1
|
Talmón-Knuser F, Soler M, González-Sala F, Lacomba-Trejo L, Samper-García P. A Systematic Review on Assessing Assessments: Unveiling Psychometric Properties of Instruments for Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in Minors under Protective Measures. CHILDREN (BASEL, SWITZERLAND) 2024; 11:144. [PMID: 38397256 PMCID: PMC10887385 DOI: 10.3390/children11020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) manifest in individuals facing attachment system challenges, particularly observed in minors under protective measures. The lack of standardized tools for assessing these difficulties and uncertainty about the most effective instruments from a psychometric perspective prompted this study. AIM Using the COSMIN checklist, we systematically reviewed instruments assessing RAD, adhering to PRISMA. METHODOLOGY Examined tools included the Disturbance Attachment Interview, Preschool Age Psychiatric Assessment, Relationship Patterns Questionnaire, Assessment of RAD and DSED, Development and Well-Being Assessment, and Reactive Attachment Disorder Questionnaire. RESULTS Of the 10 articles analyzed, the results highlight a research emphasis on internal consistency and structural and construct validity, sidelining other properties. CONCLUSION Most articles review structural validity and internal consistency. These measures are satisfactory but insufficiently evaluated. It is necessary to evaluate these tools using other indicators such as cross-cultural validity, measurement error, or responsiveness in adolescents under protective measures.
Collapse
Affiliation(s)
- Florencia Talmón-Knuser
- Department of Developmental Psychology and Education, Faculty of Health Science, Catholic University of Uruguay, Montevideo 11600, Uruguay
| | - Miriam Soler
- Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Francisco González-Sala
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| | - Paula Samper-García
- Department of Basic Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, 46010 Valencia, Spain
| |
Collapse
|
2
|
Walsh-Garcia S, Spirtos M, Mockler D, Cremin K. The Impact of Complex Trauma on Occupations and Daily Functioning in Childhood: A Scoping Review. Phys Occup Ther Pediatr 2024; 44:489-512. [PMID: 38186049 DOI: 10.1080/01942638.2023.2299272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
AIMS To explore the impact of complex trauma on occupations and daily functioning in childhood through empirical studies and asses the extent and state of available evidence. METHODS The five-stage scoping review framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR: Tricco et al.) were followed. EMBASE, MEDLINE, CINAHL, PsychINFO, and Web of Science databases were systematically searched. Included studies were empirical research published in English up to December 2022, reporting on the impact of complex trauma on daily functioning or occupations in children experiencing such trauma, defined as prolonged exposure to interpersonal trauma arising within the primary caregiving system. RESULTS Eight studies were included. They reported impacts on personal and instrumental activities of daily living, sleep, education, work, play, leisure, and social participation. Some domains lacked comprehensive investigation, and studies lacked descriptions of specific effects on these areas. CONCLUSIONS The review reveals a lack of robust empirical evidence on the impact of complex trauma on occupations and daily functioning in childhood, with limited depth for comprehensive analysis on the extent of children's occupational life impact. Further research is warranted to address identified gaps.
Collapse
Affiliation(s)
- Síomha Walsh-Garcia
- Discipline of Occupational Therapy, Trinity College Dublin, The University of Dublin, Ireland
| | - Michelle Spirtos
- Discipline of Occupational Therapy, Trinity College Dublin, The University of Dublin, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, The University of Dublin, Ireland
| | - Katie Cremin
- Discipline of Occupational Therapy, Trinity College Dublin, The University of Dublin, Ireland
| |
Collapse
|
3
|
Kerr-Davis A, Hillman S, Anderson K, Cross R. Introducing Routine Assessment of Adverse Childhood Experiences For Looked-After Children: The Use and Properties of the Trauma and Adverse Life Events (TALE) Screening Tool. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:981-994. [PMID: 38045847 PMCID: PMC10689631 DOI: 10.1007/s40653-023-00559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 12/05/2023]
Abstract
The present study aims to illustrate the process of developing, implementing, and clinically validating a new assessment measure, the Trauma and Adverse Life Events (TALE) screening tool, to assess Adverse Childhood Experiences (ACEs) among looked-after children. The TALE was developed by adapting existing ACEs measures to reflect the experiences of looked-after children. The TALE was completed by the local authority social worker for 218 children placed with Five Rivers Child Care (a UK fostering agency, residential, and educational care provider). Reliability was examined and exploratory factor analysis was conducted. Correlations between TALE scores, background variables, and psychosocial wellbeing using the carer-report Strengths and Difficulties Questionnaire (SDQ) and Child Dissociative Checklist (CDC) were also explored. The TALE was found to have acceptable reliability (α = .71). A three-factor solution was found which explained 46.24% of the variance, with factors labelled 'Direct Experience of Abuse', 'Witnessing Harm', and 'Household Dysfunction'. Exposure score was significantly associated with total difficulties score on the SDQ (rs = .24, p < .001) and Impact score was associated with the SDQ's impact score (rs = .33, p < .001). Exposure and Impact scores were both positively correlated with CDC scores (rs = .16, p = .021 and rs = .22, p = .002). This paper presents evidence of the importance of screening looked-after children for ACEs and demonstrates that the TALE is a valid and reliable tool for this purpose. Adverse and traumatic experiences were highly prevalent in this population and appeared to be closely related with children's psychosocial wellbeing. Results emphasise the importance of routine assessment of past experiences within trauma-informed psychological care and intervention planning for looked-after children.
Collapse
Affiliation(s)
- Asa Kerr-Davis
- Assessment and Therapy, Five Rivers Child Care Limited, Salisbury, Wiltshire UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Child Attachment and Psychological Therapies Research (ChAPTRe), Anna Freud Centre, London, UK
| | - Saul Hillman
- Child Attachment and Psychological Therapies Research (ChAPTRe), Anna Freud Centre, London, UK
| | - Katharine Anderson
- Assessment and Therapy, Five Rivers Child Care Limited, Salisbury, Wiltshire UK
| | - Richard Cross
- Assessment and Therapy, Five Rivers Child Care Limited, Salisbury, Wiltshire UK
| |
Collapse
|
4
|
McLeigh JD, Malthaner LQ, Tovar MC, Khan M. Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:745-757. [PMID: 37593050 PMCID: PMC10427591 DOI: 10.1007/s40653-023-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 08/19/2023]
Abstract
This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables. Data were retrieved from electronic health records for 3,067 patients seen at integrated pediatric primary care clinics serving individuals in care. Descriptive and bivariate statistics for presence of MH diagnoses and psychotropic medication prescription were calculated. Multivariable zero-inflated negative binomial regressions were used to assess relationships. Half (50.0%) of patients had at least one MH diagnosis; trauma and stressor-related (31.5%) and attention deficit hyperactivity (22.6%) disorders were most common. 27.8% of patients were prescribed at least 1 psychotropic medication. Complex chronic physical health, having 1 and 2 or more maltreatment exposures, and being 6-11 and 12-20 years of age had significantly higher rates of having a MH diagnosis while being female, Black, Hispanic, and other race were significantly associated with lower rates. Patients with at least 1 MH diagnosis that had complex chronic physical health status, experienced sexual abuse, and were 6-11 and 12-20 years of age had significantly higher rates of psychotropic medication prescription while shelter and kinship placement and female gender were significantly associated with lower rates. Findings suggest that initial and ongoing MH screening is vital for individuals in care so that appropriate interventions can be offered. Results support implementing strategies designed to increase access to MH services for this population, such as integrated care and child psychiatry consult programs. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00547-9.
Collapse
Affiliation(s)
- Jill D. McLeigh
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX USA
| | - Lauren Q. Malthaner
- University of Texas Health Science Center School of Public Health, Dallas, TX USA
| | | | - Mohsin Khan
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
| |
Collapse
|
5
|
Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
Collapse
Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| |
Collapse
|
6
|
Gregory-Wilson R, Spencer L, Handsley E, Raeburn T. Infant removal from birth parents - how does health information impact court decisions? A scoping review. Collegian 2022. [DOI: 10.1016/j.colegn.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
7
|
Reactive attachment disorder and disinhibited social engagement disorder in adolescence: co-occurring psychopathology and psychosocial problems. Eur Child Adolesc Psychiatry 2022; 31:85-98. [PMID: 33185772 PMCID: PMC8816327 DOI: 10.1007/s00787-020-01673-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
Abstract
Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.
Collapse
|
8
|
Malik S, Joychan S, Zajac J, Sinisgalli S, Namerow L. Using an Attachment-Informed Framework in the Clinical Care of Children and Adolescents: A Review of Attachment Theory and Its Impact on Developmental Psychopathology. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210608-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Dunn BJ, Keane CA, Paterson JL. The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people. Eur J Psychotraumatol 2021; 12:1988479. [PMID: 34868480 PMCID: PMC8635648 DOI: 10.1080/20008198.2021.1988479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD. METHODS This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision. DISCUSSION This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021. ABBREVIATIONS CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.
Collapse
Affiliation(s)
- Braden J Dunn
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Australia
| | - Carol A Keane
- College of Health and Human Sciences, Charles Darwin University, Casurina, Australia
| | | |
Collapse
|
10
|
Seim AR, Jozefiak T, Wichstrøm L, Kayed NS. Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence. Eur Child Adolesc Psychiatry 2020; 29:1465-1476. [PMID: 31832788 PMCID: PMC7501108 DOI: 10.1007/s00787-019-01456-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 10/26/2022]
Abstract
Although reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are acknowledged as valid disorders in young children, controversy remains regarding their validity in adolescence. An unresolved question is whether symptoms of RAD and DSED are better conceptualized as other psychiatric disorders at this age. All adolescents (N = 381; 67% consent; 12-20 years old) living in residential youth care in Norway were interviewed to determine the symptoms and diagnosis of RAD/DSED and other common psychiatric disorders using the Child and Adolescent Psychiatric Assessment (CAPA). The construct validity of RAD and DSED, including structural and discriminant validity, was investigated using confirmatory factor analysis and latent profile analysis. Two-factor models distinguishing between symptoms of RAD and DSED and differentiating these symptoms from the symptoms of other psychiatric disorders revealed better fit than one-factor models. Symptoms of RAD and DSED defined two distinct latent groups in a profile analysis. The prevalence of RAD was 9% (95% CI 6-11%), and the prevalence of DSED was 8% (95% CI 5-11%). RAD and DSED are two distinct latent factors not accounted for by other common psychiatric disorders in adolescence. RAD and DSED are not uncommon among adolescents in residential youth care and therefore warrant easy access to qualified health care and prevention in high-risk groups.
Collapse
Affiliation(s)
- Astrid R Seim
- Division of Mental Healthcare, Department of Children and Youth, St. Olavs Hospital, Trondheim, Norway.
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
| | - Thomas Jozefiak
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Nanna S Kayed
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|