Forward: Pathways from Childhood Trauma to Adolescent Violence and Delinquency

• James Garbarino, Family Life Development Center, Cornell University

Introduction

• Ricky Greenwald, Department of Psychiatry, Mount Sinai Medical Center, New York

SECTION ONE: THEORY AND RESEARCH

1. The Role of Trauma in Conduct Disorder

• Ricky Greenwald, Department of Psychiatry, Mount Sinai Medical Center, New York

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in this population, and trauma effects can help to account for many features of the disorder, including lack of empathy, impulsivity, anger, acting out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention and treatment implications are discussed.

2. Traumatic Victimization in Childhood and Persistent Problems with Oppositional-Defiance

• Julian D. Ford, University of Connecticut Health Center

A number of studies suggest similarities between the psychosocial impairment caused by traumatic victimization and the “cascade” (Patterson, 1993) of problems experienced by youths with severe and persistent problems with oppositional-defiance. Evidence indicating that traumatic victimization may be a factor in disruptive behavior disorders is reviewed. A preliminary conceptual model is proposed as a basis for clinical and research hypothesis testing concerning the potential relationship between traumatic victimization and problematic oppositional-defiance. The model postulates a chronological sequence from (a) victimization in childhood, to (b) escalating dysregulation of emotion and social information processing (“survival coping”), and to (c) severe and persistent problems with oppositional-defiance and overt or covert aggression which are compounded by post-traumatic symptoms (“victim coping”). Implications for diagnosis, prevention, treatment, and research are discussed.

3. Assessment of PTSD and Trauma Exposure in Adolescents

• Elana Newman, University of Tulsa

Increasing evidence suggests that delinquent youth are at high risk for development of PTSD. This article reviews strategies for assessing PTSD among such adolescents. Integrating scientific and clinical approaches, the rationale and implementation of the multi-modal assessment strategy for PTSD is reviewed. A brief overview regarding diagnostic challenges, clinical challenges, and the available structured and semi-structured interviews, self-report measures, and other means of assessing PTSD and trauma exposure is presented.

4. An Examination of the Relationships between Violence Exposure, Posttraumatic Stress Symptomatology, and Delinquent Activity

• Jenifer Wood, National Mental Health Association
• David Foy, Pepperdine University Graduate School of Education and Psychology
• Christopher Layne, Brigham Young University
• Robert Pynoos, University of California at Los Angeles
• C. Boyd James, Center for the Study of Violence and Social Change

The prevalence of violence exposure and PTSD symptomatology among a sample of incarcerated adolescents is compared with that among a matched sample of high-school students. Adolescents who have come to the attention of the juvenile justice system have been exposed to significantly higher levels of sexual and community violence and report significantly higher levels of PTSD symptomatology. Within the incarcerated group, adolescents who report higher levels of delinquent activity (in the form of gun possession and gang involvement) also report higher levels of some forms of violence exposure. Incarcerated youth with more serious delinquent histories displayed higher levels of PTSD symptomatology, as well.

5. Violence Exposure and PTSD Among Delinquent Girls

• Jenifer Wood, National Mental Health Association
• David Foy, Pepperdine University Graduate School of Education and Psychology
• Carole Gogeun, National Center for PTSD – White River Junction
• Robert Pynoos, University of California at Los Angeles
• C. Boyd James, Center for the Study of Violence and Social Change

This study focuses on the unique trauma histories of incarcerated girls. In particular, this study draws upon data obtained from 100 incarcerated adolescent girls, highlighting areas of similarity to and difference from incarcerated boys, including: overall levels of traumatic violence exposure, exposure to unique forms of traumatic violence, psychological symptomatology, and hypothesized trajectories of involvement in serious delinquent activity. In addition, a case example is presented to illustrate our hypotheses about the trajectories of adolescent girls’ involvement in serious delinquent behavior, as well as the prominent role of early trauma histories and repeat victimization in these trajectories.

6. Chaos and Trauma in the Lives of Adolescent Females with Antisocial Behavior and Delinquency

• Patricia Chamberlain, Oregon Social Learning Center
• Kevin J. Moore, Oregon Social Learning Center

Female adolescents entering the juvenile justice system have complex and serious problems in multiple areas of adjustment. Literature is reviewed on the prevalence and form of antisocial behavior in girls and on the long-term implications of such problems in adolescence. Risk factor characteristics, including family fragmentation, physical and sexual trauma, mental health, official arrest and self-report offending histories of a population of girls referred for out-of-home placement because of repeated and chronic juvenile offending are presented. In addition, with the exception of sexual trauma histories, these sample characteristics are compared to a similar sample of chronically offending boys. A treatment approach is described and pilot data are presented on its feasibility. Implications for designing empirically-based, gender-related treatment models are discussed.

SECTION TWO: INTERVENTIONS

7. Preliminary Development of Trauma-Focused Treatment Groups for Incarcerated Juvenile Offenders

• Robert A. McMackin, Life Resources, Inc., A Division of Catholic Charities, Lemule Shattuck Hospital, Massachusetts Department of Public Health
• Mary Beth Leisen, National Center for PTSD, Boston VA Healthcare System
• Leslie Sattler, Life Resources, Inc., A Division of Catholic Charities
• Karen Krinsley, National Center for PTSD, Boston VA Healthcare System
• David S. Riggs, National Center for PTSD, Boston VA Healthcare System

Over 90% of male juvenile offenders have been exposed to trauma. Many juvenile offenders have experienced both acute and chronic trauma. Trauma exposure among offenders is closely linked to their criminal behavior, yet few protocols have been developed to treat posttraumatic sequelae in a delinquent population. This paper describes initial efforts to develop group therapy services for incarcerated male juvenile offenders who have histories of significant trauma exposure and current symptoms of PTSD. Four separate pilot groups were conducted in two secure residential facilities. The treatment included trauma psychoeducation (including the relationship between trauma and offending) and therapeutic trauma exposure through discussion and expressive arts. The treatment development and initial implementation as well as directions for future research are discussed.

8. A Controlled Study of Eye Movement Desensitization and Reprocessing (EMDR) for Boys with Conduct Problems

• Glenn B. Soberman, Home for Boys, Kingston, NY
• Ricky Greenwald, Department of Psychiatry, Mount Sinai Medical Center, New York
• David L. Rule, St. Thomas Aquinas College

We suggest that trauma contributes to the development and persistence of conduct problems, and should be addressed. Eye movement desensitization and reprocessing (EMDR) was selected as a promising trauma treatment. Twenty-nine boys with conduct problems in residential or day treatment were randomized into standard care or standard care plus 3 trauma-focused EMDR sessions. The EMDR group showed large and significant reduction of memory-related distress, as well as trends towards reduction of post-traumatic symptoms. The EMDR group also showed large and significant reduction of problem behaviors by 2-month follow-up, whereas the control group showed only slight improvement. These findings provide support for EMDR’s use as a trauma treatment for boys ages 10-16, as well as support for the hypothesis that effective trauma treatment can lead to reduced conduct problems in this population.

9. Cognitive Processing Therapy for Incarcerated Adolescents with PTSD

• Julia A. Ahrens, Johnson County Mental Health Center, Kansas City, Kansas
• Lillian Rexford, Topeka Juvenile Correctional Facility

Despite increased recognition of trauma’s association with conduct disorders, trauma treatment for this population has been neglected. This study evaluated the effect of short-term, cognitive processing therapy (CPT) treatment on self-reported symptoms of trauma such as anxiety, depression, intrusion, avoidance and numbing. After treatment, the CPT group showed significant declines in these symptoms, while the wait-list control group did not.

10. Motivation – Adaptive Skills -Trauma Resolution (MASTR) Therapy for Adolescents with Conduct Problems: An Open Trial.

• Ricky Greenwald, Department of Psychiatry, Mount Sinai Medical Center, New York

Trauma is proposed as a key to understanding the development and persistence of adolescent conduct problems, in conjunction with other contributing factors. A trauma-focused individual therapy approach is presented as one example of how this population might be more effectively treated. This approach features motivational interviewing, self-control training, and trauma resolution, and integrates eye movement desensitization and reprocessing (EMDR). This paper reports on an open trial of six adolescents with school and conduct problems who received school-based MASTR treatment. Reductions in post-traumatic stress, related symptoms, and problem behaviors, along with improved school performance, indicate the value of further study of this treatment approach.