A-28 Attention-Deficit/Hyperactivity Disorder or Trauma?: A Case Study

Objective Previous literature has found that it can be difficult differentiating between trauma disorders and Attention-Deficit/Hyperactivity Disorder (ADHD), and that children diagnosed with ADHD have higher exposure to traumatic events compared to children without ADHD. This current case exemplifies the complexity of factors involved in ADHD, including history of trauma. Method Patient is an 11 year old, African American, cisgender male. History is significant for childhood neglect, trauma, and housing and caregiver instability. He carries a diagnosis of ADHD for which he receives psychiatric and therapeutic treatment. Neuropsychological evaluation was pursued due to concerns regarding academic skill development, attention/concentration, potential trauma reactions, and socialization skills. In particular, patient’s guardians sought evaluation to parse out what may be neurodevelopmental concerns (ADHD) versus challenges associated with his history of trauma and neglect. Results On objective measures of executive functioning, patient displayed some difficulties with planning and inhibition. Additionally, on parent and teacher forms (BASC-3 and BRIEF-2), significant concerns were noted regarding attention, hyperactivity, and other domains related to executive functioning. Parents and teachers also reported concerns regarding conduct, anxiety, and atypicality. Additionally, on the BASC-3 self-report, patient reported low self-esteem—a symptom common in both ADHD and trauma-related disorders. Conclusions This case demonstrates the difficulty of parsing out ADHD symptoms from trauma reactions. The purpose of examining this case is to further explore the relationship between trauma and ADHD, as well as to add to the conversation regarding the misattribution of symptoms related to trauma as being solely ADHD or behavioral in African American, pediatric males.

Adaptation and Validation of the Harvard Trauma Questionnaire (HTQ) and PTSD Checklist-5 (PCL-5) with Indian Women from Slums Reporting Gender-Based Violence

Background: Despite high rates of gender-based violence (GBV) in India, culturally sensitive measures that examine universal and culturally relevant trauma reactions are lacking. Although the Harvard Trauma Questionnaire (HTQ) has been used in India, no study has adapted the measure in full for use with this population. This study describes the adaptation, validation, and results from the adapted HTQ, containing the PTSD Checklist-5 (PCL-5), for Indian women from slums reporting GBV. Method: This study used the adaptation framework proposed by the HTQ measure developers. The adapted HTQ contained a (1) trauma screen relevant for stressors faced by Indian women from slums, (2) description of the index trauma, (3) description of any ongoing stressors, (4) universal trauma reactions (i.e., PTSD measured by the PCL-5), and culturally relevant trauma reactions (i.e., idioms of distress measured by a scale developed for the study). This measure was piloted on 111 women from Indian slums in face-to-face interviews. Trauma characteristics, types of ongoing stressors, and psychometric properties of the PCL-5 and idioms of distress scale were explored. These scales were validated against measures of depression (PHQ-9), anxiety (GAD-7), and somatic complaints (PHQ-9). Results: The majority of participants (77%) reported physical beatings, 18% reported unwanted sexual touch, and 28.8% reported infidelity as the primary emotional abuse. Further, 96.7% of GBV was perpetrated by partner or family member and over half reported ongoing stressors (e.g., poverty-related strain). The PCL-5 embedded in the HTQ yielded good internal consistency (Cronbach’s alpha=.88) as did the idioms of distress scale with deletion of one item (Cronbach’s alpha=.80). Both scales were externally valid, yielding large correlations with depression, anxiety, and somatic complaints (rs between .54 to .80, ps < .05). Discussion: This is the first study to develop a comprehensive measure of trauma exposure with universal and culturally relevant reactions in India. This study also enhances HTQ usage in India by delineating all the steps in the adaptation process. Results can inform the development of trauma-focused interventions for Indian women from slums.

The Role of Low Self-Control as a Mediator between Trauma and Antisociality/Criminality in Youth

Trauma exposure and low self-control are robustly associated with youth antisocial/criminal problems, but the interrelation of these constructs is unclear when taking into account both traumatic events and reactions. The objective of the present study is to examine self-control mediation effects related to trauma and juvenile delinquency, conduct disorder, crime seriousness, and aggression outcomes. The sample consisted of N = 388 male youth from Portugal (age, M = 16.01 years, SD = 1.03, age range = 13–18 years). Path analysis procedures revealed that self-control partially mediates the relation between trauma events and the examined outcomes and fully mediates the relation between trauma reactions and the examined outcomes. Research on youth trauma should examine both trauma events and trauma reactions because they have differential effects on low self-control and antisocial/criminal outcomes.