The Role of Executive Function in Predicting Children’s Outcomes in a Cognitive Behavioral Treatment for Trauma-Related Nightmares and Secondary Sleep Disturbances Abstract Predictors of children’s outcomes in trauma-focused interventions are well documented. However, little is known about the role of higher-order cognitive processes, specifically executive function (EF) abilities, in determining children’s responses to treatments specifically for trauma-related sleep disturbances. EF is independently related to PTSD reactions, sleep deficits, and nightmares. Furthermore, well-developed EF can be protective; thus, we sought to examine whether higher EF predicted better treatment outcomes for trauma-related sleep disturbances. Twenty-three children aged 5 to 17 presenting with post-traumatic nightmares (PTNs) participated in a cognitive behavioral therapy to address their trauma-related nightmares (CBT-NC). Pre- and post-treatment data were used in analyses. Findings from discriminant function analyses revealed that EF was not a statistically significant predictor of treatment outcomes across indices of nightmare frequency and distress, sleep quality, and PTSD symptomology. However, effect sizes suggested that EF was a moderate predictor of sleep quality outcomes, which has clinical implications. Treatment duration for sleep problems could be related to EF with briefer interventions being more suitable for children with high EF, whereas children with low EF may benefit from longer treatment protocols.

Treating a 16 Year Old with a History of Severe Bullying: Supplementing Cognitive Behavioural Therapy with EMDR within the Context of a Case Formulation Approach Abstract This article describes the use of a case formulation approach, integrating evidence-based treatment in the context of individual clinical traits. It focuses on the supplementation of cognitive behavioural therapy (CBT) with eye movement desensitization and reprocessing (EMDR) in the treatment of a young person, presenting with an initial diagnosis of obsessive-compulsive disorder (OCD). A case formulation suggested the possibility of a differential diagnosis of Adjustment Disorder, indicating the usefulness of the addition of EMDR sessions to process memories of severe bullying. Previous studies promote the idea of using EMDR in cases that do not meet the threshold for Post-Traumatic Stress Disorder (PTSD), in order to reduce the presentation of anxiety. Earlier research suggests that each of these models has specific strengths and attributes in the treatment of mental health difficulties and, whilst based within the context of a well-established case conceptualisation, can be effectively integrated.

Treatments for Early Childhood Trauma: Decision Considerations for Clinicians Abstract The period from birth to age six represents a time of significant risk for exposure to trauma. Following trauma exposure, children may experience significant negative and lasting psychological, cognitive, and physical effects. Over the last two decades, the demand for and availability of evidence-based treatments (EBTs) for children under the age of six who have experienced trauma has dramatically increased. Three of the most well-supported and widely disseminated EBTs for early childhood trauma are Trauma-Focused Cognitive Behavioral Therapy, Parent-Child Interaction Therapy, and Child-Parent Psychotherapy. Increasingly, clinicians are receiving training in more than one EBT. This paper provides an overview of each intervention; presents clinicians with various child, caregiver, and environmental factors to consider when deciding amongst these three EBTs; and applies these considerations to three composite cases.

Using the PAI-A to Classify Juvenile Offenders by Adjudicated Offenses Abstract To improve understanding and treatment of criminal behavior, researchers have developed typologies of juvenile offenders, primarily focusing on personality traits and criminal history to classify according to type of offense committed. Existing literature has examined underlying personality characteristics found in different subcategories of criminal offenses in juveniles; however, few studies have employed the Personality Assessment Inventory-Adolescent (PAI-A), instead choosing the MMPI-A. A typical classification model of juvenile offenses categorizes offenses into: Interpersonal, Property, and Drug/Alcohol-related charges, to further study within-group differences. The current study examines how personality profiles, examined by the PAI-A, can classify offenders into these offense-type groups. Personality profiles of participants were obtained through pre-sentencing psychological evaluations of 142 juvenile offenders ages 14 to 17. Binary logistic regressions were conducted using PAI-A Clinical, Treatment Consideration, and Interpersonal scales to predict offense-type group classifications. Results yielded statistically significant full models for all offense-type groups, with an average overall accuracy rate of 76.3%. Overall, results suggest that the PAI-A has good predictive power to classify juvenile offender types, and may be more effective in classifying certain types of offenders than the MMPI-A. Notably, Interpersonal and Treatment consideration scales were stronger predictors of offense-type than Clinical scales. This model of juvenile offender classification holds promise for more effective treatment, management, and prediction of behavior for juvenile offenders.

Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions Abstract Empirical investigations of trauma and post-traumatic stress disorder (PTSD) in individuals with autism spectrum disorder (ASD) are lacking despite indications of increased risk for exposure to potentially traumatic events in this population. Research on the treatment of traumatic stress psychopathology in ASD is even more limited and suggests a critical need for guidance in the area of ASD-specific treatment adaptations. The current paper provides preliminary recommendations for adapting current evidenced-based, trauma-specific interventions, specifically trauma-focused cognitive behavioral therapy (TF-CBT), for individuals with ASD based on well-established and evidence-based practices for working with this population. These adaptations highlight the need to incorporate treatment goals related to ASD core symptoms and associated characteristics during treatment targeting traumatic stress symptoms. Future directions are discussed, including the development of instruments measuring trauma reactions in ASD, empirical investigations of modified trauma interventions for children with ASD to evaluate effectiveness, and collaboration between professionals specializing in ASD and trauma/PTSD to advance research and facilitate effective care for this community.

Assessing the Validity and Clinical Utility of a Developmental Trauma Diagnosis in Ethnic Minority Adolescents Abstract Developmental Trauma Disorder (DTD), a proposed diagnostic construct designed to reflect symptoms common among multiply-traumatized youth, was examined in a population of primarily female, predominantly Hispanic and African-American adolescents seeking psychiatric treatment (N = 53). The study uses a mix of interview and self-report data to test the prevalence of DTD symptoms relative to PTSD symptoms in this sample as well as to differentiate the DTD symptoms from DSM-IV and DSM-5 PTSD. DTD symptomatology was found to be as prevalent in the sample as PTSD symptomatology and further, DTD was found to be distinct from PTSD These results add to the literature suggesting the utility and need for the addition of a DTD diagnosis to the DSM, as well as offer insight into a population that has not been heavily scrutinized under a DTD framework.

MEGA ♪ : Empirical Findings on the Preternatural: Sexually Violent and Predatory Sexually Violent Youth Abstract Applied are empirical findings from two major studies employing the ecologically framed MEGA♪ risk assessment tool: MEGA♪Combined Samples Studies (N = 3901 [1979–2017] (Miccio-Fonseca 2017a, d) and MEGA♪Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female sexually abusive youth, ages 4–19, including youth with low intellectual functioning of borderline or low average. Findings further support a previously presented nomenclature identifying two subsets overlooked by most contemporary risk assessment tools: sexually violent and predatory sexually violent youth (Miccio-Fonseca and Rasmussen Journal of Aggression Maltreatment & Trauma, 18, 106–128, 2009, 2014). MEGA♪Studies provided normative data, with cut-off scores (calibrated) according to age and gender, establishing four risk levels: Low, Moderate, High, and Very High. The fourth risk level, Very High, sets MEGA♪ apart from other risk assessment tools for sexually abusive youth, which are limited to three risk levels. Very High risk level definitively identifies the most dangerous youth, thus empirically supporting the nomenclature of sexually violent and predatory sexually violent youth.

The Association between Caregiver Substance Abuse and Mental Health Problems and Outcomes for Trauma-Exposed Youth Abstract Trauma-exposed youth with impaired caregivers (i.e., due to substance use and/or mental health problems) may be at particular risk for negative outcomes. This study utilized data from the National Child Traumatic Stress Network Core Data Set to examine the impact of caregiver impairment on youth outcomes. Trauma-exposed youth with an impaired caregiver due to either: substance use (n = 498), mental health problems (n = 231), or both substance use and mental health problems (n = 305) were compared to youth without a reported impaired caregiver (n = 2282) to determine if impaired caregiver status is independently associated with increased likelihood of negative behavioral and mental health outcomes and service utilization after accounting for demographics and exposure to traumatic events. Youth with impaired caregivers compared to those without were more likely to display PTSD, emotional and behavioral problems, suicidality, self-injury, and substance abuse and had higher rates of service utilization (p < 0.05). Differential patterns were observed based on the type of caregiver impairment. Findings support the importance of family-centered assessment and intervention approaches for youth affected by trauma.

Child Maltreatment, Chronic Pain, and Other Chronic Health Conditions in Youth in Foster Care Abstract Childhood maltreatment is associated with chronic pain in adults. The goals of this study were 1) to examine this relation in youth placed in foster care with high levels of maltreatment exposure, and 2) to investigate the relation between maltreatment frequency and acute pain, and maltreatment frequency and general chronic health condition. Participants included 403 youth ages 8–19 who resided in foster or residential/group homes. Youth with more maltreatment events had higher odds of chronic pain in a dose response fashion. There was no significant relation between maltreatment type and pain diagnosis, or maltreatment and general chronic health condition. This study examined both self- and case file report of maltreatment frequency and type in association with chronic pain, acute pain, and general chronic health condition in a sample of youth in foster care, providing evidence that more maltreatment exposure increases the likelihood of chronic pain, even in youth. This suggests that it may not take decades for the overloaded stress response system to lead to a serious pain condition, but that this process may occur much earlier in the lifespan. The findings have important implications for professionals working to prevent and treat the effects of child maltreatment or chronic pain.

Enhancing the Lives of Children in Out-Of-Home Care: An Exploration of Mind-Body Interventions as a Method of Trauma Recovery Abstract The prevalence and impact of trauma exposure among young people in the child welfare system in Canada warrants holistic intervention as a means of trauma recovery for this vulnerable population. A trauma-informed approach to practice is outlined through consideration of traditional trauma treatments and mind-body interventions that serve as complementary methods of therapy. Despite limited research on the effectiveness of mind-body interventions with children and adolescents in out-of-home care in Canada, a review of available literature on mindfulness, arts-based methods, and yoga suggests these therapeutic interventions promote resilience and positive development. Additional research is needed to support the use of mind-body interventions with young people in out-of-home care. Practice implications and recommendations for future research within Canada are included to increase awareness and support a working understanding of the pervasiveness of trauma exposure among this population and the value of trauma-informed, holistic intervention.