School Mental Health

, Volume 8, Issue 1, pp 77–88 | Cite as

Trauma Exposure in Elementary School Children: Description of Screening Procedures, Level of Exposure, and Posttraumatic Stress Symptoms

  • Araceli GonzalezEmail author
  • Nicholas Monzon
  • Diana Solis
  • Lisa Jaycox
  • Audra K. Langley
Original Paper


Traumatic childhood events can have a significant impact on overall child functioning. Early identification and intervention could offer significant benefits for children’s mental health and educational trajectories, but how to effectively identify young children is a challenge. In this paper, we describe screening for exposure to traumatic events and associated symptoms of posttraumatic stress, and examine differences by child gender and grade level. A total of 402 elementary school children in grades 1–5 participated across four elementary schools. We describe modified administration procedures of screening instruments for these young children. Children who endorsed exposure to one or more traumatic events were individually assessed for posttraumatic stress symptom severity. Thirty-four percent (N = 138) of children screened experienced one or more traumatic events, and 75.4 % of those exposed to at least one traumatic event endorsed moderate levels or higher of posttraumatic stress symptoms. Internal consistency of the symptom self-report instrument was adequate for children of all grade levels. Posttraumatic stress symptom severity increased for children exposed to more types of events. No gender/grade differences were found in symptom severity. Findings suggest that young children are impacted by traumatic events in relatively high numbers, that they can reliably report their posttraumatic stress symptoms, and that a large portion of those exposed to trauma experience significant distress. These results highlight the importance of early screening and identification of these children to curtail potential risk for future academic, social, and psychological maladjustment.


Trauma Children Screening 


  1. Albers, C. A., Glover, T. A., & Kratochwill, T. R. (2007). Introduction to the special issue: How can universal screening enhance educational and mental health outcomes? Journal of School Psychology, 45(2), 113–116.CrossRefGoogle Scholar
  2. Alisic, E., van der Schoot, T. A. W., van Ginkel, J. R., & Kleber, R. J. (2008). Trauma exposure in primary school children: Who is at risk? Journal of Child & Adolescent Trauma, 1(3), 263–269.CrossRefGoogle Scholar
  3. Alisic, E., Zalta, A. K., van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., et al. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry, 204(5), 335–340.CrossRefPubMedGoogle Scholar
  4. Amir, M., Kaplan, Z., & Kotler, M. (1996). Type of trauma, severity of posttraumatic stress disorder core symptoms, and associated features. The Journal of General Psychology, 123(4), 341–351.CrossRefPubMedGoogle Scholar
  5. Briggs, E. C., Fairbank, J. A., Greeson, J. K. P., Layne, C. M., Steinberg, A. M., Amaya-Jackson, L. M., et al. (2013). Links between child and adolescent trauma exposure and service use histories in a national clinic-referred sample. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 101–109.CrossRefGoogle Scholar
  6. Briggs-Gowan, M., Carter, A. S., Clark, R., Augustyn, M., McCarthy, K. J., & Ford, J. D. (2010). Exposure to potentially traumatic events in early childhood: Differential links to emergent psychopathology. Journal Child Psychology and Psychiatry, 51, 1132–1140.CrossRefGoogle Scholar
  7. Cohen, J. A., Mannarino, A. P., & Staron, V. (2006). Modified cognitive behavioral therapy for childhood traumatic grief (CBT-CTG): A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 45(12), 1465–1473.CrossRefPubMedGoogle Scholar
  8. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584.CrossRefPubMedGoogle Scholar
  9. Costello, E. J., Erkanli, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress, 15(2), 99–112.CrossRefPubMedGoogle Scholar
  10. Cunningham, J. M., & Suldo, S. M. (2014). Accuracy of teachers in identifying elementary school students who report at-risk levels of anxiety and depression. School Mental Health, 6(4), 237–250.CrossRefGoogle Scholar
  11. Daviss, W. B., Mooney, D., Racusin, R., Ford, J. D., Fleischer, A., & McHugo, G. (2000). Predicting post-traumatic stress after hospitalization for pediatric injury. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 576–583.CrossRefPubMedGoogle Scholar
  12. Delaney-Black, V., Covington, C., Ondersma, S., Nordstrom-Klee, B., Templin, T., Ager, J., et al. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of Pediatric & Adolescent Medicine, 156(3), 280–285.CrossRefGoogle Scholar
  13. Dowdy, E., Ritchey, K., & Kamphaus, R. W. (2010). School-based screening: A population-based approach to inform and monitor children’s mental health needs. School Mental Health, 2(4), 166–176.PubMedCentralCrossRefPubMedGoogle Scholar
  14. Dvorsky, M. R., Girio-Herrera, E., & Owens, J. S. (2014). School-based screening for mental health in early childhood. Handbook of school mental health: Research, training, practice, and policy (2nd ed.). (pp. 297–310) Springer, New York, NY.Google Scholar
  15. Edwards, J., & Rogers, K. (1997). The traumatic events screening inventory: Assessing trauma in children. In G. Kantor & J. Jasinski (Eds.), Out of the darkness: Contemporary perspectives on family violence (pp. 113–119). Thousand Oaks, CA: SAGE Publications Inc.CrossRefGoogle Scholar
  16. Essex, M. J., Kraemer, H. C., Slattery, M. J., Burk, L. R., Boyce, W. T., Woodward, H. R., et al. (2009). Screening for childhood mental health problems: Outcomes and early identification. Journal of Child Psychology and Psychiatry, 50(5), 562–570.PubMedCentralCrossRefPubMedGoogle Scholar
  17. Fazel, M., Hoagwood, K., Stephan, S., & Ford, T. (2014). Mental health interventions in schools in high-income countries. The Lancet Psychiatry, 1(5), 377–387.PubMedCentralCrossRefPubMedGoogle Scholar
  18. Finkelhor, D., Ormrod, R. K., Turner, H. A., & Hamby, S. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10(1), 5–25.CrossRefPubMedGoogle Scholar
  19. Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. (2009). Children’s exposure to violence: A comprehensive national survey. U.S. Department of Justice. Retrieved from:
  20. Ford, J. D. (2008). Diagnosis of traumatic stress disorders (DSM and ICD). In G. Reyes, J. D. Elhai, & J. D. Ford (Eds.), Encyclopedia of psychological trauma (pp. 200–208). Hoboken, NJ: Wiley.Google Scholar
  21. Ford, J. D., Racusin, R., Ellis, C., Daviss, W. B., Reiser, J., Fleischer, A., et al. (2000). Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Child Maltreatment, 5, 205–217.CrossRefPubMedGoogle Scholar
  22. Freeman, L. N., Mokros, H. B., & Poznanski, E. O. (1993). Violent events reported by normal school-aged children: Characteristics and depression correlates. Journal of American Academy of Child & Psychiatry, 32, 419–423.CrossRefGoogle Scholar
  23. Gabbay, V., Oatis, M., Silva, R. R., & Hirsch, G. S. (2004). Epidemiological aspects of PTSD in children and adolescents. In R. R. Silva (Ed.), Posttraumatic stress disorders in children, adolescents: Handbook (1st ed.). New York: WW Norton & Company.Google Scholar
  24. Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(4), 409–418.CrossRefPubMedGoogle Scholar
  25. Grasso, D. J., Ford, J. D., & Briggs-Gowan, M. (2013). Early life trauma exposure and stress sensitivity in young children. Journal of Pediatric Psychology, 38(1), 94–103.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Greeson, J. K. P., Briggs, E. C., Layne, C. M., Belcher, H. M. E., Ostrowski, S. A., Kim, S., et al. (2014). Traumatic childhood experiences in the 21st century: broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. Journal of Interpersonal Violence, 29(3), 536–556.CrossRefPubMedGoogle Scholar
  27. Grogger, J. (1997). Incarceration-related costs of early childbearing. In R. A. Maynard (Ed.), Kids having kids (pp. 231–256). Washington, DC: Urban Institute.Google Scholar
  28. Guzman, M. P., Jellinek, M., George, M., Hartley, M., Squicciarini, A. M., Canenguez, K. M., et al. (2011). Mental health matters in elementary school: First-grade screening predicts fourth grade achievement test scores. European Child and Adolescent Psychiatry, 20(8), 401–411.CrossRefPubMedGoogle Scholar
  29. Hurt, H., Malmud, E., Brodsky, N. L., & Giannetta, J. (2001). Exposure to violence: Psychological and academic correlates in child witnesses. Archives of Pediatric and Adolescent Medicine, 155(12), 1351–1356.CrossRefGoogle Scholar
  30. Husky, M. M., Kaplan, A., McGuire, L., Flynn, L., Chrostowski, C., & Olfson, M. (2011). Identifying adolescents at risk through voluntary school-based mental health screening. Journal of Adolescence, 34(3), 505–511.CrossRefPubMedGoogle Scholar
  31. Ialongo, N. S., Edelsohn, G., & Kellam, S. G. (2001). A further look at the prognostic power of young children’s reports of depressed mood and feelings. Child Development, 72, 736–747.CrossRefPubMedGoogle Scholar
  32. Jaycox, L. H., Langley, A. K., Stein, B. D., Wong, M., Sharma, P., Scott, M., et al. (2009). Support for students exposed to trauma: A pilot study. School Mental Health, 1(2), 49–60.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Jaycox, L. H., Stein, B. D., Kataoka, S. H., Wong, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 41(9), 1104–1110.CrossRefPubMedGoogle Scholar
  34. Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., et al. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(3), 311–318.CrossRefPubMedGoogle Scholar
  35. Kilpatrick, D. G., & Saunders, B. E. (1999). Prevalence and consequences of child victimization: Results from the national survey of adolescents (Final Report No. 93-IJ-CX-0023). Charleston, SC: US Department of Justice.Google Scholar
  36. Langley, A. K., Gonzalez, A., Sugar, C. A., Solis, D., & Jaycox, L. (2015). Bounce back: Effectiveness of an elementary school-based intervention for multicultural children exposed to traumatic events. Journal of Consulting and Clinical Psychology, 83(5), 853–865.PubMedCentralCrossRefPubMedGoogle Scholar
  37. Levitt, J. M., Saka, N., Romanelli, L. H., & Hoagwood, K. (2007). Early identification of mental health problems in schools: The status of instrumentation. Journal of School Psychology, 45(2), 163–191.CrossRefGoogle Scholar
  38. Luby, J. L., Belden, A., Sullivan, J., & Spitznagel, E. (2007). Preschoolers’ contribution to their diagnosis of depression and anxiety: Uses and limitations of young child self-report of symptoms. Child Psychiatry and Human Development, 38, 321–338.CrossRefPubMedGoogle Scholar
  39. Luthra, R., Ambramovitz, R., Greenbergm, R., Schoor, A., Newcorn, J., Schmeidler, J., et al. (2009). Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents. Journal of Interpersonal Violence, 24(11), 1919–1927.CrossRefPubMedGoogle Scholar
  40. Price, M., Higa-McMillan, C., Kim, S., & Frueh, B. C. (2013). Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity. Journal of Anxiety Disorders, 27(7), 652–660.CrossRefPubMedGoogle Scholar
  41. Pynoos, R. S., Rodriguez, N., Steinberg, A. S., Struber, A., & Fredrick, C. (1998). The UCLA PTSD reaction index for DSM IV (Revision 1). Los Angeles: UCLA Trauma Psychiatry Program.Google Scholar
  42. Ribbe, D. (1996). Psychometric review of traumatic events screening inventory for children (TESI-C). In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 386–387). Lutherville, MD: Sidran.Google Scholar
  43. Romer, D., & McIntosh, M. (2005). The roles and perspectives of school mental health professionals in promoting adolescent mental health. In D. L. Evans, E. B. Foa, R. E. Gur, H. Hendin, C. P. O’Brien, M. Seligman, et al. (Eds.), Treating and preventing adolescent mental health disorders: What we know and what we don’t know: A research agenda for improving the mental health of our youth (pp. 597–615). New York, NY: Oxford University Press.CrossRefGoogle Scholar
  44. Schwab-Stone, M., Ayers, T. S., Kasprow, W., Voyce, C., Barone, C., & Shriver, T. (1995). No safe haven: A study of violence exposure in an urban community. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1343–1352.CrossRefPubMedGoogle Scholar
  45. Severson, H. H., Walker, H. M., Hope-Doolittle, J., Kratochwill, T. R., & Gresham, F. M. (2007). Proactive, early screening to detect behaviorally at-risk students: Issues, approaches, emerging innovations, and professional practices. Journal of School Psychology, 45(2), 193–223.CrossRefGoogle Scholar
  46. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children for DSM-IV: (Child and Parent Versions). San Antonio, TX: Psychological Corporation.Google Scholar
  47. Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Elliott, M. N., et al. (2003). A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. Journal of the American Medical Association, 290(5), 603–611.CrossRefPubMedGoogle Scholar
  48. Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Current Psychiatry Reports, 6, 96–100.CrossRefPubMedGoogle Scholar
  49. Suliman, S., Mkabile, S. G., Fincham, D. S., Ahmed, R., Stein, D. J., & Seedat, S. (2009). Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Comprehensive Psychiatry, 50, 121–127.CrossRefPubMedGoogle Scholar
  50. The President’s New Freedom Commission on Mental Health. (2003). Retrieved from

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Araceli Gonzalez
    • 1
    Email author
  • Nicholas Monzon
    • 1
  • Diana Solis
    • 2
  • Lisa Jaycox
    • 3
  • Audra K. Langley
    • 4
  1. 1.Department of PsychologyCalifornia State University, Long BeachLong BeachUSA
  2. 2.UCLA Semel Institute for Neuroscience and Human BehaviorLos AngelesUSA
  3. 3.RAND CorporationArlingtonUSA
  4. 4.UCLA Departments of Psychiatry and PediatricsLos AngelesUSA

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