How do you screen for childhood trauma? One doctor at the 2022 Annual Psychiatric Times™ World CME Conference in San Diego, one doctor shared his most helpful tips.
In his presentation, “How to Assess/Diagnose Childhood Trauma,” at the 2022 Annual Psychiatric Times™ World CME Conference in San Diego, Mark B. Hamner, MD pointed out that the Department of Health and Human Services data on child abuse underestimates traumatic exposure, given they only address abuse and not other traumas. “And abuse is often not reported,” he added.
What Children Are at Risk?
Children can experience a number of traumatic experiences beyond physical, sexual, or psychological abuse and neglect, said Hamner, including: natural disasters or terrorism; family or community violence; the sudden or violent loss of a loved one; substance use disorder either personally or within their family; refugee and war experiences, including torture; serious accidents or life-threatening illness; military family related stressors, like deployment or parental loss, can all play a part in the child’s traumatic history.
Additionally, in the National Comorbidity Survey Replication Adolescent supplement, which looked at a national survey of adolescents aged 13 to 17, the lifetime prevalence of DSM-IV PTSD was 4.7% higher in girls.
Children and adolescents who identify as part of the LGBTQ+ community experience trauma at unique, higher rates. Common traumas include bullying, harassment, traumatic loss, intimate partner violence, physical and sexual abuse, stigma, and more.
“Somatization is a significant posttraumatic stress symptom,” said Hamner. “Some have argued this should be included in diagnostic criteria.”
An exemplifying study looked at the relationship between PTSD symptoms and somatization, and between intelligence and somatization in child sexual abuse victims to determine whether the type of abuse had an effect on the relationship between PTSD symptoms and somatization.1
The study concluded that somatization in children who were sexually abused was influenced by the severity of PTSD symptoms and intelligence, and the effect of the PTSD symptoms on somatization was moderated by type of abuse.
How to Screen This Population
When screening children and adolescents for trauma, Hamner shared a few tips that might help. 1. Make time in therapy sessions to complete screening measures with family members.
2. Allow the parent and child to choose the language in which the screen is completed.
3. Use developmentally appropriate strategies, like a chalk or dry erase board.
4. Let them decide the order in which they complete measures when possible.
5. Use visual aids.
6. If child is resistant, read aloud to them.
7. Offer to complete over 1 to 3 sessions.
8. Praise all children and parents for “hard work.”
9. Check endorsement of critical items like hurting oneself and develop safety plan.
10. Take time to explain what will happen next and clarify that you will readminister measures on an ongoing basis.
The National Child Traumatic Stress Network is an important resource, Hamner also noted. Specifically, he mentioned their Child and Adolescent Trauma Screen (CATS) instrument.2 It is downloadable and brief, taking only 5 to 10 minutes to complete. This could be a helpful tool in the screening arsenal, he said.
“There are the unique developmental considerations in this age range,” concluded Hamner. “It’s a vastly under researched area, not only in terms of epidemiology but also in terms of treatments.”
1. Bae SM, Kang JM, Chang HY, et al. PTSD correlates with somatization in sexually abused children: type of abuse moderates the effect of PTSD on somatization. PLoS One. 2018;13(6):e0199138.
2. Child and Adolescent Trauma Screen. International Society for Traumatic Stress Studies. Accessed August 12, 2022. https://istss.org/clinical-resources/child-trauma-assessments/child-and-adolescent-trauma-screen-(cats)