(PS4-D76) The Relationship Between Treatment Delay After Childhood Exposure to Interpersonal Trauma and Baseline PTSD Symptoms

More than 25% of youth in the United States are exposed to interpersonal trauma (e.g., physical abuse, sexual abuse, witnessing domestic violence, traumatic bereavement, peer sexual assault; Finkelhor et al., 2009) annually, and 25% develop symptoms of posttraumatic stress disorder (PTSD; Alisic et al., 2014). Previous studies have found that earlier initiation of mental health treatment may improve the treatment responses of veterans with PTSD (Maguen et al., 2014). However, no studies have examined the relationship between treatment delay and PTSD symptoms in traumatized children. Given endemic levels of childhood exposure to interpersonal trauma, understanding this relationship may inform the implementation and dissemination of evidence-based trauma interventions. The present study aims to examine whether treatment delay predicts children’s PTSD symptoms at the start of treatment. We hypothesize a more prolonged treatment delay will predict higher baseline PTSD symptoms.

A multicultural sample of 189 youth aged 5-17 years old (M = 11.95; SD = 3.38) receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2017) at a community clinic were assessed at a baseline evaluation. Treatment Delay was defined as the number of months elapsed between the first experience of interpersonal trauma and the date of the baseline evaluation. Covariates well-established in the literature were collected: age at first exposure to trauma (Kaplow & Widom, 2007), number of trauma types (Cloitre et al., 2009), and frequency, duration, and severity of trauma (Lombera et al., 2021). Child PTSD symptoms were assessed using the Child PTSD Symptom Scale for DSM-IV and DSM-5 (CPSS; Foa et al., 2001; Foa et al., 2018). Treatment delay, age at onset, and the frequency, duration, and severity of traumatic experiences were assessed using aggregate information from child and caregiver report on the Traumatic Events Characteristics Survey (TECS; Brown & Sharma-Patel, 2010). The total number of interpersonal traumas experienced by each child were reported by children and caregivers using the PTSD screener of the Schedule for Affective Disorders and Schizophrenia, Kiddie Version (K-SADS; Kaufman et al., 1997).

Results revealed that the average time between first exposure to interpersonal trauma and entering TF-CBT was 61.32 months (SD = 46.22), or 5.11 years. A hierarchical linear regression was conducted to evaluate the prediction of baseline child PTSD symptoms (dependent variable) from treatment delay (criterion variable) with child age at onset, number of trauma types endorsed, and frequency, duration, and severity of the first traumatic experience as covariates. Covariates were entered into the first block and the criterion variable was included in the second block. Treatment delay accounted for unique variance above and beyond variance accounted for by the covariates (R² = 0.028, p = 0.02). However, the overall model was not significant. Additional research should attempt to replicate this finding given the lack of literature in this area. Clinical implications and future research directions will be discussed.