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1.
Acta Psychiatr Scand ; 145(6): 628-639, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35266162

RESUMO

OBJECTIVE: Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS: The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS: A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION: This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.


Assuntos
Transtornos Mentais , Transtornos de Estresse Pós-Traumáticos , Adolescente , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Progressão da Doença , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Psicometria , Psicoterapia , Qualidade de Vida , Reprodutibilidade dos Testes , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia
2.
J Trauma Stress ; 34(4): 711-720, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34048078

RESUMO

Developmental trauma disorder (DTD) and posttraumatic stress disorder (PTSD) have been found to have both shared and unique traumatic antecedents. The present study was an independent replication, with the DTD Structured Interview and the Traumatic Events Screening Instrument administered to 271 children in mental health treatment in six U.S. sites. On an unadjusted basis, DTD (27.3% prevalence, N = 74) and PTSD (40.2% prevalence, N = 109) both were associated with traumatic physical assault or abuse, family violence, emotional abuse, caregiver separation or impairment, and polyvictimization. After controlling for PTSD, DTD was associated emotional abuse, OR = 2.9, 95% CI [1.19, 6.95], and traumatic separation from a primary caregiver, OR = 2.2, 95% CI [1.04. 4.60], both of which also were associated with caregiver impairment, physical assault/abuse, and witnessing family/community violence. Three traumatic antecedents associated with PTSD were not associated with DTD: noninterpersonal trauma, sexual trauma, and traumatic loss. Children exposed to both traumatic victimization and attachment trauma (36.2%) or attachment trauma alone (32.5%) were more likely than children exposed only to victimization (17.5%) or those with no history of victimization or attachment trauma (8.1%) to meet the symptom criteria for DTD, χ²(3, N = 271) = 17.68, p < .001. Study findings replicate and extend prior DTD field trial study results, showing that, although PTSD and DTD share traumatic antecedents, DTD is uniquely associated with traumatic emotional abuse and caregiver separation. Further research is needed to examine how specific trauma types contribute to the risk, course, and severity of DTD.


Assuntos
Maus-Tratos Infantis , Vítimas de Crime , Violência Doméstica , Transtornos de Estresse Pós-Traumáticos , Criança , Humanos , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia
3.
J Trauma Stress ; 31(5): 631-642, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30338544

RESUMO

Developmental trauma disorder (DTD) has been proposed as clinical framework for the sequelae of complex trauma exposure in children. In this study, we investigated whether DTD is associated with different traumatic antecedents than posttraumatic stress disorder (PTSD). In a multisite sample of 236 children referred from pediatric or mental health treatment, DTD was assessed using the DTD Structured Interview. Trauma history was assessed using the Traumatic Events Screening Instrument (TESI). On an unadjusted basis, both DTD, odds ratios (ORs) = 2.0-3.8, 95% CI [1.17, 7.19]; and PTSD, ORs = 1.8-3.0, 95% CI [1.04, 6.27], were associated with past physical assault and/or abuse, family violence, emotional abuse, neglect, and impaired caregivers; and DTD was associated community violence, OR = 2.7, 95% CI [1.35, 5.43]. On a multivariate basis after controlling for the effects of PTSD, DTD was associated with family and community violence and impaired caregivers, ORs = 2.0-2.5, 95% CI [1.09, 5.97], whereas PTSD was only associated with physical assault and/or abuse after controlling for the effects of DTD, OR = 2.4, 95% CI [1.07, 4.99]. Exposure to both interpersonal trauma and attachment adversity was associated with the highest DTD symptom count, controlling for the PTSD symptom count. Although childhood PTSD and DTD share several traumatic antecedents, DTD may be uniquely associated with pervasive exposure to violent environments and impaired caregiving. Therefore, DTD warrants further investigation as a framework for the assessment and treatment of children with histories of interpersonal victimization and attachment adversity.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Abuso Sexual na Infância/psicologia , Violência Doméstica/psicologia , Acontecimentos que Mudam a Vida , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Análise de Variância , Criança , Progressão da Doença , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtorno Reativo de Vinculação na Infância/psicologia , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/etiologia
4.
J Trauma Stress ; 31(2): 255-264, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29532959

RESUMO

Risk for traumatic sequelae is conveyed directly by risk factors (i.e., exposure to trauma), and via the disruption of developmental competencies. Exposure to caregiver trauma is an especially salient risk factor, as its early and pervasive nature is likely to undermine multiple facets of development, most notably the emergence of cognitive controls (i.e., executive function [EF]). Deficits in EF have been observed among youth exposed to multiple types of trauma and are associated with a range of functional impairments, posttraumatic stress symptoms (PTSS), and behavioral disorders; they represent a mechanism by which the negative impact of caregiver trauma is conveyed. This study included 672 youth in residential placement, and examined the associations between both caregiver and noncaregiver trauma, measured by the Trauma History Profile (THP); executive dysfunction, measured by the Behavioral Inventory of Executive Function (BRIEF); PTSS, measured by the UCLA Posttraumatic Stress Disorder (PTSD) Reaction Index (PTSD-RI); and externalizing and internalizing problems, measured by the Child Behavior Checklist (CBCL). A structural equation model demonstrated direct associations between caregiver trauma and PTSS, ß = .15; noncaregiver trauma and externalizing problems, ß = .14; gender and PTSS, ß = .26, externalizing problems, ß = .12, and internalizing problems, ß = .26; and age and externalizing problems, ß = -.11. We observed indirect effects via deficits in EF between caregiver trauma and PTSS, ß = .04 and externalizing problems, ß = .19. Results indicate for screening for executive dysfunction among trauma-impacted youth is needed, as it represents a critical therapeutic target.


Assuntos
Maus-Tratos Infantis/psicologia , Função Executiva , Exposição à Violência/psicologia , Comportamento Problema , Adolescente , Ansiedade/etiologia , Cuidadores , Criança , Depressão/etiologia , Feminino , Humanos , Masculino , Modelos Psicológicos , Instituições Residenciais , Transtornos de Estresse Pós-Traumáticos/etiologia
5.
Int J Stress Manag ; 24(2): 173-195, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28458503

RESUMO

Research on Posttraumatic Stress Disorder and chronic childhood abuse has revealed that traditional trauma treatments often fail to fully address the complicated symptom presentation, including the somatic complaints, loss of awareness of one's emotional and physical being in the present moment, and overall lack of integration between the self and the body. The mindfulness-based intervention of hatha yoga shows promise as a complementary treatment, and focuses on personal growth in addition to symptom reduction. This qualitative study explored the experiences of thirty-one adult women with PTSD related to chronic childhood trauma who participated in a 10-week Trauma Sensitive Yoga class, specifically examining perceived changes in symptoms and personal growth. Five themes were identified that reflect participants' feelings of Gratitude and compassion, Relatedness, Acceptance, Centeredness, and Empowerment. Results and implications for research and clinical work are presented.

6.
Appl Psychophysiol Biofeedback ; 41(3): 251-61, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26782083

RESUMO

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.


Assuntos
Neurorretroalimentação/fisiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Doença Crônica/terapia , Eletroencefalografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
7.
J Anxiety Disord ; 99: 102766, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37690357

RESUMO

OBJECTIVE: Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD. METHOD: In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions. RESULTS: We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions. CONCLUSIONS: Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Adolescente , Humanos , Criança , Feminino , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Comorbidade , Psicopatologia , Acontecimentos que Mudam a Vida , Fatores de Risco
8.
J Child Adolesc Trauma ; 16(1): 145-159, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36776636

RESUMO

Youths and parents/caregivers who have experienced multiple forms of severe interpersonal trauma may demonstrate severe and persistent symptoms of complex trauma including high-risk behaviors. Engagement, and sustaining engagement, of these youths and parents/caregivers in evidence-supported trauma treatment is a critical challenge, especially when youths or parents/caregivers have experienced chronic traumas that may be expected to continue into the foreseeable future. An extensive literature review was conducted leading to development of an assessment framework that could increase engagement of youths and parents/caregivers in trauma treatment based on research on chronic trauma, complex trauma, Developmental Trauma Disorder (DTD), and factors that promote engagement. A multi-dimensional assessment guide was developed to enable clinicians to differentiate types of chronic trauma based on a continuum of past, current and expected exposure over time and then to use this guide collaboratively with youths and parents/caregivers to develop priorities for treatment and service planning that matches their needs and strengths. The assessment guide incorporates exposure to intra-familial and community forms of interpersonal trauma, attachment disruptions, established symptoms of PTSD, Complex PTSD and DTD, as well as social-emotional development. The assessment and treatment planning guides proposed in this article expand applicability of evidence-supported trauma-informed therapy to youths and families who have not been engaged by programs offering treatments that are focused on past or single incident traumas or do not address disrupted attachments, multi-generational experiences of adversity, discrimination and community violence, life-threatening dangers or the impact of chronic trauma on youth, parent/caregiver and family development.

9.
Res Child Adolesc Psychopathol ; 50(11): 1501-1513, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35476235

RESUMO

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.


Assuntos
Transtornos Mentais , Comportamento Autodestrutivo , Suicídio , Criança , Humanos , Adolescente , Psicopatologia , Ideação Suicida , Comportamento Autodestrutivo/epidemiologia , Transtornos Mentais/epidemiologia
10.
Res Child Adolesc Psychopathol ; 50(9): 1207-1218, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35438445

RESUMO

Developmental Trauma Disorder (DTD) is a proposed child psychopathology diagnosis with emotion/somatic, attention/behavioral, and self/relational dysregulation symptoms extending beyond posttraumatic stress disorder (PTSD). Confirmatory factor analyses (CFAs) tested four structural models with structured interview data for trauma history, PTSD, and DTD with 507 children receiving mental health or pediatric care ( N = 162, 32% diagnosed with DTD; N = 176; 35% with PTSD; N = 169, 33% with neither). A unidimensional model with a single latent variable had unacceptable fit (RMSEA = 0.094; CFI = 0.844). Compared to a model with PTSD and DTD as correlated first-order latent variables, a multidimensional model with correlated latent variables corresponding to the PTSD and DTD symptom clusters (Dc 2 =105.62, Ddf = 14, p < .001) and a hierarchical variant with correlated second order DTD and PTSD latent variables (Dc 2 =48.10, Ddf = 6, p < .001) fit the data better. The non-hierarchical multidimensional model was superior to the hierarchical variant (Dc 2 =66.05, Ddf = 8, p < .001). Stronger latent variable inter-correlations within PTSD and DTD domains than across domains, suggested that DTD and PTSD are distinguishable despite their inter-correlation. Exposure to family violence was the primary correlate of both the DTD and PTSD second-order latent variables. Results indicate that children's trauma-related symptoms involve six inter-correlated domains extend beyond PTSD's symptoms (i.e., re-experiencing, avoidance, arousal) to include DTD symptoms of emotional, cognitive-behavioral, and self-relational dysregulation. The inter-relationship of the DTD and PTSD latent variables suggest that DTD may constitute a component within a complex PTSD diagnosis paralleling the new adult CPTSD diagnosis.


Assuntos
Violência Doméstica , Transtornos de Estresse Pós-Traumáticos , Adulto , Nível de Alerta , Criança , Análise Fatorial , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Síndrome
11.
Eur J Psychotraumatol ; 13(2): 2133488, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36340008

RESUMO

Background: Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). Objective: To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. Method: Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. Results: A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). Conclusion: Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.


Antecedentes: El trastorno traumático del desarrollo (DTD en su sigla en inglés) es un diagnóstico psiquiátrico infantil propuesto para las secuelas psicopatológicas y del desarrollo de la victimización y el trauma del apego que se extiende más allá del trastorno de estrés postraumático (TEPT).Objetivo: Determinar si un subgrupo de niños afectados por un trauma se caracteriza por síntomas de DTD que se extienden más allá o coexiste con los síntomas del trastorno de estrés postraumático (TEPT).Método: Se realizaron análisis de clase latente (LCA en su sigla en inglés) centrados en la persona con datos de 507 niños (de 7 a 18 años de edad, (M = 12.11, DS = 2/92); 49% mujeres) remitidos al estudio por médicos pediátricos o de salud mental.Resultados: Una solución de cuatro clases fue óptima (LMR = 398.264, p < .001; Entropía = .93): (1) combinado DTD + TEPT (n = 150); (2) DTD predominante (n = 156); (3) TEPT predominante (n = 54); (4) síntomas mínimos (n = 147). De acuerdo con investigaciones previas, la clase DTD + TEPT tenía más probabilidades de haber experimentado abuso emocional traumático y negligencia (X2 (3) = 16.916 y 28.016, respectivamente, p < .001), y tenía la mayor comorbilidad psiquiátrica (F(3, 502) = 3.204, p < .05). Los miembros de la clase DTD predominante tenían más probabilidades de cumplir los criterios para el trastorno oposicionista desafiante (ODD en su sigla en inglés) (X2 (3) = 84.66, p < .001).Conclusión: Los síntomas de DTD pueden ocurrir con, o por separado de, los síntomas de TEPT. Los niños con síntomas de DTD + TEPT altos tenían una comorbilidad psiquiátrica extensa, mientras que aquellos con síntomas de DTD altos y síntomas mínimos de TEPT tenían muchas probabilidades de cumplir con los criterios para ODD. En la evaluación y tratamiento clínico y de investigación de niños con comorbilidad psiquiátrica compleja o problemas de comportamiento disruptivo, se deben considerar los síntomas de DTD, tanto junto con, como en ausencia de, síntomas de TEPT.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Criança , Humanos , Feminino , Adolescente , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Comorbidade , Saúde Mental
12.
Psychol Trauma ; 14(7): 1167-1174, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31855007

RESUMO

OBJECTIVE: The emergence of updated Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) criteria for posttraumatic stress disorder (PTSD), which includes modified criteria for young children, raises questions regarding the need for developmentally appropriate standalone psychiatric diagnosis encompassing complex trauma presentations in children. The present study addresses these questions by examining how DSM-5 PTSD and proposed developmental trauma disorder (DTD) diagnoses relate to functional impairment and trauma exposure using clinician-report surveys. METHOD: We surveyed psychotherapists across the United States, and asked them to report on the symptom characteristics, functional impairment, and trauma exposure of children, adolescents, and young adults under their care (n = 210; age range = 2-21). We fit symptom data to the draft criteria for (1) DTD, a proposed trauma diagnosis for children and (2) existing criteria for adult and child/preschool PTSD. RESULTS: Results indicated that comorbidity between DTD and PTSD was high (52.4% and 59.9% for adult and child/preschool criteria, respectively). Comorbid DTD/PTSD and DTD-alone groups had more functional domains impacted and greater exposure to some types of trauma relative to the other groups. CONCLUSIONS: These findings speak to the relationship between trauma complexity and wide-ranging symptom presentations, provide support for research and clinical emphasis on a developmentally informed diagnosis, and may support existing treatment approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Transtornos de Estresse Pós-Traumáticos , Adolescente , Adulto , Criança , Pré-Escolar , Comorbidade , Coleta de Dados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
13.
J Am Psychiatr Nurses Assoc ; 17(6): 431-44, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21868714

RESUMO

BACKGROUND: The Trauma Center at Justice Resource Institute has adapted a form of Hatha yoga into a trauma-sensitive adjunctive component of intervention for use with complexly traumatized individuals exhibiting chronic affective and somatic dysregulation and associated behavioral, functioning, and health complaints. OBJECTIVES: This article explores the use of yoga with traumatized youth (aged 12-21 years) in residential treatment. DESIGN: A review of the literature on the somatic impact of trauma exposure provides a rationale for the use of yoga with this population and highlights an emerging evidence base in support of this practice. Case vignettes illustrate the integration of structured, gentle yoga practices into residential programming for youth with severe emotional and behavioral problems. RESULTS: Anecdotal data and clinical observation underscore the promise of yoga as a viable approach to build self-regulatory capacity of traumatized youth. CONCLUSIONS: Future directions in the development and evaluation of trauma-informed yoga practices for youth are discussed.


Assuntos
Tratamento Domiciliar , Estresse Psicológico/psicologia , Yoga/psicologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Meditação/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Transtornos do Humor/psicologia , Transtornos do Humor/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Transtornos Somatoformes/psicologia , Transtornos Somatoformes/terapia , Estresse Psicológico/terapia , Adulto Jovem
14.
J Am Psychiatr Nurses Assoc ; 17(6): 378-92, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22142975

RESUMO

Research has established that chronic stress, including traumatic events, leads to adverse health outcomes. The literature has primarily used two approaches: examining the effect of acute stress in a laboratory setting and examining the link between chronic stress and negative health outcomes. However, the potential health impact of a single or acute traumatic event is less clear. The goal of this literature review is to extend the literature linking both chronic trauma exposure and posttraumatic stress disorder to adverse health outcomes by examining current literature suggesting that a single trauma may also have negative consequences for physical health. The authors review studies on health, including cardiovascular, immune, gastrointestinal, neurohormonal, and musculoskeletal outcomes; describe potential pathways through which single, acute trauma exposure could adversely affect health; and consider research and clinical implications.


Assuntos
Doença , Nível de Saúde , Acontecimentos que Mudam a Vida , Transtornos de Estresse Pós-Traumáticos/complicações , Estresse Psicológico/complicações , Doenças Cardiovasculares/complicações , Comorbidade , Gastroenteropatias/complicações , Humanos , Hidrocortisona , Doenças do Sistema Imunitário/complicações , Doenças Musculoesqueléticas/complicações , Dor/complicações , Transtornos Psicofisiológicos/complicações , Saúde Reprodutiva , Fatores de Risco
15.
Eur J Psychotraumatol ; 12(1): 1929028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34249242

RESUMO

Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.


Antecedentes: El Trastorno por Trauma del Desarrollo (TTD) tiene una amplia comorbilidad con trastornos internalizantes y externalizantes distintos del trastorno de estrés postraumático (TEPT).Objetivo: Replicar los hallazgos de la comorbilidad del TTD y determinar si esta comorbilidad es distinta y se extiende más allá de las comorbilidades del TEPT.Método: Se evaluó el TTD mediante una entrevista estructurada, y se identificaron probables trastornos psiquiátricos del DSM-IV con módulos de detección KSADS-PL, en una muestra multicéntrica de 271 niños (de 8 a 18 años de edad; 47% mujeres) en tratamiento en salud mental ambulatorio o residencial por múltiples (M = 3,5 [SD = 2,4]) diagnósticos psiquiátricos distintos del TEPT o el TTD.Resultados: El TTD (N=74, 27%) y el TEPT (N=107, 39%) fueron altamente comórbidos y compartían varias comorbilidades de trastornos internalizantes y externalizantes del DSM-IV. Los niños con TTD con o sin TEPT tenían más diagnósticos comórbidos (M = 5,7 y 5,2 [SD = 2,4 y 1,7], respectivamente) que los niños con TEPT pero sin TTD (M = 3,8 [SD = 2,1]) o sin TEPT ni TTD (M = 2,1 [SD = 1,9]), F[3,267] = 55,49, p < .001. Además, en una base multivariante que controlaba los datos demográficos e incluía todos los posibles trastornos comórbidos, el TTD se asoció con el trastorno de ansiedad por separación, la depresión y el trastorno oposicionista desafiante después de controlar el TEPT, mientras que el TEPT se asoció sólo con el trastorno de ansiedad por separación después de controlar el TTD. Tanto el TTD como el TEPT se asociaron con suicidalidad.Conclusiones: El DTD se asocia con comorbilidad psiquiátrica más allá del TEPT, y el DTD justifica una evaluación para la planificación del tratamiento con niños en servicios psiquiátricos intensivos.


Assuntos
Comorbidade , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adolescente , Ansiedade de Separação/psicologia , Criança , Transtorno Depressivo/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Escalas de Graduação Psiquiátrica
16.
Psychol Trauma ; 12(8): 918-929, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32658503

RESUMO

OBJECTIVE: Developmental trauma or chronic early childhood exposure to abuse and neglect by caregivers has been shown to have a long-lasting pervasive impact on mental and neural development, including problems with attention, impulse control, self-regulation, and executive functioning. Its long-term effects are arguably the costliest public health challenge in the United States. Children with developmental trauma rarely have a satisfactory response to currently available evidence-based psychotherapeutic and pharmacological treatments. Neurofeedback training (NFT) is a clinical application of brain computer interface technology, aiming to alter electrical brain activity associated with various mental dysfunctions. NFT has shown promise to improve posttraumatic stress disorder (PTSD) symptoms. METHOD: This randomized controlled study examined the effects of NFT on 37 children, aged 6-13 years with developmental trauma. Participants were randomly divided into active NFT (n = 20) or treatment-as-usual control (n = 17). Both groups underwent 4 assessments during equivalent timelines. The active group received 24 NFT sessions twice a week. RESULTS: This pilot study demonstrated that 24 sessions of NFT significantly decreased PTSD symptoms, internalizing, externalizing, other behavioral and emotional symptoms, and significantly improved the executive functioning of children aged 6-13 years with severe histories of abuse and neglect who had not significantly benefited from any previous therapy. CONCLUSIONS: NFT offers the possibility to improve learning, enhance self-efficacy, and develop better social relationships in this hitherto largely treatment-resistant population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/terapia , Neurorretroalimentação/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Criança , Feminino , Humanos , Masculino , Projetos Piloto
17.
Psychol Trauma ; 12(8): 878-887, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32496098

RESUMO

Objective: Wilderness therapy (WT) is a complementary/integrative approach for treating struggling adolescents by using outdoor adventure activities to foster personal and interpersonal growth/well-being. Empirical support for the effectiveness of traditional WT is growing, but evidence supporting trauma-informed WT (TIWT) is lacking. This pilot study addresses that gap. Method: Between 2009 and 2019, 816 adolescents (Ages 13-17, Mage = 15.36, SD = 1.25; 41.1% female) completed the Youth-Outcome Questionnaire-SR 2.0 at intake and discharge (M = 75.02 days, SD = 28.77). Three-hundred seventy-eight adolescents also completed the Family Assessment Device-General Functioning (FAD-GF), and 253 adolescents completed two, 2.5-min segments of heart-rate-variability biofeedback (one while resting and one while using a coping skill). One-hundred eighty-nine caregivers completed the Youth-Outcome Questionnaire 2.01, and 181 caregivers completed the FAD-GF. Between 25 and 99 adolescents and caregivers also completed psychological and family measures at 6 months and 1 year postdischarge. Results: Adolescents reported experiencing improvements in psychological and family functioning. They also exhibited improvement in psychophysiological functioning (heart-rhythm coherence). Caregivers reported improvements in family functioning and their child's psychological functioning. Caregivers observed more persisting benefits in their child's psychological functioning, whereas adolescents reported more persisting benefits in family functioning. Changes in psychological and family functioning were related. There were very few differential effects on the basis of demographic factors, trauma exposure, or past and current treatment factors. Conclusion: Results of this pilot study suggest TIWT is a promising complementary/integrative intervention for improving the psychological, family, and psychophysiological functioning of struggling adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Terapias Complementares/métodos , Psicoterapia/métodos , Tratamento Domiciliar/métodos , Transtornos de Estresse Traumático/psicologia , Transtornos de Estresse Traumático/terapia , Meio Selvagem , Adaptação Psicológica , Adolescente , Terapias Complementares/psicologia , Relações Familiares/psicologia , Feminino , Humanos , Masculino , Projetos Piloto , Inquéritos e Questionários , Resultado do Tratamento
18.
Eur J Psychotraumatol ; 10(1): 1562841, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30728917

RESUMO

Background: Developmental trauma disorder (DTD) has been proposed to describe the biopsychosocial sequelae of exposure to interpersonal victimization in childhood that extend beyond the symptoms of post-traumatic stress disorder (PTSD). Objective: To characterize the psychopathology comorbid with DTD and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders were identified with screening modules on the Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime version (K-SADS-PL), in a multi-site sample of 236 children (7-18 years old; 50% female) referred by paediatric or mental health providers. Results: DTD (N = 80, 34%) and PTSD (N = 69, 29%) were highly comorbid and shared several DSM-IV internalizing disorder and DSM, 5th Edition (DSM-5) dysregulation disorder comorbidities. However, DTD, but not PTSD, was associated with comorbid panic disorder and disruptive behaviour disorders. On a multivariate basis including all probable DSM-IV disorders and DSM-5 dysregulation disorders, DTD was associated with separation anxiety disorder and attention deficit hyperactivity disorder after controlling for PTSD, while PTSD was associated with major depression and generalized anxiety disorder after controlling for DTD. Conclusions: DTD's comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behaviour disorders. DTD warrants further investigation as a potential diagnosis or a complex variant of PTSD in children, similar to the adult symptoms of disturbances of self-organization in the proposed International Classification of Diseases, 11th revision (ICD-11) complex post-traumatic stress disorder subtype.


Antecedentes: El Trastorno Traumático del Desarrollo ha sido propuesto para describir las secuelas psicosociales de la exposición a la victimización interpersonal en la infancia que se extiende más allá de los síntomas del trastorno de estrés postraumático (TEPT).Objetivo: Caracterizar la comorbilidad psicopatológica con el DTD y determinar si esta comorbilidad es diferente de, y se extiende más allá, de las comorbilidades del TEPT.Método: El DTD fue evaluado por medio de una entrevista estructurada, y probables trastornos psiquiátricos bajo el DSM-IV fueron identificados con los módulos de tamizaje KSADS-PL (en sus siglas en inglés), en una muestra 236 niños (de edades entre 7 y 18 años de edad; 50% mujeres) provenientes de múltiples sitios y que fueron referidos por proveedores pediátricos y de salud mental.Resultados: El DTD (N=80, 34%) y el TEPT (N = 69, 29%) fueron altamente comórbidos y compartieron comorbilidades con el trastorno internalizado del DSM-IV y el trastorno de desregulación del DSM-5. Sin embargo, el DTD, pero no el TEPT, se asoció a comorbilidad con trastorno de pánico y trastornos de la conducta disruptiva. Sobre una base multivariada incluyendo todos los probables trastornos del DSM-IV y los trastornos de desregulación del DSM-5, el DTD se asoció con el trastorno de ansiedad por separación y con el trastorno de déficit atencional con hiperactividad luego de controlar el TEPT, mientras que el TEPT se asoció con la depresión mayor y el trastorno de ansiedad generalizada luego de controlar el DTD.Conclusiones: Las comorbilidades del DTD se superponen con, pero se entienden más allá del TEPT para así incluir pánico, ansiedad de separación, y los trastornos de la conducta disruptiva. El DTD garantiza las investigaciones futuras como un potencial diagnóstico o una variante compleja del TEPT en niños, similar a los síntomas adultos de las perturbaciones en la auto-organización en el subtipo del TEPT Complejo propuesto del CIE-11.

19.
PLoS One ; 14(4): e0215940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31017962

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0166752.].

20.
Psychol Assess ; 31(11): 1294-1306, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31318252

RESUMO

Categorizing and quantifying exposure to trauma and childhood adversities (CAs) presents a significant measurement and analytic challenge. The current study examined the co-occurrence of trauma and CA types using network analyses, an alternative to traditional measurement models. The Trauma History Profile, assessing lifetime exposure to 20 different trauma and CA types, was administered to 618 treatment-seeking children and youth ages 4 to 18 years (52.8% female). The generalized similarity model (Kovács, 2010) was used to construct a network of trauma/CA types to visualize relationships and detect cohesive groups. Four clusters of trauma/CA types emerged: overt forms occurring at the individual level (e.g., physical, sexual, and psychological maltreatment), environmental forms at the family level (e.g., neglect, impaired caregiving), environmental forms occurring at the community level (e.g., community and school violence), and acute forms (e.g., loss, medical trauma). Age of onset data indicated that neglect and psychological maltreatment were most predictive of later occurrences of other trauma and CAs. Structural equation modeling indicated that trauma/CA clusters displayed specific associations with posttraumatic stress, internalizing, and externalizing symptoms. Results demonstrate the potential utility of network analysis to understand the co-occurrence and temporal ordering of multiple types of trauma and CAs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Maus-Tratos Infantis/psicologia , Violência/psicologia , Ferimentos e Lesões/psicologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Mecanismos de Defesa , Análise Fatorial , Feminino , Humanos , Masculino
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