Past the Pandemic: a virtual intervention supporting the well-being of healthcare workers through the COVID-19 pandemic.

To decrease burnout and improve mental health and resiliency among doctors, nurses, and hospital staff during the COVID-19 pandemic, the University of Colorado partnered with ECHO Colorado to offer the state's healthcare workforce an interactive, psychoeducational, and online intervention that encouraged connection and support. The series utilized the Stress Continuum Model as its underlying conceptual framework. Between July 2020 and February 2022, 495 healthcare workers in Colorado participated in the series across eight cohorts. One-way repeated measures ANOVAs were performed to test for differences in pretest and posttest scores on series' objectives. Healthcare workers showed significant improvement from pretest to posttest in (1) knowing when and how to obtain mental health resources, F(1, 111) = 46.497, p < 0.001, (2) recognizing of the importance of being socially connected in managing COVID-related stress, F(1, 123) = 111.159, p < 0.001, (3) managing worries, F(1, 123) = 94.941, p < 0.001, (4) feeling prepared to manage stressors related to the pandemic, F(1, 111) = 100.275, p < 0.001, (5) feeling capable in dealing with challenges that occur daily, F(1, 111) = 87.928, p < 0.001, and (6) understanding the Stress Continuum Model F(1, 123) = 271.049, p < 0.001. This virtual series showed efficacy in improving the well-being of healthcare workers during a pandemic and could serve as a model for mental health support for healthcare workers in other emergency response scenarios.

Expert consensus regarding indicators of a traumatic reaction in autistic youth: a Delphi survey.

OBJECTIVE: It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth. METHODS: We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating. RESULTS: Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy. CONCLUSIONS: Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.

A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma.

Background: Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure. Objectives: To describe the range of coping strategies autistic individuals use following traumatic events. Methods: Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes. Results: Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors. Conclusions: Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.

Exploring potential sources of childhood trauma: A qualitative study with autistic adults and caregivers.

LAY ABSTRACT: The stressors autistic individuals encounter and experience as traumatic may vary from those not on the spectrum and typically measured. We conducted in-depth interviews with autistic adults and caregivers of children and adults on the spectrum to identify potential sources of trauma for autistic individuals and evaluate the ability of a standard trauma measure to capture those experiences. Fourteen autistic adults and 15 caregivers with varied backgrounds, clinical profiles, and histories of adversity were interviewed. Participants also completed standard measures of autism, traumatic exposures, and stress. Interviews were analyzed to record both traditional sources of trauma, for comparison with the standard measure, and distinct sources, described as traumatic only in the narratives of participants. Participants described varied experiences as traumatic. Whereas some reflected traditional traumas (e.g. maltreatment) and forms of social marginalization, others reflected conflicts between autistic characteristics and the environment (e.g. sensory trauma). All adults and most caregivers described sources of trauma in interviews not reported on the standard measure. Results have implications for assessing traumatic events in autism and for understanding their contribution to the mental health of this group.

Screening and treatment of trauma-related symptoms in youth with autism spectrum disorder among community providers in the United States.

Using a cross-sectional survey of 673 multidisciplinary autism spectrum disorder providers recruited from five different sites in the United States, we examined the frequency with which community-based providers inquire about, screen, and treat trauma-related symptoms in their patients/students and assessed their perceptions regarding the need for and barriers to providing these services. Univariate and bivariate frequencies of self-reported trauma service provision, training needs, and barriers were estimated. Multivariable logistic regressions identified provider and patient-related factors associated with trauma-related symptoms screening and treatment. Over 50% of providers reported some screening and treatment of trauma-related symptoms in youth with autism spectrum disorder. Over 70% informally inquired about trauma-related symptoms; only 10% universally screened. Screening and treatment varied by provider discipline, setting, amount of interaction, and years of experience with autism spectrum disorder, as well as by patient/student sex, ethnicity, and socioeconomic status. Most providers agreed that trauma screening is a needed service impeded by inadequate provider training in trauma identification and treatment. The findings indicate that community providers in the United States of varied disciplines are assessing and treating trauma-related symptoms in youth with autism spectrum disorder, and that evidence-based approaches are needed to inform and maximize these efforts.

Pediatrician's Practical Approach to Sleep Disturbances in Children Who Have Experienced Trauma.

Sleep difficulties are a common challenge among children who have experienced trauma. Pediatricians are best positioned to work with families to address sleep challenges after traumatic events and help families return to healthy sleep patterns. In this article, we review the underlying concepts that connect trauma to disturbed sleep, types of sleep difficulties seen in children exposed to trauma, and explore ways in which pediatricians can support families as they help their child return to a normal sleep cycle, including the identification of co-occurring conditions and the use of medications. [Pediatr Ann. 2019;48(7):e280-e285.].

Use of Prazosin for Pediatric PTSD-Associated Nightmares and Sleep Disturbances: A Retrospective Chart Review.

INTRODUCTION: Youth exposed to trauma have an increased risk for developing posttraumatic stress disorder (PTSD) and associated sleep disturbances and nightmares. The alpha-1 antagonist prazosin reduces sleep disturbances and nightmares in adults with PTSD; however, its use in youth with PTSD has not been systematically evaluated. We retrospectively examined the tolerability and clinical outcomes associated with prazosin treatment in youth with PTSD-related nightmares and dysomnias. METHOD: A retrospective chart review identified youth with PTSD (N = 40) treated with prazosin between 2014 and 2016 in a trauma clinic. We assessed the UCLA PTSD Reaction Index for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition scores (and sub-scores for intrusive, hyperarousal, avoidant and negative cognition/mood symptoms) and sleep scale, as well as adverse events and vital signs. Linear mixed effects models were utilized to evaluate the change in symptom severity, and vital signs were monitored throughout treatment. RESULT: Follow-up data were available for 34 patients with PTSD (mean age 13.4 ± 2.9 years, 82% female), of whom 76% had a history of sexual abuse and 65% had at least one comorbid psychiatric disorder. The mean duration of prazosin treatment was 10.2 ± 8.1 (range 2-30) weeks, and the mean number of follow-up visits was 3 ± 1.23. Of these 34 patients, 79% received trauma-focused cognitive behavioral therapy. The dose range of prazosin was 1-15 mg at every bedtime (0.02-0.3 mg/kg), with 35% receiving ≥5 mg/day. Treatment-emergent side effects were reported by 26% (n = 8) of patients, including dizziness (18%), anxiety (9%) and headaches (6%). Prazosin treatment was associated with improved sleep and nightmares over time (pre-treatment 7.3 ± 0.9, post-treatment 3.1 ± 2.4; p < 0.001). CONCLUSION: Prazosin was well-tolerated and associated with improvements in nightmares and sleep in youth with PTSD. Adverse events were consistent with the known side-effect profile of prazosin and included dizziness and nausea.

Child-Adult Relationship Enhancement in Primary Care (PriCARE): A Randomized Trial of a Parent Training for Child Behavior Problems.

OBJECTIVE: Child-Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group parent training designed to teach positive parenting skills. Our objective was to measure PriCARE's impact on child behavior and parenting attitudes. METHODS: Parents of children 2 to 6 years old with behavior concerns were randomized to PriCARE (n = 80) or control (n = 40). Child behavior and parenting attitudes were measured at baseline (0 weeks), program completion (9 weeks), and 7 weeks after program completion (16 weeks) using the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory 2 (AAPI2). Linear regression models compared mean ECBI and AAPI2 change scores from 0 to 16 weeks in the PriCARE and control groups, adjusted for baseline scores. RESULTS: Of those randomized to PriCARE, 43% attended 3 or more sessions. Decreases in mean ECBI intensity and problem scores between 0 and 16 weeks were greater in the PriCARE group, reflecting a larger improvement in behavior problems [intensity: -22 (-29, -16) vs -7 (-17, 2), P = .012; problem: -5 (-7, -4) vs -2 (-4, 0), P = .014]. Scores on 3 of the 5 AAPI2 subscales reflected greater improvements in parenting attitudes in the PriCARE group compared to control in the following areas: empathy toward children's needs [0.82 (0.51, 1.14) vs 0.25 (-0.19, 0.70), P = .04], corporal punishment [0.22 (0.00, 0.45) vs -0.30 (-0.61, 0.02), P = .009], and power and independence [0.37 (-0.02, 0.76) vs -0.64 (-1.19, -0.09), P = .003]. CONCLUSIONS: PriCARE shows promise in improving parent-reported child-behavior problems in preschool-aged children and increasing positive parenting attitudes.

Prevention of Youth Violence: A Public Health Approach.

The causes of youth violence are multifactorial and include biological, individual, familial, social, and economic factors. The influence of parents, family members, and important adults can shape the beliefs of the child toward violence in a significant manner. However, the influence of school and the neighborhood also have an important role in attitudes and behaviors of children toward violence. The complexity of factors related to violence requires a comprehensive public health approach. This article focuses on evidence-based models of intervention to reduce violence while emphasizing collective impact as a guiding principle.

Traumatic Childhood Events and Autism Spectrum Disorder.

Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae; however, this topic has been understudied. This review considers the rationale for examining traumatic events and related symptomology in individuals with ASD and summarizes the limited research on this topic. A conceptual framework for understanding the interplay of ASD, trauma and traumatic sequelae is proposed and recommendations for future research presented.

Evaluation and treatment of childhood physical abuse and neglect: a review.

According to 2010 CDC estimates, 1 in 5 US children have experienced maltreatment. Risk factors for child maltreatment include child characteristics such as non-compliance and diagnostic conditions that increase caregiver burden. Parent characteristic risk factors include parental mental illness and low social support. New developments in radiologic evaluation of child maltreatment will be reviewed. New findings in evidence based psychotherapies for childhood maltreatment will be discussed. A review of the role of pharmacotherapy in child maltreatment cases will also be presented. New evidence from prevention models targeting young mothers and families are also reviewed.

Pharmacological secondary prevention of PTSD in youth: challenges and opportunities for advancement.

Child and adolescent posttraumatic stress disorder (PTSD) is associated with an increased risk for a number of deleterious mental and physical health outcomes that if untreated may persist throughout the life course. Efficacious interventions applied soon after trauma exposure have the potential to reduce or prevent the development of PTSD symptoms and their associated impact on behavior and physical health. We review extant research related to treatment-modifiable peritraumatic predictors of pediatric PTSD, which have informed an emerging field of pharmacologic secondary prevention (i.e., occurring shortly following trauma exposure) of PTSD. Challenges and opportunities for early posttrauma PTSD prevention are described. Finally, we offer new models for biologically informed integration of pharmacologic and psychosocial secondary prevention intervention strategies for children and adolescents.

Treatment of childhood sexual abuse: an updated review.

Childhood sexual abuse (CSA) involves multiple complex factors that make the evaluation of therapeutic interventions especially complicated. PTSD prevalence rates of CSA are approximately 37 % -53 %. Several other psychiatric sequelae of CSA exist. CSA appears to disrupt brain and body physiology. One co-located service delivery model reported a 52 % linkage rate of CSA survivors with mental health treatment. This article reviews current literature on the treatment of CSA, including psychosocial interventions, pharmacotherapy, and early preventative interventions. It also provides an update on the short- and long-term sequelae of CSA and implications for future research directions. A literature search of papers published in the last 3 years was conducted using the keywords treatment, sexual abuse, childhood, epigenetics, resilience and review, and searching the following databases: PsycInfo, PubMed, Substance Abuse and Mental Health Services Administration, and Centers for Disease Control.

The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD.

OBJECTIVE: This pilot study evaluated the effectiveness of a four-session, caregiver-child Intervention, the Child and Family Traumatic Stress Intervention (CFTSI), to prevent the development of chronic posttraumatic stress disorder (PTSD) provided within 30 days of exposure to a potentially traumatic event (PTE). METHOD: One-hundred seventy-six 7 to 17-year-old youth were recruited through telephone screening based on report of one new distressing posttraumatic stress symptom after a PTE. Of those, 106 youth were randomly assigned to the Intervention (n = 53) or a four-session supportive Comparison condition (N = 53). Group differences in symptom severity were assessed using repeated measures with mixed effects models of intervention group, time, and the interaction of intervention and time. Logistic regression analyses were performed to assess treatment condition and any subsequent traumas experienced as predictors for full and partial PTSD diagnosis at 3-month follow-up. An exploratory chi-square analysis was performed to examine the differences in PTSD symptom criteria B, C, and D at follow-up. RESULTS: At baseline, youth in both groups had similar demographics, past trauma exposures and symptom severity. At follow-up, the Intervention group demonstrated significantly fewer full and partial PTSD diagnoses than the Comparison group on a standardized diagnostic measure of PTSD. Also, there was a significant group by time interaction for Trauma Symptom Checklist for Children's Posttraumatic Stress and Anxiety Indices as the CFTSI group had significantly lower posttraumatic and anxiety scores than the Comparison group. CONCLUSIONS: The results suggest that a caregiver-youth, brief preventative early intervention for youth exposed to a PTE is a promising approach to preventing chronic PTSD.

Research review: The relationship between childhood violence exposure and juvenile antisocial behavior: a meta-analytic review.

BACKGROUND: The connection between childhood violence exposure and antisocial behavior in adolescence has received much attention and has important implications for understanding and preventing criminal behavior. However, there are a limited number of well-designed prospective studies that can suggest a causal relationship, and little is known about the magnitude of the relationship. METHODS: This meta-analysis provides a quantitative comparison of 18 studies (N = 18,245) assessing the relationship between childhood (before age 12) violence exposure and adolescent antisocial behavior. An overall effect size (Cohen's d) was calculated for each study, an average for the 18 studies, and averages for subsets of analyses within studies. RESULTS: Results indicated a small effect from prospective studies (d = .31) and a large effect from cross-sectional studies (d = .88). The effect for victimization (d = .61) was larger than for witnessing violence (d = .15). CONCLUSIONS: Effect size varied across studies employing different methodologies, populations, and conceptualizations of violence exposure and antisocial behavior. These findings do not support a simple, direct link from early violence exposure to antisocial behavior but suggest that many factors influence this relationship.

Acute service delivery in a police-mental health program for children exposed to violence and trauma.

The Child Development Community Policing Program represents a national model of community-based collaboration between police and mental health professionals for violence-exposed and traumatized children. Administrative data from clinical records of a 24-hour consultation service were examined through stepwise multivariate logistic regression to identify child and event characteristics associated with a direct, in-person response at the time of police contact. Of 2361 children, 809 (34.3%) received a direct, in-person response. Relative to Caucasian children, Hispanic youth were more likely to receive this form of response (OR = 1.36). An acute clinical response was more likely for incidents of gang involvement (OR = 8.12), accidents (OR = 5.21), felony assaults (OR = 2.97), property crimes (OR = 2.30), family violence (OR = 1.53) and psychiatric crises (OR = 1.29). Acute response was less likely when juvenile conduct problems (OR = 0.61), fires (OR = 0.59), child maltreatment (OR = 0.57), and domestic violence (OR = 0.44) were involved. Incidents that were more severe or involved a primary mental health component were related to utilization of intensive CDCP resources.

The traumatized child at the emergency department.

The emergency department child and adolescent psychiatrist is in the unique position of informing and helping emergency department providers address the traumatic impact of the cause of a child's emergency presentation and the potential iatrogenic exacerbation of the acute traumatic response. The child and adolescent psychiatrist must become a clinical traumatologist who provides the necessary consultation and education that lead to practice change in emergency department awareness and procedures and performs the optimal evaluation and interventions for children who present in psychiatric crisis.

Children exposed to community violence: the rationale for early intervention.

Children are exposed to violence in their homes and communities at extraordinarily high rates. Given the alarming rates of exposure and its known impact on child developmental outcomes, crisis intervention geared at interrupting the negative effects of violence exposure are increasingly important. This review provides a rationale for the implementation of early and crisis intervention strategies for children exposed to community violence and recommends principles for applying these interventions. These principles are based on the body of research concerning risk and protective factors for children who have been exposed to violence. Relevant factors are reviewed and recommended principles are explicated that correlate to these factors. Issues concerning developmentally informed crisis intervention, support of parental executive functioning, and the need for active community partnership to help ameliorate risk factors are highlighted.