Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure.

Although nightmares are frequently endorsed symptoms in children who have experienced trauma, limited research has been conducted on how nightmares vary with different forms of trauma exposure. Our goal was to assess the relationship between nightmares, trauma exposure, and symptoms of Posttraumatic Stress Disorder (PTSD) in youth. A total of 4440 trauma exposed treatment-seeking youth (ages 7 to 18) were administered the UCLA PTSD Reaction Index. Different trauma types, total traumas experienced, and PTSD symptoms were analyzed with correlations and a logistic regression in relation to nightmare frequency. Overall, 33.1% of participants reported experiencing clinically-significant nightmares. 79.1% of the sample experienced more than one trauma type, with an average of 3.06 trauma types endorsed. A binary logistic regression demonstrated the odds of reporting clinically-significant nightmares increased by 1.3 times for every additional type of trauma experienced. Lastly, nightmares were positively correlated with all PTSD criterion. The current study provides prevalence rates of trauma exposure and nightmares in a large, statewide sample of treatment-seeking youth. Each new trauma type experienced resulted in a greater likelihood of endorsing clinically-significant nightmares. This study provides useful information related to assessing and addressing nightmares in youth who have experienced trauma.

Empirically-guided assessment of complex trauma for children in foster care: A focus on appropriate diagnosis of attachment concerns.

Complex trauma is defined as repeated or prolonged exposure to traumatic events perpetrated within the caregiving relationship during early childhood. Diagnostic decision making is challenging for this vulnerable population, given the widespread impact of these experiences across domains of developmental, social, emotional, and behavioral functioning. One domain, attachment, receives considerable attention for youth within the child welfare system, leading to frequent diagnosis of attachment disorders (i.e., reactive attachment disorder and disinhibited social engagement disorder). This is concerning, given the rarity, level of misunderstanding, associated stigma, and lack of psychometrically sound measures to assess attachment disorders. This article provides an overview of complex trauma and its effects, with a focus on attachment concerns. It subsequently describes one statewide assessment program for youth in the child welfare system with a history of experiencing complex trauma, elaborating on strengths and areas of future growth. A case study demonstrates the program's adherence to established guidelines and the resulting diagnoses and recommendations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Contributing factors predicting nightmares in children: Trauma, anxiety, dissociation, and emotion regulation.

OBJECTIVE: There is little research in the current literature regarding contributing factors to nightmares in children. This study aimed to test potentially overlapping predictors of nightmare distress and severity, including anxiety, dissociation, trauma history, vagal tone, and parental processing of emotions. METHOD: Sixty parent-child dyads (children ages 6-11) filled out a variety of child-report and parent-observation inventories on nightmare frequency and distress, dissociation, anxiety, and trauma history of the child. Children were monitored on heart rate variability and vagal tone. Both parent and child participated in a discussion of positive and negative life events that were later coded for degree of parent processing of emotional information. RESULTS: Anxiety, trauma history, dissociation, and baseline vagal tone accounted for 39% of the variance in nightmare distress. Anxiety and dissociation were positive predictors of nightmare distress in the multiple regression. Parent processing variables were weak predictors in the current analysis. CONCLUSIONS: The predictive power of anxiety, dissociation, vagal tone, and trauma history was not entirely due to their overlap, as shown by uniquely significant beta weights in the prediction of distress. Treatment procedures with multiple intervention points targeting physiological and psychological sources of nightmare distress may be warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).