The child and Adolescent Trauma Screen 2 (CATS-2) – validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents

Sachser, Cedric; Berliner, Lucy; Risch, Elizabeth; Rosner, Rita; Birkeland, Marianne Skogbrott; Eilers, Rebekka; Hafstad, Gertrud Sofie; Pfeiffer, Elisa; Plener, Paul L.; Jensen, Tine K.

doi:10.1080/20008066.2022.2105580

Cited by 45 publications

(37 citation statements)

References 36 publications

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“…Among the referred patients, 173 youth were eligible for receiving TF-CBT and agreed to participate in the study according to the following criteria: exposure to at least one potentially traumatic event, age between 6 and 18 years, and PTSS of clinically significance, defined as a score of ≥15 on CATS-2 (Child and Adolescent Trauma Screen-2; Sachser et al, 2022 ). Among these, 73 fulfilled criteria for either PTSD or CPTSD and were included in the study sample (89.0% girls M age = 15.4, SD = 1.8).…”

Section: Methodsmentioning

confidence: 99%

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Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Jensen

Braathu

Birkeland

et al. 2022

European Journal of Psychotraumatology

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Background: Complex posttraumatic stress disorder (CPTSD) has recently been added to the ICD-11 diagnostic system for classification of diseases. The new disorder adds three symptom clusters to posttraumatic stress disorder (PTSD) related to disturbances in self-organization (affect dysregulation, negative self-concept, and disturbances in relationships). Little is known whether recommended evidence-based treatments for PTSD in youth are helpful for youth with CPTSD. Objectives: This study examined whether Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is useful in reducing PTSD and CPTSD in traumatized youth. Methods: Youth ( n = 73, 89.0% girls, M age = 15.4 SD = 1.8) referred to one of 23 Norwegian child and adolescent mental health clinics that fulfilled the criteria for PTSD or CPTSD according to ICD-11 and received TF-CBT were included in the study. Assessments were conducted pre-treatment, and every fifth session. Linear mixed effects models were run to investigate whether youth with CPTSD and PTSD responded differently to TF-CBT. Results: Among the 73 youth, 61.6% ( n = 45) fulfilled criteria for CPTSD and 38.4% ( n = 28) fulfilled criteria for PTSD. There were no differences in sex, age, birth country, trauma type, number of trauma types or treatment length across groups. Youth with CPTSD had a steeper decline in PTSD and CPTSD compared to youth with PTSD. The groups reported similar levels of PTSD and CPTSD post-treatment. The percentage of youth who dropped out of treatment was not different across groups. Further, the groups did not differ significantly in number of received treatment sessions. Conclusions: This is the first study to examine whether TF-CBT is helpful for youth who have CPTSD using a validated instrument for measuring CPTSD. The results suggest that TF-CBT may be useful for treating CPTSD in youth. These are promising findings that should be replicated in studies with larger sample sizes.

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Section: Methodsmentioning

confidence: 99%

“…Exposure to potentially traumatic events, posttraumatic stress disorder and complex posttraumatic disorder were measured by the Child and Adolescent Trauma Screen 2 (CATS-2) (Sachser et al, 2022 ). CATS-2 measures PTSD according to both DSM-5 and ICD-11, as well as CPTSD according to ICD-11.…”

Section: Methodsmentioning

confidence: 99%

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Jensen

Braathu

Birkeland

et al. 2022

European Journal of Psychotraumatology

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“…These criteria were included in the collaborating agreement signed by each clinic and the implementing institution. Inclusion criteria for patients receiving TF-CBT were age between 6-18 and clinically significant PTSS (≥ 15) based on the Child and Adolescent Trauma Screen (CATS; [50,51].…”

Section: Methodsmentioning

confidence: 99%

“…Posttraumatic stress symptoms were measured using the Child and Adolescent Trauma Screen (CATS) [50]. From 2018, version 2.0 of CATS was used [51]. The CATS is based on the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and version 2.0 measures PTSS according to both DSM 5 and ICD-11.…”

Section: Posttraumatic Stress Symptomsmentioning

confidence: 99%

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Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Skar

Braathu

Jensen

et al. 2022

BMC Health Serv Res

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Background There is a paucity of evidence about effective implementation strategies to increase treatment response and prevent drop-out among children receiving evidence-based treatment. This study examines patient, therapist, and implementation factors and their association to nonresponse and drop-out among youth receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Methods Youth (n = 1240) aged 6–18 (M = 14.6) received TF-CBT delivered by 382 TF-CBT therapists at 66 clinics. Odds ratio analyses were used to investigate whether pretreatment child (age, gender, number of trauma experiences, post-traumatic stress symptoms (PTSS), therapist (education), and implementation strategy factors (high-low, low-low, low–high intensity therapist and leadership training respectively) or tele-mental health training during the Covid-19 pandemic are associated with nonresponse (above clinical PTSS level post-treatment) and drop-out (therapist-defined early termination). Fidelity checks were conducted to ensure that TF-CBT was used consistently. Results One fourth of the children (24.4%) were nonresponders and 13.3 percent dropped out. Exposure to three or more traumatic experiences were related to nonresponse and drop-out. Higher baseline PTSS was related to a higher probability of nonresponse. There was no effect of therapist education or child gender on nonresponse and drop-out, whereas children over 15 years had a higher likelihood of both. After controlling for baseline PTSS, the effect of age on nonresponse was no longer significant. Drop-out was related to fewer sessions, and most dropped out during the first two phases of TF-CBT. Fidelity was high throughout the different implementation phases. High-intensity therapist training was related to a lower probability of both nonresponse and drop-out, whereas low therapist and leadership training were related to a higher likelihood of both. Multivariate analysis revealed higher child age and higher PTSS baseline scores as significant predictors of nonresponse, and number of trauma experiences (> = 3) at baseline as the only predictor of drop-out. Conclusions High-intensity therapist training seem key to prevent patient nonresponse and drop-out. Leadership training might positively affect both, although not enough to compensate for less intensive therapist training. More complex cases (higher PTSS and exposure to more traumas) predict nonresponse and drop-out respectively, which underscores the importance of symptom assessment to tailor the treatment. The lack of predictive effect of therapist education increases the utilization of TF-CBT. Trial registration Retrospectively registered in ClinicalTrials, ref. nr. NCT05248971.

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Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents

Goreis,

Pfeffer,

Hajek Gross

et al. 2024

JAMA Netw Open

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ImportanceNonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI.ObjectiveTo use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI.Design, Setting, and ParticipantsFrom June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024.ExposureExposure to NSSI-related stimuli.Main Outcomes and MeasuresDuring both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed.ResultsA total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI—but not those without a history of NSSI—showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P &lt; .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P &lt; .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P &lt; .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P &lt; .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P &lt; .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group.Conclusions and RelevanceIn this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers.Trial RegistrationGerman Clinical Trials Register identifier: DRKS00025905.

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The child and Adolescent Trauma Screen 2 (CATS-2) – validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents

Cited by 45 publications

References 36 publications

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents

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