Richard A. Oberfield

The intellectual performance of traumatized children and adolescents with or without posttraumatic stress disorder

This study compared the Wechsler Intelligence Scale for Children-III (WISC-III) scores of traumatized youth with posttraumatic stress disorder (PTSD) to the scores of trauma-exposed and nonexposed comparison groups without PTSD. All groups were free of additional major childhood psychiatric disorders. The PTSD group scored significantly lower than the comparison groups on verbal subtests, but not on performance subtests. The scores of the trauma-exposed PTSD negatives and nontrauma exposed controls were not significantly different. Accordingly, PTSD and not a history of trauma exposure in the absence of PTSD was associated with lower verbal IQ.

Posttraumatic Stress Disorder: Memory and Learning Performance in Children and Adolescents

BACKGROUND Despite the wealth of information in adult posttraumatic stress disorder (PTSD) literature, few studies have explored the memory and learning performance of trauma-exposed youth. This study examined if memory deficits are associated with PTSD or with trauma exposure in the absence of PTSD. METHODS Youth exposed to traumatic incidents underwent clinical interviews to diagnose PTSD and exclude major comorbid disorders. Youth with conditions that could impede performance on a memory scale (e.g., limited intellectual functioning, current substance abuse, psychopharmacological treatment) were excluded. Three groups of participants were identified (PTSD positives [n = 29], traumatized PTSD negatives [n = 62], and nontraumatized control subjects [n = 40]). Participants completed the Wide Range Assessment of Memory and Learning (WRAML). RESULTS Youth with PTSD evidenced significantly lower scores on the WRAML General Memory, Verbal Memory, and Learning indices compared with nontraumatized control subjects. With the exception of Verbal Memory, youth with and without PTSD performed comparably on all other indices. Nonsignificant differences were noted on the Visual Memory Index. CONCLUSIONS General memory and verbal memory impairments as evidenced in adult populations were observed among this sample of youth. Given the developmental trajectory of memory capabilities, the implications of such early trauma exposure and memory deficits are considered.

An analysis of the internalizing and externalizing behaviors of traumatized urban youth with and without PTSD

To test the differential validity of the posttraumatic stress disorder (PTSD) classification, 3 groups of youths (PTSD, traumatized PTSD negatives, and controls) were examined. Youth with major comorbid disorders were excluded. On the basis of an analysis of parent-derived Child Behavior Checklist (CBCL) ratings, significant variations in CBCL scores were associated with PTSD but not with exposure to exceptional stress in the absence of PTSD. The results also indicated that traumatic exposure without the development of PTSD was not associated with higher estimates of psychopathology.

The Validity of the Children's PTSD Inventory

The Childrens PTSD Inventory (CPTSDI) was administered to 76 traumatized and 28 nontraumatized youths. CPTSDI diagnoses were compared to DICA-R and SCID PTSD diagnoses. Moderate to high sensitivity, specificity, positive and negative predictive power, and diagnostic efficiency were evidenced across criterion measures. Convergent validity was evidenced by significant correlations with the Revised Childrens Manifest Anxiety Scale, Childrens Depression Inventory, Child Behavior Checklist (CBCL) Internalizing scale, and the Junior Eysenck Personality Inventory (JEPI) Neuroticism scale. Discriminant validity was observed through nonsignificant correlations with the CBCL Externalizing and the JEPI Extraversion scales.

The self-concept of traumatized children and adolescents with or without PTSD

This study compared the Piers-Harris 2 scores of youth with PTSD (n=30) to the scores of traumatized youth without PTSD (n=60) and a non-traumatized comparison group (n=39). In the absence of major comorbid disorders, youth with PTSD evidenced significantly lower scores than the traumatized PTSD negatives and controls on five of six Piers-Harris 2 scales. With the exception of scores on an index of perceived parental acceptance of child behavior, trauma exposure in the absence of PTSD was not associated with lower Piers-Harris 2 scores.

Interdisciplinary approach to conversion disorders in adolescent girls

Abstract In patients in whom physical causes of symptoms have been adequately ruled out, the authors recommend that positive evidence for a diagnosis of conversion disorder be sought. A well-supported diagnosis of conversion disorder can help avoid “doctor shopping” and unnecessary ongoing and repeated medical procedures. By involving the primary physician in the diagnosis at an early stage, the ground is set for a cooperative treatment program and better patient acceptance of the emotional component. Five descriptive cases in girls aged 12½ to 16 years are presented.

A suicide by self-immolation--psychosocial perspectives

This paper reports on a case of suicide by self-immolation on the funeral pyre of the husband. The custom of Sati or widow-burning is reviewed historically and its meaning explored within the psycho-social setting of Hinduism. The contribution of developmental events and psychiatric illness is considered.

Family Therapy with Adolescents: Treatment of a Teenage Girl with Globus Hystericus and Weight Loss

Abstract Family therapy has emerged in recent years as an effective modality of treatment for adolescents as well as for children. Three major orientations within family therapy are described: insight-oriented, structural and strategic. Developmental considerations relating to adolescence are discussed in relation to each type of family treatment. The treatment, including the successive use of these distinct styles of family therapy, of an adolescent girl suffering from a somatic symptom and weight loss is presented.

Self-Reported Anxiety Among Traumatized Urban Youth

This study compared the Revised Children’s Manifest Anxiety Scale (RCMAS) scores of traumatized youth with or without PTSD to the scores of a nonclinical comparison group. Child diagnostic interviews identified children with PTSD (28), traumatized children without PTSD (63), and a nonclinical comparison group (41). In the absence of major comorbid disorders, children with PTSD had significantly higher RCMAS total scores and significantly higher scores on the RCMAS Physiological Anxiety, Worry/Oversensitivity, and Social Concern/Concentration subscales. Nonsignificant differences were observed between groups on the RCMAS Lie subscale. The RCMAS scores of the traumatized PTSD negatives and controls did not significantly differ. Implications for research and practice are considered.

A School-Age Boys/Single Mothers Group

A group psychotherapy model is presented to treat school-age boys with moderately severe behavior problems and their single mothers. The model combines features of traditional latency-age groups and the more recently described multiple-family groups. The specific developmental difficulties encountered by the boys, such as residual conflicts related to separation/individuation and sexual identity, are discussed and group dynamics involving these issues are explored. In view of the increasing number of single-parent families in the United States, this model provides a cost-effective means of offering psychotherapeutic treatment to the children of such families in a clinic setting.