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Clinical Considerations in Assessing Trauma and PTSD in Adolescents

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Abstract

The developmental tasks and underlying neurobiological development associated with adolescence result in high rates of traumatization and posttraumatic stress disorder for this age group. Although the development of new measures is ongoing, assessing traumatized adolescents continues to present challenges. This article outlines some of the issues complicating an accurate assessment of trauma and posttraumatic stress disorder. Inaccuracies inherent in reporting traumatic exposure and associated sequelae are confounded by varying definitions of trauma, chronicity or multiplicity of exposure, and developmental factors unique to adolescence. Considerations in conducting thorough assessments are reviewed, with a focus on understanding the factors underlying the unintentional minimization and/or active concealment of traumatic events and trauma symptoms. Suggestions for enhancing assessment accuracy are offered, and treatment implications are discussed.

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References

  • Alberts, A., Elkind, D., & Ginsberg, S. (2007). The personal fable and risk-taking in early adolescence. Journal of Youth and Adolescence, 37, 71–76.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (text rev.). Washington, DC: Author.

    Google Scholar 

  • Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, E., & Spinhoven, P. (2006). Validation of the multiple language versions of the Reactions of Adolescents to Traumatic Stress Questionnaire. Journal of Traumatic Stress, 19, 241–255.

    Article  PubMed  Google Scholar 

  • Bedard-Gilligan, M., & Zoellner, L. (2008). The utility of the A1 and A2 criteria in the diagnosis of PTSD. Behaviour Research and Therapy, 46, 1062–1069.

    Article  PubMed Central  PubMed  Google Scholar 

  • Briere, J. (1996). The Trauma Symptom Checklist for Children. Odessa FL: Psychological Assessment Resources.

    Google Scholar 

  • Briere, J., Kaltman, S., & Green, B. (2008). Accumulated childhood trauma and symptom complexity. Journal of Traumatic Stress, 21, 223–226.

    Article  PubMed  Google Scholar 

  • Briggs-King, E. (2009, March). Highlights from the core data set. Paper presented at the All Network Conference of the National Child Traumatic Stress Network, Orlando, FL.

  • Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

    Google Scholar 

  • Copeland, W., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577–584.

    Article  PubMed  Google Scholar 

  • Courtois, C. (1996). Healing the incest wound: Adult survivors in therapy. New York: Norton.

    Google Scholar 

  • Courtois, C., & Ford, J. (2009). Treating complex traumatic stress disorders: An evidence-based guide. New York: Guilford Press.

    Google Scholar 

  • Dahl, R. (2001). Affect regulation, brain development, and behavioral/emotional health in adolescence. CNS Spectrums, 6, 60–72.

    PubMed  Google Scholar 

  • Dahl, R., & Gunnar, M. (2009). Heightened stress responsiveness and emotional reactivity during pubertal maturation: Implications for psychopathology. Development and Psychopathology, 21, 1–6.

    Article  PubMed  Google Scholar 

  • Dyer, K., Dorahy, M., Hamilton, G., Corry, M., Shannon, M., MacSherry, A., et al. (2009). Anger, aggression, and self-harm in PTSD and complex PTSD. Journal of Clinical Psychology, 65, 1099–1114.

    Article  PubMed  Google Scholar 

  • Elkind, D. (1967). Egocentrism in adolescence. Child Development, 38, 1025–1033.

    Article  PubMed  Google Scholar 

  • Elklit, A., & Petersen, T. (2008). Exposure to traumatic events among adolescents in four nations. Torture, 18, 2–11.

    PubMed  Google Scholar 

  • Finkelhor, D., Ormrod, R., & Turner, H. (2007a). Poly-victimization: A neglected component in child victimization. Child Abuse and Neglect, 31, 7–26.

    Article  PubMed  Google Scholar 

  • Finkelhor, D., Ormrod, R., & Turner, H. (2007b). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19, 149–166.

    Article  PubMed  Google Scholar 

  • Fletcher, K. (1996). Psychometric review of Dimensions of Stressful Events (DOSE) Ratings Scale. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 144–151). Lutherville, MD: Sidran Press.

    Google Scholar 

  • Fletcher, K. (1992). Young Adult Upsetting Times Checklist (YAUTC). Unpublished measure, Psychiatry Department, University of Massachusetts Medical Center.

  • Ford, J., Ghosh-Ippen, C., Wolpaw, J., Racusin, R., Rogers, K., Ellis, C., et al. (2005). Traumatic Events Screening Inventory for Children (TESI-C) Version 8.5. Dartmouth, VT: National Center for PTSD and Dartmouth Child Psychiatry Research Group.

    Google Scholar 

  • Ford, J., Stockton, P., Kaltman, S., & Green, B. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence, 21, 1399–1416.

    Article  PubMed  Google Scholar 

  • Franklin, C., Sheeran, T., & Zimmerman, M. (2002). Screening for trauma history, posttraumatic stress disorder, and subthreshold PTSD in psychiatric outpatients. Psychological Assessment, 4, 467–471.

    Article  Google Scholar 

  • Garbarino, J., & deLara, E. (2002). And words can hurt forever: How to protect adolescents from bullying, harassment, and emotional violence. New York: The Free Press.

    Google Scholar 

  • Ghesquiere, A., Fan, M., Berliner, L., Rivara, F., Jurkovich, G., Russo, J., et al. (2008). Adolescents’ and parents’ agreement on posttraumatic stress disorder symptoms and functioning after adolescent injury. Journal of Traumatic Stress, 21, 487–491.

    Article  PubMed  Google Scholar 

  • Habib, M., & Labruna, V. (2006). The Adolescent Trauma History Checklist and Interview. Copyrighted scale, North Shore University Hospital.

  • Habib, M., Sonnenklar, J., Labruna, V., Sunday, S., DeRosa, R., & Pelcovitz, D. (2005). Structured Interview for Disorders of Extreme Stress- Adolescent Version (SIDES-A). Unpublished measure; North Shore University Hospital.

  • Kendall-Tackett, K. (2003). Treating the lifetime health effects of childhood victimization. Kingston, NJ: Civic Research Institute.

    Google Scholar 

  • Kilpatrick, D., Ruggiero, K., Acierno, R., Saunders, B., Resnick, H., & Best, C. (2003). Violence and risk of PTSD, major depression, substance abuse-dependence, and comorbidity: Results from the national survey of adolescents. Journal of Consulting and Clinical Psychology, 71, 692–700.

    Article  PubMed  Google Scholar 

  • Kilpatrick, D., & Saunders, B. (2003). Prevalence and consequences of child victimization: Results from the National Survey of Adolescents. Final Report to the U.S. Department of Justice. National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.

    Google Scholar 

  • Kraemer, B., Wittmann, L., Jenewein, J., Maier, T., & Schnyder, U. (2009). Is the stressor criterion dispensable? Psychopathology, 42, 333–336.

    Article  PubMed  Google Scholar 

  • Maier, T. (2006). Post-traumatic stress disorder revisited: Deconstructing the A-criterion. Medical Hypotheses, 66, 103–106.

    Article  PubMed  Google Scholar 

  • Mash, E., & Barkley, R. (2007). Assessment of childhood disorders (4th ed.). New York: Guilford Press.

    Google Scholar 

  • Nader, K. (2008). Understanding and assessing trauma in children and adolescents: Measures, methods, and youth in context. New York: Routledge.

    Google Scholar 

  • Nader, K., Newman, E., Weathers, F., Kaloupek, D., Kriegler, J., & Blake, D. (2004). Clinician-Administered PTSD Scale for children and adolescents (CAPS- C). Los Angeles: Western Psychological Press.

    Google Scholar 

  • Pelcovitz D., van der Kolk, B., Roth, S., Mandel, F., Kaplan, S., & Resick, P. (1997). Development of a criteria set and a structured interview for disorders of extreme stress. Journal of Traumatic Stress, 10, 3–16.

    PubMed  Google Scholar 

  • Pynoos, R., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). UCLA PTSD Index for DSM-IV. Copyrighted scale, UCLA Neuropsychiatric Institute.

  • Reich, W., & Todd, R. (1999). Missouri Assessment of Genetics Interview for Children (MAGIC). St. Louis, MO: Washington University School of Medicine.

    Google Scholar 

  • Reyna, V., & Farley, F. (2006). Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psychological Science in the Public Interest, 7, 1–44.

    Google Scholar 

  • Rosen, G., Spitzer, R., & McHugh, P. (2008). Problems with the post-traumatic stress disorder diagnosis and its future in DSM-V. The British Journal of Psychiatry, 192, 3–4.

    Article  PubMed  Google Scholar 

  • Schore, A. (2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 7–66.

    Article  Google Scholar 

  • Silk, J., Siegle, G., Whalen, D., Ostapenko, L., Ladouceur, C., & Dahl, R. (2009). Pubertal changes in emotional information processing: Pupillary, behavioral, and subjective evidence during emotional word identification. Developmental Psychopathology, 21, 7–26.

    Article  Google Scholar 

  • Spear, L. (2009). Heightened stress responsivity and emotional reactivity during pubertal maturation: Implications for psychopathology. Development and Psychopathology, 21, 87–97.

    Article  PubMed Central  PubMed  Google Scholar 

  • Spitzer, R., First, M., & Wakefield, J. (2007). Saving PTSD from itself in DSM-V. Journal of Anxiety Disorders, 21, 233–241.

    Article  PubMed  Google Scholar 

  • Steinberg, L. (2007). Risk-taking in adolescence: New perspectives from brain and behavioral science. Current Directions in Psychological Science, 16, 55–59.

    Article  Google Scholar 

  • Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S., & Woolard, J. (2008). Age differences in sensation seeking and impulsivity as indexed by behavior and self-report: Evidence for a dual systems model. Developmental Psychology, 44, 1764–1777.

    Article  PubMed  Google Scholar 

  • Stevens, M., Kiehl, K., Pearlson, G., & Calhoun, V. (2007). Functional neural networks underlying response inhibition in adolescents and adults. Behavioural Brain Research, 181, 12–22.

    Article  PubMed Central  PubMed  Google Scholar 

  • Stroud, L., Foster, E., Handwerger, K., Papandonatos, G. D., Granger, D., Kivlighan, K. T., et al. (2009). Stress response and the adolescent transition: Performance versus peer rejection stress. Development and Psychopathology, 21, 47–68.

    Article  PubMed Central  PubMed  Google Scholar 

  • Taylor, L., & Weems, C. (2009). What do youth report as a traumatic event? Toward a develop-mentally informed classification of traumatic stressors. Psychological Trauma: Theory, Research, Practice, and Policy, 1, 91–106.

    Article  Google Scholar 

  • Weathers, F., & Keane, T. (2007). The criterion A problem revisited: Controversies and challenges in defining and measuring psychological trauma. Journal of Traumatic Stress, 20, 107–121.

    Article  PubMed  Google Scholar 

  • Yates, T. M. (2004). The developmental psychopathology of self-injurious behavior: Compensatory regulation in posttraumatic adaptation. Clinical Psychological Review, 24, 35–74.

    Article  Google Scholar 

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Habib, M., Labruna, V. Clinical Considerations in Assessing Trauma and PTSD in Adolescents. Journ Child Adol Trauma 4, 198–216 (2011). https://doi.org/10.1080/19361521.2011.597684

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  • DOI: https://doi.org/10.1080/19361521.2011.597684

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