Rochelle F. Hanson

A Case Series: Cognitive-Behavioral Treatment (Exposure, Relaxation, and Rescripting Therapy) of Trauma-Related Nightmares Experienced by Children

Two case studies are presented to demonstrate that children who experience trauma-related nightmares may benefit from cognitive-behavioral therapy for this sleep problem. The treatment was adapted from the empirically supported adult treatment for chronic trauma-related nightmares: exposure, relaxation, and rescripting therapy (ERRT). Pretreatment and posttreatment nightmare frequency and severity were measured in addition to subjective nightmare-related distress, behavioral problems, sleep quality and quantity, and symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression. Improvement in nightmare and sleep disturbance frequencies were found as well as reductions in parents’ reports of child behavior problems. This study provides preliminary support for the use of ERRT with children.

The Trauma Symptom Checklist for Young Children (TSCYC): reliability and association with abuse exposure in a multi-site study

OBJECTIVE The Trauma Symptom Checklist for Young Children (TSCYC) is a 90-item caretaker-report measure of childrens trauma- and abuse-related symptomatology. It contains two reporter validity scales and eight clinical scales [Post-traumatic Stress-Intrusion (PTS-I), Post-traumatic Stress-Avoidance (PTS-AV), Post-traumatic Stress-Arousal (PTS-AR), Post-traumatic Stress-Total (PTS-TOT), Sexual Concerns (SC), Dissociation (DIS), Anxiety (ANX), Depression (DEP), and Anger/Aggression (ANG)], as well as an item assessing hours per week of caretaker contact with the child. This paper introduces the TSCYC and describes its psychometric properties in a multisite validity study. METHOD A total of 219 TSCYCs administered by six clinician/researchers across the United States were analyzed for scale reliability and association with several types of childhood maltreatment. RESULTS The TSCYC clinical scales have good reliability and are associated with exposure to childhood sexual abuse, physical abuse, and witnessing domestic violence. The PTS-I, PTS-AV, PTS-AR, and PTS-TOT scales were most predictive, followed by SC in the case of sexual abuse and DIS in the case of physical abuse. There were a small number of age, sex, and race effects on TSCYC scores. CONCLUSIONS The TSCYC appears to have reasonable psychometric characteristics, and correlates as expected with various types of trauma exposure. Subject to continued validation and the development of general population norms, its use as a clinical measure is supported.

INCOME, RACE/ETHNICITY, AND EXPOSURE TO VIOLENCE IN YOUTH: RESULTS FROM THE NATIONAL SURVEY OF ADOLESCENTS

This study examined the associations between household income, race/ethnicity, and exposure to violence in a nationally representative sample of youth. Participants included a national probability sample of adolescents (ages 12-17), who completed a telephone interview that assessed lifetime occurrences of witnessing violence, receipt of physically abusive punishment, physical assault, and sexual assault. Results indicated that as household income increased prevalence of witnessing violence, receipt of physically abusive punishment, physical assault, and sexual assault decreased for Caucasian but not African-American or Hispanic youth. In addition to the interaction of household income with race/ethnicity, a main effect of race/ethnicity across income groups was apparent for witnessing violence. More specifically, African-American and Hispanic youth reported significantly higher rates of witnessing violence at each income level relative to their Caucasian counterparts. Findings from this nationally representative sample of youth suggest that it may be simplistic to interpret high rates of violence exposure among minority youth as due to their disproportionate representation among the economically disadvantaged in the United States. This study illustrates the importance of examining risk and protective factors separately for each type of violence experienced by youth, and underscores the need to assess the generalizability of risk and protective factors across racial/ethnic groups. � 2000 John Wiley & Sons, Inc.

Prevalence and correlates of dating violence in a national sample of adolescents.

OBJECTIVE Dating violence is an important but understudied public health concern in adolescents. This study sought to examine the lifetime prevalence of serious forms of dating violence in 12- to 17- year-olds, risk and protective factors associated with dating violence, and the relation between dating violence and mental health. METHOD A nationally representative sample of adolescents (N = 3,614) completed a telephone-based interview that assessed serious forms of dating violence (i.e., sexual assault, physical assault, and/or drug/alcohol-facilitated rape perpetrated by a girlfriend, boyfriend, or other dating partner). RESULTS Prevalence of dating violence was 1.6% (2.7% of girls, 0.6% of boys), equating to approximately 400,000 adolescents in the U.S. population. Risk factors included older age, female sex, experience of other potentially traumatic events, and experience of recent life stressors. Findings also suggested that dating violence is associated with posttraumatic stress disorder and major depressive episode after controlling for demographic variables, other traumatic stressors, and stressful events. CONCLUSIONS These findings indicate that dating violence is a significant public health problem in adolescent populations that should be addressed through early detection, prevention, and intervention.

Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems:

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Childrens (APSAC) position and also was endorsed by the American Psychological Associations Division 37 and the Division 37 Section on Child Maltreatment.

Prevalence, Case Characteristics, and Long-Term Psychological Correlates of Child Rape among Women: A National Survey

Using telephone interview methods, a national probability sample of adult women was screened for a history of completed rape in childhood, and characteristics of child rape incidents were assessed. All respondents were evaluated for a history of major depressive episode, post-traumatic stress dis-order (PTSD), and substance use problems. Implications of the results for prevention, intervention, and future research are discussed.

Factors related to the reporting of childhood rape

OBJECTIVE The aim of this study was to examine whether there would be differences in reported versus unreported cases of childhood rape on incident characteristics including life threat, physical injury, identity of the perpetrator, frequency of assault(s), and rates of posttraumatic stress disorder or major depression. METHOD In a telephone interview, a national probability sample of 4,008 (weighted) adult women was screened for a history of completed rape in childhood. Respondents were also assessed for DSM-III-R diagnoses of major depressive episode and/or posttraumatic stress disorder (PTSD). Three hundred forty-one (8.5%) of these women were victims of at least one rape prior to the age of 18, for a total of 437 completed rapes. Of these 437 rape incidents, 52 (11.9%) were reported to the police or other authorities. RESULTS Significant differences were obtained between reported versus nonreported cases on incident characteristics, including life threat, physical injury, identity of the perpetrator. Reported cases were more likely to involve life threat and/or physical injury, and were more likely to have been committed by a stranger than nonreported cases. No significant differences between reported and nonreported cases were found concerning whether the rape involved a single incident versus series of events, or rates of PTSD or major depression. CONCLUSIONS Findings suggest that different characteristics are associated with reported versus unreported cases of childhood rape. Since few cases of childhood rape are actually reported to the authorities, it appears that we may be missing valuable information. Implications for research and clinical intervention are discussed.

Is disclosure of childhood rape associated with mental health outcome? Results from the National Women's Study.

Clinicians often assert that disclosure of childhood rape is beneficial to victims because it sets the occasion for protective action and can bring them into contact with professionals trained to address rape-related mental health needs. Consistent with this is the hypothesis that victims of childhood rape who disclose their victimization soon after it occurs are at lower risk for later psychosocial difficulties relative to those who delay disclosure or never disclose. We explored this issue with a nationally representative sample of 3,220 adult women; 288 (8.9%) endorsed at least one instance of forcible sexual penetration prior to age 18. Results revealed a significantly higher past-year prevalence of posttraumatic stress disorder (PTSD) and major depressive episodes among women who waited longer than 1 month to disclose their rape relative to nondisclosers and women who disclosed within 1 month of the rape. Delayed disclosure remained associated with PTSD after controlling for demographic and rape characteristics. Patterns of disclosure were not associated with past-year substance-use problems.

Reactive Attachment Disorder: what we know about the disorder and implications for treatment.

In recent years, there has been an increase in the number of children diagnosed with Reactive Attachment Disorder (RAD). There is considerable disagreement about what this entity actually entails and, in particular, what types of assessments and interventions to use with these children and families. Children with a history of maltreatment (i.e., physical, sexual, emotional abuse, and/or severe neglect) are particularly likely to receive this diagnosis, because the behavior problems often seen in these children are presumed to stem from the maladaptive relationships they have had with abusive caregivers. However, many children are receiving this diagnosis because of behavior problems that clearly extend beyond the DSM-IV criteria for RAD. Perhaps the most concerning consequence of the RAD diagnosis is the emergence of novel treatments that lack a sound theoretical basis or empirical support, and may potentially be traumatizing and dangerous to the child. Thus, the purpose of this article is to review and synthesize what is known about RAD and attachment disorders and to discuss implications for treatment.

Relations Among Gender, Violence Exposure, and Mental Health: The National Survey of Adolescents

Using a nationally representative sample of 4,008 adolescents, this study examines gender differences in violence exposure, major depressive episode (MDE) and posttraumatic stress disorder (PTSD), and characteristics of violence incidents. It was hypothesized that there would be gender differences in the types of violence exposure reported and in the prevalence of MDE and PTSD and that gender would moderate the relationship between violence exposure and mental health outcomes. Results indicated significant gender differences in rates of violence exposure, PTSD, and MDE. Additionally, gender was a moderating variable in the relation between sexual assault and PTSD, but not in the other violence exposure?mental health relations examined. It thus appears that the pathways for developing PTSD may be different for male and female victims of sexual abuse. Implications for interventions and future research are discussed.