Stepping Together for Children After Trauma (ST-CT): Feasibility and Predictors of Outcome of a Parent-led, Therapist Assisted Treatment.

Stepping Together for Children after Trauma (ST-CT) is the first step of the promising intervention Stepped Care CBT for Children after Trauma. In ST-CT, the task of leading treatment is partially shifted to the parents, and the child and parent work together to complete therapeutic tasks from a workbook with therapist supervision. We aimed to investigate the feasibility of ST-CT in Norwegian first line services and explore child factors predicting outcome. Eighty-two children (mean age 9.9 years, 56% girls) participated. Feasibility was defined by treatment completion, reductions of child posttraumatic stress symptoms (PTSS) mid- and post-treatment, and client treatment satisfaction. Predictors included child baseline PTSS, depressive symptoms, posttraumatic cognitions, externalizing symptoms, number of different traumatic events, and type of trauma. Results showed that rates of completion (78.0%) and response (81% of completers/59.8% intention-to-treat) were comparable to previous studies by the ST-CT developer. Overall treatment effect was d = 2.46 and client treatment satisfaction was high (mean score child: 8.3, parent: 9.0, on a scale from 0 - 10). Higher baseline PTSS and depressive symptoms predicted poorer outcome at both mid- and post-treatment, while more posttraumatic cognitions, and exposure to interpersonal trauma predicted poorer outcome at mid-treatment only. These associations were no longer significant in the fully adjusted models. In conclusion, ST-CT shows promise as an effective first line treatment in this new context, with two of three children responding to the treatment. Baseline PTSS, depression, post-traumatic cognitions and type of trauma may be related to outcomes and should be explored further. (Trial registration:  ClinicalTrials.gov Identifier: NCT04073862. Retrospectively registered June 3rd 2019, first patient recruited May 19th 2019).

What is preexisting strength? Predicting free association probabilities, similarity ratings, and cued recall probabilities.

Measuring lexical knowledge poses a challenge to the study of the influence of preexisting knowledge on the retrieval of new memories. Many tasks focus on word pairs, but words are embedded in associative networks, so how should preexisting pair strength be measured? It has been measured by free association, similarity ratings, and co-occurrence statistics. Researchers interpret free association response probabilities as unbiased estimates of forward cue-to-target strength. In Study 1, analyses of large free association and extralist cued recall databases indicate that this interpretation is incorrect. Competitor and backward strengths bias free association probabilities, and as with other recall tasks, preexisting strength is described by a ratio rule. In Study 2, associative similarity ratings are predicted by forward and backward, but not by competitor, strength. Preexisting strength is not a unitary construct, because its measurement varies with method. Furthermore, free association probabilities predict extralist cued recall better than do ratings and co-occurrence statistics. The measure that most closely matches the criterion task may provide the best estimate of the identity of preexisting strength.