These ratings describe a range of reactions that children and adolescents may exhibit to any of the variety of traumatic experiences described above. Unlike the Trauma Experiences, which are cumulative over the child’s lifetime, these symptoms are rated based on how the child is doing over the past 30 days.
For Trauma Stress Symptoms, the following categories and action levels are used:
0 | indicates a dimension where there is no evidence of any needs.
1 | indicates a dimension that requires monitoring, watchful waiting, or preventive activities.
2 | indicates a dimension that requires action to ensure that this identified need or risk behavior is addressed.
3 | indicates a dimension that requires immediate or intensive action.
NU Quick Tip
This domain rates how a child is adjusting to trauma. Consider scoring any item in this domain for a child that has experienced trauma.
14. Adjustment to Trauma
This item covers the youth’s reaction to any of a variety of traumatic experiences – such as emotional, physical, or sexual abuse, separation from family members, witnessing violence, or the victimization or murder of family members or close friends. This dimension covers both adjustment disorders and posttraumatic stress disorder from DSM-IV. This is a cause and effect item that describes how the child is currently adjusting to trauma experienced previously.
0 | Child has not experienced any significant trauma or has adjusted well to traumatic experiences.
1 | Child has some mild problems with adjustment due to trauma. Child may have an adjustment disorder or other reaction that might ease with the passage of time. Or, child may be recovering from a more extreme reaction to a traumatic experience.
2 | Child has marked adjustment problems associated with traumatic experiences. Child may have nightmares or other notable symptoms of adjustment difficulties.
3 | Child has post-traumatic stress difficulties as a result of traumatic experience. Symptoms may include intrusive thoughts, hyper-vigilance, constant anxiety, and other common symptoms of Post Traumatic Stress Disorder (PTSD).
**LOOK OUT**
This item is rated if a child has any trouble adjusting to trauma, in whatever manner that is expressed for the child. This item should almost always be scored a 1 at minimum if there has been any recent trauma experiences.
15. Traumatic Grief / Separation
This rating describes the level of traumatic grief due to death or loss or separation from significant caregivers, siblings, or other significant figures.
0 | There is no evidence that the child has experienced traumatic grief or separation from significant caregivers or the child has adjusted well to separation.
1 | Child is experiencing some level of traumatic grief due to death or loss of a significant person or distress from caregiver separation in a manner that is appropriate given the recent nature of loss or separation.
2 | Child is experiencing a moderate level of traumatic grief or difficulties with separation in a manner that impairs functioning in some but not all areas. This could include withdrawal or isolation from others.
3 | Child is experiencing significant traumatic grief or separation reactions. Child exhibits impaired functioning across several areas (e.g. interpersonal relationships, school) for a significant period of time following the loss or separation.
16. Reexperiencing
These symptoms consist of intrusive memories or reminders of traumatic events, including nightmares, flashbacks, intense reliving of the events, and repetitive play with themes of specific traumatic experiences. These symptoms are part of the DSM-IV criteria for PTSD.
0 | This rating is given to a child with no evidence of intrusive symptoms.
1 | This rating is given to a child with some problems with intrusions, including occasional nightmares about traumatic events.
2 | This rating is given to a child with moderate difficulties with intrusive symptoms. This child may have recurrent frightening dreams with or without recognizable content or recurrent distressing thoughts, images, perceptions or memories of traumatic events. This child may exhibit trauma-specific reenactments through repetitive play with themes of trauma or intense physiological reactions to exposure to traumatic cues.
3 | This rating is given to a child with severe intrusive symptoms. This child may exhibit trauma-specific reenactments that include sexually or physically traumatizing other children or sexual play with adults. This child may also exhibit persistent flashbacks, illusions or hallucinations that make it difficult for the child to function.
17. Avoidance
These symptoms include efforts to avoid stimuli associated with traumatic experiences. These symptoms are part of the DSM-IV criteria for PTSD.
0 | This rating is given to a child with no evidence of avoidance symptoms.
1 | This rating is given to a child who exhibits some avoidance. This child may exhibit one primary avoidant symptom, including efforts to avoid thoughts, feelings or conversations associated with the trauma.
2 | This rating is given to a child with moderate symptoms of avoidance. In addition to avoiding thoughts or feelings associated with the trauma, the child may also avoid activities, places, or people that arouse recollections of the trauma.
3 | This rating is given to a child who exhibits significant or multiple avoidant symptoms. This child may avoid thoughts and feelings as well as situations and people associated with the trauma and be unable to recall important aspects of the trauma.
18. Numbing
These symptoms include numbing responses that are part of the DSM-IV criteria for PTSD. These responses were not present before the trauma.
0 | This rating is given to a child with no evidence of numbing responses.
1 | This rating is given to a child who exhibits some problems with numbing. This child may have a restricted range of affect or be unable to express or experience certain emotions (e.g., anger or sadness).
2 | This rating is given to a child with moderately severe numbing responses. This child may have a blunted or flat emotional state or have difficulty experiencing intense emotions or feel consistently detached or estranged from others following the traumatic experience.
3 | This rating is given to a child with significant numbing responses or multiple symptoms of numbing. This child may have a markedly diminished interest or participation in significant activities and a sense of a foreshortened future.
19. Dissociation
Symptoms included in this dimension are daydreaming, spacing or blanking out, forgetfulness, fragmentation, detachment, and rapid changes in personality often associated with traumatic experiences. This dimension may be used to rate dissociative disorders (e.g., Dissociative Disorder NOS, Dissociative Identity Disorder) but can also exist when other diagnoses are primary (e.g., PTSD, depression)
0 | This rating is given to a child with no evidence of dissociation.
1 | This rating is given to a child with minor dissociative problems, including some emotional numbing, avoidance or detachment, and some difficulty with forgetfulness, daydreaming, spacing or blanking out.
2 | This rating is given to a child with a moderate level of dissociation. This can include amnesia for traumatic experiences or inconsistent memory for trauma (e.g., remembers in one context but not another), more persistent or perplexing difficulties with forgetfulness (e.g., loses things easily, forgets basic information), frequent daydreaming or trance-like behavior, depersonalization and/or derealization. This rating would be used for someone who meets criteria for Dissociative Disorder Not Otherwise Specified or another diagnosis that is specified “with dissociative features.”
3 | This rating is given to a child with severe dissociative disturbance. This can include significant memory difficulties associated with trauma that also impede day to day functioning. Child is frequently forgetful or confused about things he/she should know about (e.g., no memory for activities or whereabouts of previous day or hours). Child shows rapid changes in personality or evidence of distinct personalities. Child who meets criteria for Dissociative Identity Disorder or a more severe level of Dissociative Disorder NOS would be rated here.