallel process latent growth curve model.

Many studies show that perceived social support protects against the development of posttraumatic stress symptoms (PTSS) in the aftermath of trauma, but less is known about support in relation to PTSS in trauma therapy. This study examined associations between perceived social support and PTSS in children and adolescents during trauma therapy. Parallel process latent growth curve modeling was used to examine trajectories of perceived social support and PTSS over five measurement waves in a sample of 156 patients, aged between 10 and 18 years (M age = 15.1, SD = 2.2, 79.5% girls), randomized to receive trauma-focused cognitive behavior therapy (TF-CBT) or therapy-as-usual (TAU). Across all participants there was an average decline in PTSS and increase of perceived social support from pre-therapy to 18 months after therapy. Most of the change occurred during therapy and was maintained after therapy. Higher levels of PTSS prior to therapy were associated with lower levels of perceived social support prior to therapy, and a decrease in PTSS was associated with increase in perceived social support. This co-development may have been directed by a third underlying factor or short-term temporal effects. Studies investigating within-person associations over shorter time intervals will benefit our understanding of possible temporal effects.

Assessing Children's Responses to Interparental Conflict: Validation and Short Scale Development of SIS and CPIC-Properties Scales.

The Children's Perception of the Interparental Conflict Scale (CPIC) and The Security in the Interparental Subsystem (SIS) are two widely used scales capturing (a) children's perception of the interparental conflict properties and (b) children's reactions to the conflict. The aims of this study were to validate the part of CPIC measuring children's perception of the conflict (CPIC-properties) and a modified SIS-version in a Scandinavian context and to develop concise short versions of the scales. Confirmatory factor analyses (CFA) were used to analyze the underlying factor structure of the full and short versions of the scales in a sample of N = 393 children and youth aged 10-15 years old (M age = 11.1, SD = 0.5; 52.2% girls). Regression analyses were used in creating the short scales and in investigating the predictive strengths of the short versions. The full and short versions of the CPICproperties and the modified SIS had excellent fit according to a two level model (CPICproperties) and a three-level model (modified SIS). The CPIC-properties was reduced from 25 items to 17 items and the modified SIS was reduced from 38 items to 17 items. The internal consistencies of both long and short versions were satisfactory. The predictive strengths of the short subscales were comparable to the full subscales'. The findings support the validity of the full and short versions of the CPIC-properties and the modified SIS. The advantages of the short versions are discussed; these scales should be validated in future studies.

Trajectories and possible predictors of treatment outcome for youth receiving trauma-focused cognitive behavioral therapy.

OBJECTIVE: Even though there is strong evidence for the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for trauma-exposed youth, there are still youth who continue to struggle with posttraumatic stress symptoms (PTSS) after treatment. Investigating treatment trajectories and predictors of symptom change can increase our understanding of factors associated with nonresponse so that trauma treatment can be optimized. METHOD: The sample consisted of 155 youths (M age = 13.9 years, SD = 2.8, 72.3% girls) who received TF-CBT. To examine whether different treatment trajectories could be identified, growth mixture models with linear effects of time were estimated based on Clinical-Administered PTSD-Scale (CAPS-CA) scores at pretreatment, posttreatment and follow-up. We further explored whether gender, age, trauma type, comorbid depression and anxiety, and posttraumatic cognitions were associated with treatment response. RESULTS: The participants' trajectories could best be represented by 2 latent classes; nonresponders (21% of the sample) and responders (79% of the sample). The nonresponder group was characterized by a higher pretreatment PTSS level and slower improvement in PTSS compared with the responder group. Gender was the only significant predictor, where girls were more likely to be assigned to the nonresponder group. CONCLUSIONS: The findings indicate that clinicians need to be aware that girls and youth with high levels of pretreatment PTSS may be at risk of nonresponse. The results support previous findings showing that TF-CBT is suitable across different age groups and can be an effective treatment for youth with a range of traumatic experiences and additional comorbid symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Does the therapist matter? Therapist characteristics and their relation to outcome in trauma-focused cognitive behavioral therapy for children and adolescents.

BACKGROUND: There is a broad evidence-base for the effectiveness of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) in treating children and adolescents with posttraumatic stress disorder (PTSD). The effect of therapist characteristics on patient symptoms has been neglected in psychotraumatology research and necessitates further investigation. OBJECTIVE: This study aims to investigate the impact of therapist characteristics (gender, clinical experience and theoretical background) on posttraumatic stress symptoms (PTSS) in a heterogeneous and international sample of traumatized children and adolescents. METHOD: Data from two RCTs on the effectiveness of TF-CBT in Norway and Germany were included, comprising N = 52 therapists (78.8% female) and N = 153 patients (72.3% female). All therapists underwent thorough training and continuous supervision in TF-CBT. The Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) assessed pre- and post-treatment served as the outcome variable in a linear mixed-effects model with therapists' theoretical background, prior clinical experience and gender as independent variables, adjusted for patient gender, measurement time and country. The possibility of an interaction between therapist and patient gender was investigated subsequently. RESULTS: None of the therapist characteristics were significantly related to PTSS. There was no indication of an interaction between patient and therapist gender (p =.878). CONCLUSION: The lack of evidence for a relationship of therapists' theoretical orientation and clinical experience with outcome suggests that a wider dissemination of TF-CBT may be warranted. More studies with larger therapist and patient sample sizes and including only community practice are needed.

Antecedentes: Hay una amplia base de evidencia de la efectividad de la Terapia Cognitivo Conductual con foco en el trauma (TF-CBT) en el tratamiento de niños y adolescentes con Trastorno de Estrés Postraumático (TEPT). El efecto de las características del terapeuta sobre los síntomas del paciente ha sido dejado de lado en la investigación en psicotraumatología y requiere mayor investigación.Objetivo: Este estudio apunta a investigar el impacto de las características del terapeuta (género, experiencia clínica y conocimiento teórico) sobre los síntomas de estrés postraumático (PTSS) en una muestra heterogénea e internacional de niños y adolescentes traumatizados.Método: Se incluyeron datos de dos ERC (RCTs) acerca de la efectividad de la TF-CBT en Noruega y Alemania, que constan de N=52 terapeutas (78.8% mujeres) y N=153 pacientes (72.3% mujeres). Todos los terapeutas se sometieron a entrenamiento y supervisión contínua en TF-CBT. La Escala de TEPT administrada por clínicos para niños y adolescentes (CAPS-CA) aplicada pre y post tratamiento sirvió como variable de resultado en un modelo lineal de efectos mixtos con el conocimiento teórico del terapeuta, su experiencia clínica previa y género como variables independientes, ajustada por género del paciente, tiempo de medición y país. La posibilidad de una interacción entre el género del terapeuta y del paciente se investigó posteriormente.Resultados: Ninguna de las características del terapeuta se relacionaron significativamente a PTSS. No hubo indicios de una interacción entre el género del paciente y del terapeuta (p=.878).Conclusión: La falta de evidencia para una relación entre la orientación teórica y experiencia clínica del terapeuta y el resultado sugiere que se puede requerir una más amplia diseminación de TF-CBT. Se requiere mós estudios, con muestras de mayor tamaño de pacientes y terapeutas y que incluya sólo práctica comunitaria.

Emotional reactions in parents of the youth who experienced the Utøya shooting on 22 July 2011; results from a cohort study.

OBJECTIVE AND SETTING: The objective of this study was to provide knowledge about the emotional reactions in parents whose offspring experienced a mass shooting on Utøya island in Norway in 2011. The research questions included whether parents' reactions were influenced by their offspring's symptom level, age, living situation and parental gender. DESIGN: The study was designed as an open cohort study. The data were collected at two time points; 4-5 months and 14-15 months after the shooting. PARTICIPANTS: The participants were 531 parents of youth exposed to the Utøya island attack. OUTCOME MEASURES: The Parental Emotional Reaction Questionnaire measured parents' reactions, and University of California, Los Angeles Post-traumatic Stress Disorder Reaction Index measured youths' post-traumatic stress symptoms. RESULTS: Parental emotional reactions were positively related to post-traumatic stress reactions in offspring at wave 1: Est.=0.20, 95% CI 0.10 to 0.30, p<0.001, over time (wave 1and wave 2 nested within individuals): Est.=0.23, CI 0.13 to 0.32, p<0.001, and at wave 2: Est.=0.26, CI 0.12 to 0.39, p<0.001. Youths' age was not significantly related to parental emotional reactions, neither at wave 1: Est.=0.19, CI -0.40 to 0.77, p=0.531, over time: Est.=0.26, CI -0.27 to 0.79, p=328, nor at wave 2: Est.=0.32, CI -0.41 to 1.05, p=0.389. Mothers were more emotionally upset than fathers both at wave 1: Est.=-5.66, CI -7.63 to -3.69, p<0.001, over time: Est.=-5.36, CI -7.18 to -3.55, p<0.001, and at wave 2: Est.=-5.33, CI -7.72 to -2.53, p<0.001. CONCLUSIONS: The findings suggest that parenting after trauma should be addressed in outreach programmes and in planning of healthcare services.

A Follow-Up Study from a Multisite, Randomized Controlled Trial for Traumatized Children Receiving TF-CBT.

Trauma-focused cognitive behavioral therapy (TF-CBT) is the treatment of choice for traumatized youth, however, follow-up studies are scarce, and treatment effects for co-occurring depression show mixed findings. The aims of this study were to examine whether treatment effects of TF-CBT are maintained at 18 month follow-up and whether degree of co-occurring depression influences treatment effects. As rapid improvement in psychological functioning is warranted for youth, we also investigated whether the symptom trajectory was different for TF-CBT compared to therapy as usual (TAU). The sample consisted of 156 youth (M age = 15.05, 79.50% girls) randomly assigned to TF-CBT or TAU. The youth were assessed for posttraumatic stress symptoms (PTSS), depression, anxiety and general mental health symptoms. Mixed effects analyses followed the symptom courses over 5 time points. Youth receiving TF-CBT maintained their symptom improvement at 18 months follow-up with scores below clinical cut-of on all symptom measures. The most depressed youth had also a significant decline in symptoms that were maintained at follow-up. Symptom trajectories differed as the TF-CBT group reported a more rapid symptom reduction compared to the TAU condition. In the TAU condition, participants received 1.5 times the number of treatment sessions compared to the TF-CBT participants. After 18 months the groups were significantly different on general mental health symptoms only. In conclusion, youth receiving TF-CBT experienced more efficient improvement in trauma related symptoms than youth receiving TAU and these improvements were maintained after 18 months. Also youth experiencing serious co-occurring depression benefitted from TF-CBT.

International development and psychometric properties of the Child and Adolescent Trauma Screen (CATS).

BACKGROUND: Systematic screening is a powerful means by which children and adolescents with posttraumatic stress symptoms (PTSS) can be detected. Reliable and valid measures based on current diagnostic criteria are needed. AIM: To investigate the internal consistency and construct validity of the Child and Adolescent Trauma Screen (CATS) in three samples of trauma-exposed children in the US (self-reports: n=249; caregiver reports: n=267; pre-school n=190), in Germany (self-reports: n=117; caregiver reports: n=95) and in Norway (self-reports: n=109; caregiver reports: n=62). METHOD: Internal consistency was calculated using Cronbach's α. Convergent-discriminant validity was investigated using bivariate correlation coefficients with measures of depression, anxiety and externalizing symptoms. CFA was used to investigate the DSM-5 factor structure. RESULTS: In all three language samples the 20 item symptom score of the self-report and the caregiver report proved good to excellent reliability with α ranging between .88 and .94. The convergent-discriminant validity pattern showed medium to strong correlations with measures of depression (r =.62-.82) and anxiety (r =.40-.77) and low to medium correlations with externalizing symptoms (r =-.15-.43) within informants in all language versions. Using CFA the underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported (n =475 for self-report; n =424 for caregiver reports). LIMITATIONS: The external validation of the CATS with a DSM-5 based semi-structured clinical interview and corresponding determination of cut-points is pending. CONCLUSION: The CATS has satisfactory psychometric properties. Clinicians may consider the CATS as a screening tool and for symptom monitoring.

Factor structure of the Parent Emotional Reaction Questionnaire: analysis and validation.

BACKGROUND: Although many children experience violence and abuse each year, there is a lack of instruments measuring parents' emotional reactions to these events. One instrument, the Parent Emotional Reaction Questionnaire (PERQ), allows researchers and clinicians to survey a broad spectrum of parents' feelings directly related to their children's traumatic experiences. The objectives of this study were: (1) to examine the factor structure and the internal consistency of the PERQ; (2) to evaluate the discriminant validity of the instrument; and (3) to measure whether potential subscales are sensitive to change. METHOD: A Norwegian sample of 120 primary caregivers of a clinical sample of 120 traumatized children and youths (M age=14.7, SD=2.2; 79.8% girls) were asked to report their emotional reactions to their child's self-reported worst trauma. Exploratory factor analysis was used to explore the underlying factor structure of the data. RESULTS: The analysis of the PERQ showed a three-factor structure, conceptualized as PERQdistress, PERQshame, and PERQguilt. The internal consistencies of all three subscales were satisfactory. The correlations between the PERQ subscales and two other parental measurements revealed small to moderate effect sizes, supporting the discriminant validity of the PERQ subscales. The differences in sum scores of the PERQ subscales before and after a therapeutic intervention suggest that all of the subscales were sensitive to change. CONCLUSIONS: Study findings support the validity of conceptualizing the PERQ as three separate subscales that capture clinically meaningful features of parents' feelings after their children have experienced trauma. However, the subscales need to be further evaluated using a larger sample size and a confirmatory factor analytic approach.

The change and the mediating role of parental emotional reactions and depression in the treatment of traumatized youth: results from a randomized controlled study.

BACKGROUND: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has been shown to efficiently treat children and youth exposed to traumatizing events. However, few studies have looked into mechanisms that may distinguish this treatment from other treatments. The objective of this study was to investigate whether the parents' emotional reactions and depressive symptoms change over the course of therapy in the treatment conditions of TF-CBT and Therapy as Usual (TAU), and whether changes in the reactions mediate the difference between the treatment conditions on child post-traumatic stress (PTS) symptoms and child depressive symptoms. METHOD: A sample of 135 caregivers of 135 traumatized children and youth (M age = 14.8, SD = 2.2, 80% girls) was randomly assigned to receive either TF-CBT or TAU. The parents' emotional reactions were measured using the Parental Emotional Reaction Questionnaire (PERQ), and their depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). The children's outcomes were post-traumatic stress (PTS) reactions and depression, as measured by the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Mood and Feelings Questionnaire (MFQ), respectively. RESULTS: The parents' emotional reactions and depressive symptoms decreased significantly from pre- to post-therapy, but no significant differences between the two treatment conditions were found. The changes in reactions did not significantly mediate the treatment difference between TF-CBT and TAU on child PTS symptoms. However a mediating effect was found on child depressive symptoms. CONCLUSION: The results showed that although the parents experienced reductions in emotional reactions and depressive symptoms when their child received therapy, this was only significantly related to the difference in outcome between TF-CBT and TAU on child depressive symptoms. Possible explanations for these results are discussed along with the implications for clinicians and suggestions for future research. CLINICAL TRIALS IDENTIFIER: NCT00635752.

Diagnostic utility of CPSS vs. CAPS-CA for assessing posttraumatic stress symptoms in children and adolescents.

OBJECTIVES: This study compared the diagnostic utility of the symptom part of the child PTSD symptom scale (CPSS) screening instrument with the clinician-administered PTSD scale for children and adolescents (CAPS-CA). METHODS: The study included a clinical sample of traumatized children and adolescents (mean age 15.1, range 10-18) living in Norway, who were assessed for posttraumatic stress symptoms using the CPSS and the CAPS-CA. Diagnostic utility was investigated using receiver operating characteristic analyses. RESULTS: The results showed that CPSS reached medium effect sizes (AUC from .63 to .76). The sensitivity was good (.80), but the specificity was relatively low (.56). Kappa between CPSS and CAPS-CA was low (κ=.27). CONCLUSIONS: Findings suggests that CPSS is a good tool for screening purposes, but not as a diagnostic instrument in an early phase of assessment. Implications and limitations of the findings are discussed.