Best practices and emerging trends in assessment of trauma in students with autism spectrum disorder

Children and adolescents with autism have a higher likelihood of being exposed to bullying, abuse, and sexual assault which, through repeated exposure, has been demonstrated to impede academic, social, and physical functioning among this population. However, the complexity of unpacking the characteristics of autism and trauma can pose a challenge for school psychologists in using the most appropriate clinical method of intervention. This paper summarizes the co-occurrence of autism and trauma in an effort to better inform practitioners and recommends the need for valid and reliable assessments that measure adverse experiences for children with autism. A practitioner assessment guide of childhood trauma and autism spectrum disorder is also provided to facilitate a comprehensive assessment process. We conclude that there is a pressing need for more research examining the relationship between autism and trauma by better understanding the relationship of these constructs, and for the development of more effective assessments to provide more evidence-based interventions.     

Abuse disclosures of youth with problem sexualized behaviors and trauma symptomology

BackgroundThe majority of youth with problem sexualized behaviors (PSB) have substantiated experiences of abuse or exposures to violence (Silovsky & Niec, 2002). Little is known about specific abuse experiences that may differentiate youth with PSB from those without. Few studies have examined the types of abuse associated with post-traumatic stress symptomology.ObjectiveThe current study explored two research questions: (1) Do children with PSB differ from children without PSB in terms of their abuse disclosures?; and (2) Are the types of abuse disclosed associated with the child’s scores on a post-traumatic stress measure?.Participants & settingData were analyzed for youth (N = 950) ages 3–18 years who completed a clinical assessment at a child advocacy center in the Midwest during the 2015 calendar year.MethodsYouth completed assessments that included a forensic interview and either the Trauma Symptom Checklist for Young Children (TSCYC) for children ages 3–10 years, or the Trauma Symptom Checklist for Children (TSCC) for children ages 11–16 years. Bivariate logistic regression was used to answer the research questions.ResultsFindings indicated that youths who disclosed offender to victim fondling were less likely to disclose PSB (OR = 0.460, p = .026), and children exposed to pornography were more likely to disclose PSB (OR = 3.252, p = .001). Additionally, youth who disclosed physical abuse (OR = 1.678, p = .001) or victim to offender sexual contact (OR = 2.242, p = .003) had higher odds of clinically significant trauma scores.ConclusionsImplications for practitioners and future research directions are discussed.     

Prior opportunities to identify abuse in children with abusive head trauma

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n = 73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p < 0.01) and healing fractures (31 vs. 19%, p = 0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.     

Family trauma and its association with emotional and behavioral problems and social adjustment in adolescent Cambodian refugees

OBJECTIVE: The main aim of this study was to investigate the effect of war-related trauma on the subsequent social adjustment and functioning of young Cambodian refugees. METHOD: This longitudinal study of 67 young Cambodian refugees in Montreal interviewed in the first year of high school and then 2 years later examines a family's exposure to war related premigration trauma and its association with an adolescent's emotional and behavioral problems and social adjustment. Emotional and behavioral problems were assessed using the Youth Self-Report and an inventory of risk behavior. Social adjustment was assessed in terms of academic achievement, peer relations, and feeling of competence. RESULTS: The trauma a family suffered before leaving their homeland and prior to the teenager's birth seems to play a protective role at various times in adolescence with regard to externalized symptoms, risk behavior, and school failure in boys, and foster positive social adjustment in girls. CONCLUSIONS: These reactions may be understood as overcompensation by the children of the survivors of a massacre, to whom the implicit duty to succeed has been passed on. They suggest that a broader range of posttraumatic responses to war situations should be investigated and that trauma's dual nature as both burden and source of strength should be examined more closely.     

Assessment of factors resulting in abuse evaluations in young children with minor head trauma

OBJECTIVE: The primary objective was to determine which of the examined factors prompted physicians to initiate a further abuse evaluation in young children with minor head injury. The recording of important historical elements in the charts of these patients was also evaluated. METHODS: Charts of 349 children less than 3 years of age with minor head injury were retrospectively reviewed. Age, race, sex, insurance status, findings on head CT, mechanism of injury, witnessing of event and delay in seeking care were analyzed for association with performance of skeletal survey and referral to Child Protective Services (CPS). RESULTS: Increased odds of CPS referral and increased odds of obtaining a skeletal survey were associated with positive findings on head CT, delay in seeking care, and unknown mechanism of injury. Despite a known association of age/ambulatory status with abuse, the age of the child was not associated with increased odds of abuse evaluation, and younger age was not associated with increased odds of documenting whether the injury was witnessed or when the injury occurred. Documentation of timing of injury was lacking in 29.2% of the charts. Witnessing of the event was undocumented in 48.7% of cases. CONCLUSION: Clinicians may not be using readily available, important information when considering the initiation of an abuse evaluation in young children. Clinicians seeing acutely injured children may need further education regarding developmental status and its effect on mechanisms of injury and the importance of detailed documentation in cases where abuse is a possible cause of injury. PRACTICE IMPLICATIONS: Historical factors associated with injuries in young children continue to be poorly documented. Increased pediatric training for emergency medicine physicians, clinical protocols for evaluation and documentation of injured children, and regular continuing medical education on child development and its implications on mechanisms of injury for clinicians practicing in acute care settings are needed changes that may bring about improvements.     

眼外伤住院493例临床分析

眼外伤是致盲致残的主要原因之一。做好调查研究 ,分析原因和提出预防措施 ,对于保护和挽救视力 ,维护眼的健康 ,具有重要的临床和社会意义。兹将我院 1990 .10～ 2 0 0 0 .10月住院治疗的眼外伤患者 4 93例统计分析如下。1　临床资料1.1　一般情况　 10年中我科共收治住院病人 2 14 5人 ,其中眼外伤 4 93例 ,占同期住院病人的 2 2 .98%。男 4 47例占 90 .6 7% ,女 4 6例占 9.33% ,男女之比为10 .3:1。年龄 1～ 76岁 ,以 8～ 4 0岁最多共 395例占80 .12 % ,其中 8～ 2 0岁共 14 5例占 2 9.4 1% ,2 1～ 4 0岁共 2 5 0例占 5 0 .70 %。右眼 2 …     

浅析106例腹部闭合性损伤的诊治与护理

腹部闭合性损伤不论是战时或是平时均是较常见的一种外科急症。由于病情急重而且发展快,需要在诊断、治疗及护理过程中,认真分析病情,结合病史、病人的症状和体征、辅助检查的结果,从而及时正确诊断和处理,以及精细无误的病情观察和护理,从而减少并发症和死亡率,使病人顺利康复。     

Interpersonal trauma and suicide attempts in low-income depressed mothers in home visiting

BackgroundRisk of suicide is a major concern for depressed mothers in the perinatal period. The strongest predictor of completing suicide is having made a previous attempt. Little is known about the clinical features of low-income, depressed mothers who have attempted suicide in contrast to those who have not.ObjectiveThis study examined clinical and psychosocial features of 170 low-income, young, depressed mothers with and without previous suicide attempts who were enrolled in an early childhood home visiting program.MethodMothers were identified via screening at three months postpartum and diagnosed with major depressive disorder (MDD) using a semi-structured interview. Psychiatric history and presentation, child maltreatment history, intimate partner violence, and social functioning were measured.Results31.8% of mothers had previous suicide attempts. Mean age of first attempt was 14.38 years (SD = 2.55) and the median number of lifetime attempts was 2. In contrast to no attempts, those who had attempted suicide had more MDD symptoms, earlier age of first MDD episode, and more episodes. A previous attempt was associated with greater childhood trauma, more current MDD symptoms and PTSD diagnosis. No differences were found on intimate partner violence. Mothers who made an attempt reported lower levels of tangible social support and smaller social networks.ConclusionsHistory of suicide attempts is associated with childhood trauma history and later psychosocial impairments in low income, depressed mothers in home visiting. Implications for addressing the needs of depressed mothers with suicide attempt histories in the context of early childhood programs are discussed.     

Cumulative trauma and symptom complexity in children: A path analysis

Multiple trauma exposures during childhood are associated with a range of psychological symptoms later in life. In this study, we examined whether the total number of different types of trauma experienced by children (cumulative trauma) is associated with the complexity of their subsequent symptomatology, where complexity is defined as the number of different symptom clusters simultaneously elevated into the clinical range. Children's symptoms in six different trauma-related areas (e.g., depression, anger, posttraumatic stress) were reported both by child clients and their caretakers in a clinical sample of 318 children. Path analysis revealed that accumulated exposure to multiple different trauma types predicts symptom complexity as reported by both children and their caretakers.     

Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma

Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p < 0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.     

Mapping the intersections of gender and college trauma

The purpose of this qualitative study was to explore the complex juncture of gender and experiences of trauma in college. Two research questions guided this investigation: (a) How does gender intersect with an individual’s experience(s) of trauma during college? and (b) What sociocultural contexts shape the role of gender intersecting with traumatic experiences in college? Data were collected using interviews and visual mapping/written response activities. Analysis revealed three dominant themes when gender was salient in traumatic experience, including: (a) gender norms contributing to the production of trauma; (b) gender norms restricting traumatic recovery; and (c) trauma catalyzing the interrogation of gender norms. Results of this study underscore the importance of continued attention in both research and practice to the complex ways in which systems of oppression around gender, in particular, but other identities broadly, offer both restrictions and possibilities for those navigating traumatic recovery.     

Childhood trauma and psychosis: Beyond the association

Childhood traumas have been extensively associated with the development of psychotic disorders. However, our understanding of processes underlying this relationship remains poor. In order to address this issue, we examined which specific aspects of childhood trauma are significantly associated with a first episode of psychosis. 109 patients with first episode of psychosis and 145 controls representative from general population were recruited in three centers in France. Child experiences of care and abuses allowed obtaining information about types of childhood trauma, age at first exposure, identity of perpetrator, and social support. Odds ratio were calculated for each of these aspects, adjusted for age, sex, and education. Sexual and physical abuses (OR = 2.26 (1.19–4.32)), and separation from one or both parents (OR ranging from 1.94 to 3.17; all significant) are significantly associated with an increased risk to present a first episode of psychosis. Furthermore, separation from mother occurring before age of 4 (OR = 5.96 (1.24–28.77)), and sexual and physical abuses perpetrated by someone other than parents (OR = 4.61 (1.66–12.80)) were also associated with an increased risk of first episode of psychosis. Finally, social support was significantly associated with a decreased risk to develop psychotic disorders (OR ranging from 0.33 to 0.42; all significant). Together, these findings suggest that some but not all aspects of childhood trauma are related to a significant risk to develop a first episode of psychosis.     

莫里森小说《慈悲》的心理创伤解读

在《慈悲》中,莫里森用了大量篇幅描写人物和集体遭受的心理创伤,这对人物性格刻画和彰显文章主题具有重要作用。事实上,小说中的每个人物或多或少在成长过程中都经历了巨大的心理创伤,也都采取了相应的应对机制。为此,基于创伤理论视角,文章旨在剖析十七世纪的美国社会遭受的个体心理创伤、集体心理创伤和创伤应对机制。     

The grip of trauma: How trauma disrupts the academic aspirations of foster youth

The academic challenges foster youth encounter during their P-12 education have been widely reported. Yet, despite these challenges, the majority of foster youth desire postsecondary education. What is less known is the reason why so few foster youth alumni who desire a four-year college degree, achieve this goal. For the participants in this four-year longitudinal study, maltreatment, resulting in foster care placement, and the ensuing exposure to the foster care system, resulted in trauma histories and mental health diagnoses. Anxiety, depression, and posttraumatic stress disorder (PTSD), were the most common diagnosis. The participants shared the ways in which these mental health challenges manifested throughout their college education. Of those in the study, almost half successfully graduated from college, a third dropped out, and only two remain enrolled. This study provides a unique and critical insight into the experiences of foster youth, enrolled in a four-year university, by sharing their stories