Cook et al. (2025), Experts in traumatic stress are concerned about global impact of what is happening in US. European Journal of Psychotraumatology, 16(1), 2496125 published an editorial warning of severe consequences from recent US federal policy and funding shifts. While raising valid concerns about the global significance of trauma, five key weaknesses were identified that call for a more balanced appraisal: (1) trauma care remains primarily within private and community systems, not federally-provided direct service; (2) equating minority identity stress with life-threatening trauma lacks empirical basis and risks diluting the concept of trauma; (3) reductions in USAID and WHO funding reflect discretionary policy choices rather than breaches of duty, with little evidence of direct global trauma impact; (4) termination of certain NIH grants reflects democratic priorities, not arbitrary suppression of science; and (5) even if all Trump administration cuts were enacted, the US research budget still dwarfs that of other countries. Critiques of policy are important, but overstating trauma impacts in multifaceted issues risks undermining the credibility of the field.

Bessel van der Kolk's book The Body Keeps the Score has maintained exceptional cultural and clinical influence since its publication in 2014, remaining a best-seller and shaping public discourse on trauma. Its central claims - that trauma causes lasting neurobiological damage and that body-based treatments are uniquely effective - have been widely embraced but seldom subjected to systematic critical evaluation in peer-reviewed literature. This commentary synthesises the evidentiary basis for these claims as a counterweight to an influential narrative. It situates these findings within broader discussions of neuroscience framing, cultural appeal and evidence-based communication, underscoring the need for rigorous, balanced engagement with widely disseminated mental health narratives.

Objective: Self-report questionnaires are common for measuring posttraumatic stress disorder (PTSD). The experience of life threat-Criterion A-serves a gatekeeper function for diagnosing PTSD, and evidence suggests false positives are common on questionnaires. It remains unknown how common they are and whether extra instructions can reduce them. Methods: The present study assessed 42 youths, 10-17 years of age, from a clinic setting. Youths and parents completed regular PTSD questionnaires and then enhanced versions with more detailed instructions and examples of Criterion A and non-Criterion A events. Parents completed a semistructured interview as the verification of true versus false positives. Results: In the full sample, parents endorsed 41 and children endorsed 45 false positive events. The mean was significantly greater than zero for both parents and children. Parents endorsed 59 and children endorsed 138 false positive symptoms. When false positive events were endorsed, this was significantly associated with more false positive symptoms for both parents and children. An enhanced questionnaire failed to reduce false positive events for the full sample. Discussion: The common occurrence of false positives suggests caution is warranted when interpreting estimates from questionnaire-based research about the prevalence of PTSD. While this attempt to eliminate false positives was not fully successful, there may be other useful enhancements to consider in future research.

Purpose: While stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) is an effective service delivery model, understanding predictors of Step One, a parent-led therapist-assisted treatment, will help inform how to best match children at baseline to treatments. Method : Potential predictor variables were explored from 63 parent–child Step One participants with 43 responders and 20 non-responders. Baseline tailoring variables explored were anticipated critical life events, demographics, trauma-related variables, and child and parent outcomes. Results: Predictors of Step One non-response were parental depression, child anger outbursts and Hispanic/Latino parents even after controlling for child demographics, child post-traumatic stress, severity, and impairment. Conclusions: Parents with depression and children with high anger outbursts should consider starting with Step Two, therapist-led TF-CBT. Step One may benefit from including TF-CBT culturally modified strategies for Hispanic/Latino parents. If preference is to start with Step One, these parents and children should be closely monitored for treatment progress.

In volume 28 of this journal, Harnett et al. [1] reported their effort to understand how structural inequities partially explain differences between racial groups on neurophysiology and brain connectivity [1]. The authors’ interpretation was that inequities are a form of chronic stress of structural racism which acts on human development to cause enduring brain differences. Given the strong interest in unequal treatment of races and government’s history of intervening with a strong hand when justified by science, I believe this paper merits additional comment on how the findings were interpreted.

BackgroundBased on factor analysis research, DSM-5 revised the diagnostic criteria for posttraumatic stress disorder (PTSD) by increasing symptom clusters from three to four.AimsTo question whether that is an appropriate use of factor analysis.MethodsReviewed the literature on five issues of factor analysis relevant to diagnostic criteria: (1) discovery of factors identical to symptom clusters, (2) consensus about the number of factors in best-fitting models, (3) configural variance between subpopulations to explain inconsistent model results, (4) methods to externally validate factors after discovery, and (5) treatment response of symptom clusters to externally validate factors. Two hundred four articles using DSM-IV or DSM-5 symptoms were included.ResultsTwo of four DSM-5 clusters were discovered with exploratory factor analysis. Support for a best-fitting model was inconsistent. Models with the highest number of factors were the best mathematical fit 87% of the time. Subpopulations did not reveal a pattern of configural variance to explain inconsistent findings. External validation of factors relied entirely on questionnaires. A review of 143 randomized controlled trials did not reveal differential treatment response of any symptom cluster.ConclusionFindings did not support the usefulness of factor analysis because the findings are too disparate to be helpful.

Substantial concerns have been raised about the lack of an empirical basis for revisions made to the criteria for posttraumatic stress disorder (PTSD) in the DSM-5. Although researchers have examined the broader impact of these revisions on diagnostic prevalence, no study to date has examined the contribution of each individual revision. The current study sought to explore how each change in criteria and cluster structure affect frequency of PTSD diagnosis. Between July 2012 and October 2021, PTSD symptoms were collected at intake from child/parent reports (n = 65) at a pediatric mental health clinic and from adult patient reports (n = 322) at an outpatient mental health clinic. Compared to the frequency of PTSD diagnosis for adults based on DSM-IV criteria (73.6%), the frequency did not significantly increase with the addition of negative beliefs (74.8%), distorted thoughts (76.1%), and reckless or self-destructive behavior (74.2%), and increased significantly with a small effect with the addition of persistent negative emotional state (79.5%). The trend was similar for the youth sample across all new symptoms. A four-cluster structure diagnosed fewer individuals compared to a three-cluster structure across different sets of symptoms. The overall impact, however, was for DSM-5 to diagnose fewer adults but the same number of youths. Significant associations were found for age and sex with some new items. Findings add new concerns to the growing literature on problematic impacts of DSM-5 revisions to PTSD.

To evaluate the impact of a tailored Symptom Allergy Indication Direction Self-care (SAIDS) counseling by pharmacists on consumers' correct understanding of over-the-counter (OTC) medication use.This study used a time-based sampling of two independent cohorts at a single community pharmacy in Taiwan for two years beginning in December 2018. In the control cohort, participants received conventional counseling for the OTCs they selected. In the intervention cohort, participants received SAIDS counseling along with pointing out OTC package label instructions. A paper-and-pencil survey was administered face-to-face to evaluate participants' understanding for the correct use of OTCs. Descriptive statistics and chi-square tests were used to evaluate the effect of the SAIDS approach on cohorts' understanding of OTC use.Compared with conventional OTC counseling, participants reported better understanding regarding potential side effects of OTCs that they acquired (p < 0.001) and were more aware of strategies to cope with the associated side effects (p < 0.001).Despite the time constraints that pharmacists often can offer to each customer, the SAIDS counseling approach may refine the structure and effectiveness of pharmacists' OTC counseling skills and thereby improve consumers' understanding of their ailments and self-care medications in Taiwan.

ObjectiveTrauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapist-led treatment for children after trauma. Parents often experience barriers to treatment engagement, including cost. Stepped care TF-CBT (SC-TF-CBT) was developed as an alternative delivery system. Step One is a parent-led therapist-assisted treatment. Step Two provides therapist-led TF-CBT for children who did not benefit from Step One and require more intensive treatment. This study compared SC-TF-CBT to standard TF-CBT in a community-based non-inferiority trial.MethodA total of 183 children (aged 4-12 years) experiencing posttraumatic stress symptoms (PTSS) and their caregivers were randomly assigned to SC-TF-CBT or standard TF-CBT within 6 community clinics. Assessments occurred at baseline, mid- and posttreatment, and 6 and 12 months. Primary outcomes included PTSS and impairment. Secondary outcomes included severity, diagnostic status, remission, and response. Treatment cost, acceptability, and satisfaction were measured. Difference and non-inferiority tests were applied.ResultsSC-TF-CBT participants changed at rates comparable to participants in TF-CBT for primary and secondary measures. SC-TF-CBT was non-inferior to TF-CBT for PTSS, impairment, and severity at all time points except for impairment at the 6-month assessment. Attrition did not differ between treatment arms (132 participants were completers). Baseline treatment acceptability was lower for SC-TF-CBT parents, although there was no difference in expected treatment improvements or treatment satisfaction at posttreatment. Based on regression estimates, total costs were 38.4% lower for SC-TF-CBT compared to TF-CBT, whereas recurring costs were 53.7% lower.ConclusionStepped Care TF-CBT provides an alternative way to deliver treatment for some children and parents, with reduced cost for providers and parents.Clinical trial registration informationStepped Care for Children after Trauma: Optimizing Treatment; https://clinicaltrials.gov; NCT02537678.

Abstract Mental health clinicians perform complex tasks with patients that potentially could be improved by the massive computing power available through mobile apps. This study aimed to analyse commercially available mobile and computer applications (apps) focused on treating psychiatric disorders. Apps were analysed by two independent raters for whether they took advantage of computer power to process data in a fashion that augments four main elements of clinical treatment including (1) assessment/diagnosis, (2) treatment planning, (3) treatment fidelity monitoring, and (4) outcome tracking. The evidence base for each of these apps was also explored via PsychINFO, Research Gate and Google Scholar. Searches of the Google Play Store, the Apple App Store, and the One Mind PsyberGuide found 722 apps labelled for mental health use, of which 163 apps were judged relevant to clinical work with patients with psychiatric disorders. Fifty-nine of these were determined to contain a computer-driven function for at least one of the four main elements of clinical treatment. The most common element was assessment/diagnosis (55/59 apps), followed by outcome tracking (34/59 apps). Six apps updated treatment plans using user input. Only one app tracked treatment fidelity. None of the apps contained computer-driven functions for all four elements. Twelve apps were supported in randomized clinical trials to show greater efficacy compared with either wait-list or other active treatments. Results showed that these four clinical elements can be meaningfully augmented, but the full potential of computer processing appears unreached in mental health-related apps. Key learning aims (1) To understand what apps are currently available to treat clinical-level psychiatric problems. (2) To understand how many of the commercially available mental health-focused apps can be used for the treatment of clinical populations. (3) To understand how mental health services can be complemented by utilizing computer processing power within apps.

The etiology of oppositional defiant disorder (ODD) is not well understood but appears to have both biologically-based roots and can develop following adverse experiences. The current study is the first to examine the interaction between biologically-based factors and type of trauma experience (i.e., interpersonal and non-interpersonal) and associations with ODD. The psychophysiological factors included baseline resting heart rate, respiratory sinus arrhythmia (RSA), and cortisol. ODD was measured as two dimensions of irritable and defiant/vindictive. The sample included 330 children, 3–7 years-old, oversampled for a history of trauma. Results showed the interactions between baseline physiological arousal variables and trauma type in predicting ODD dimensions were not supported. However, the baseline RSA by trauma interaction was a significant predictor of defiance/vindictiveness among boys, but not girls, when interpersonal trauma was compared to controls. Several other gender differences emerged. Among boys, both interpersonal and non-interpersonal trauma were predictive of ODD dimensions; however, among girls, non-interpersonal trauma was not. Among girls, there was a significant negative bivariate relationship between baseline cortisol and irritability. Also, when the sample was restricted to those with interpersonal trauma only and controls, baseline RSA was negatively associated with irritability in girls only (controlling for trauma). Finally, retrospective reports revealed that children who met criteria for ODD diagnosis and experienced interpersonal trauma were more likely to exhibit ODD symptoms prior to their trauma compared to those who experienced non-interpersonal trauma. Results are discussed in the context of previous mixed findings, and avenues for future research are highlighted.

This study examined the influence of trauma exposure and posttraumatic stress (PTS) severity on accuracy of recall of autobiographical memory of traumatic events and pleasant events in very young children. Two hundred sixteen 3-6 year-old children with trauma exposure were interviewed with standardized interviews. Forty-one non-trauma-exposed controls were interviewed about stressful events for comparison. Accuracy of recall for both traumatic and pleasant events was not associated with severity of PTS. Trauma-exposed children showed significantly less accurate recall of trauma events compared to pleasant events. This difference was limited to children who experienced repeated trauma or Hurricane Katrina-related trauma experiences as opposed to single-blow types of trauma experiences. There was no difference in accuracy of recall of trauma events in the trauma-exposed group versus stressful events in the control group. There was also no difference in accuracy of recall of pleasant events between the trauma-exposed and the control groups. These findings do not support traditional theories that autobiographical recall is impaired in those with posttraumatic stress disorder or with trauma exposure. These findings demonstrate that very young children have access to and can verbalize accurate autobiographical recall of trauma events, which is important for clinical assessment and treatment.

Child welfare recipients face unique obstacles for accurate mental health screening and assessment. This study examined the concordance between youth and caregiver respondents on mental health problems. Agreement between youths and caregivers about traumatic event exposure was mostly Moderate or Substantial, but greater discrepancy was associated with greater child psychopathology. Both caregivers and children endorsed PTSD symptoms more often than internalizing, externalizing, and ADHD problems. Single respondents - whether child, foster parent, or biological parent - significantly underestimated severity compared to multiple respondents. Repeat screenings showed that concordance between youth and caregiver endorsements did not improve after six months of entering care.

Measurement-based care (MBC) has been called the bridge for the gap between outcomes achieved in randomized clinical trials and routine clinical care.(1) Trials of MBC have improved outcomes, helped identify patients with residual symptoms, prompted clinicians to know when to intensify treatment, created more informed patients, and improved the patient-provider relationship.(1) These previous studies were grant-funded projects, however, which were implemented on project deadlines with research staff committed to the success of the project. In a recent Letter to the Editor in the Journal, Liu et al.(2) reported on their efforts to implement a digital measurement feedback system in a pediatric clinic. This Letter to the Editor, to my knowledge, was the first report about how a clinic implements MBC without grant funding on a project deadline, which is likely to be more generalizable to community practice. The purpose of this report is to add our clinic experience.

The purpose of the study was to determine the level of access that youths in child welfare have to mental health providers in a single state. Mystery shoppers called every provider publicly advertised in Medicaid managed care organization networks. Results showed that 25.4% of the advertised network was able to schedule a new appointment for a child in Department of Children and Family Services guardianship. There were 9.7 accessible providers of any discipline (MD, PhD, or licensed masters-level clinician) per 10,000 Medicaid-enrolled youths in the population. The level of access to MDs was 4.1 times lower than the nationally recommended level.

OBJECTIVE:Associations of neurobiological differences with posttraumatic stress disorder (PTSD) have generated interest in their temporal relation. Support has been voiced for the neurotoxic stress theory (NST) in which neurobiological differences develop following exposure and PTSD development. In contrast, the diathesis stress theory (DST) posits that neurobiological differences existed prior to exposure and may be vulnerability factors for PTSD. Studies in the first wave of neurobiological PTSD research were all cross sectional, but a second wave of research followed which used prospective repeated-measures designs that measured neurobiology prior to trauma exposure experiences, allowing greater causal inference.METHODS:This study reviewed the second-wave studies in hopes of developing a preliminary consensus to support either the NST or the DST based on this more powerful prospective, repeated-measures study design.RESULTS:Twenty-five second-wave studies were located that measured neurobiology prior to traumatic experiences. Nineteen studies supported the DST. Of 10 studies that were capable of testing the NST, only 3 were supportive.CONCLUSION:The implications of the NST versus the DST have profound implications for understanding the fragility of the human brain and possible paths forward for future research on assessment, treatment, and social policy.

Objective: The Diagnostic Infant and Preschool Assessment was revised to include Likert ratings (DIPA-L) to give a broader range of severity ratings that may have greater utility for clinical and research purposes. In addition, the instrument was updated for Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and two types of Likert ratings-frequency versus problem intensity-were explored for posttraumatic stress disorder (PTSD) symptoms. Concurrent construct validation and test-retest reliability were examined for the five most common disorders seen in very young children in outpatient clinics: PTSD, attention-deficit/hyperactivity disorder, oppositional defiant disorder, separation anxiety disorder, and generalized anxiety disorder (GAD). A sixth disorder, disruptive mood dysregulation disorder (DMDD), which was created in DSM-5, was tested for the first time. Functional impairment was also examined. Methods: The caregivers of 58 two- through six-year-old children (57 mothers and 1 father) were recruited from an outpatient clinic. They were interviewed at Time 1, and 52 were reinterviewed at Time 2 by research assistants (children's age M 4.7 years, standard deviation 1.2). Results: Few differences were found between the ratings of frequency versus problem intensity for PTSD symptoms. Tests of concurrent criterion validation were acceptable for all disorders when compared against disorder-specific questionnaires; the range of Pearson correlation coefficients was 0.56-0.94. A trend for attenuation of diagnoses from Time 1 to Time 2 was evident, but not statistically significant. Test-retest reliabilities were strong when examined with continuous Likert scores, except for GAD (the range of intraclass correlation coefficients values was 0.29-0.91, but were less consistent for categorical disorder-level status [the range of Cohen's kappa s was 0.35-0.79]). The range of internal consistencies was 0.78-0.95, excluding DMDD, which could not be calculated. Conclusions: The updated and revised DIPA-L demonstrated many acceptable features of a valid and reliable instrument for the assessment of very young children. While the findings are tentative given the small sample size, the DIPA-L is the only diagnostic instrument for young children with a replication, tested in clinic populations, updated for DSM-5, with psychometrics for functional impairment, and has Likert ratings.

A subtype of the posttraumatic stress disorder diagnosis for children 6 years and younger (PTSD-6Y) was introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). This study utilized confirmatory factor analytic techniques to evaluate the proposed DSM-5 PTSD-6Y factor structure and criterion and convergent validity against competing models. Data for N = 284 (3–6 years) trauma-exposed young children living in New Orleans were recruited following a range of traumas, including medical emergencies, exposure to Hurricane Katrina and repeated exposure to domestic violence. The model was compared to DSM-IV, a 4-factor ‘dysphoria’ model that groups symptoms also associated with anxiety and depression, and alternate 1- and 2- factor models. Convergent validity was established against the Child Behavior Checklist (CBCL). Criterion related validity was established by comparing each model to a categorical rating of impairment. The Dysphoria and PTSD-6Y models offered the better accounts of symptom structure, although neither satisfied minimum requirements for a good fitting model. These two models also only showed small levels of convergence with CBCL dimensions. The 1-factor model offered the most compelling balance of sensitivity and specificity, with the 2-factor model and the Dysphoria model following closely behind. These CFA results do not support the symptom clusters proposed within the DSM-5 for PTSD-6Y. Although a 4-factor Dysphoria model offers a better overall account of clustering patterns (relative to alternate models), alongside acceptable sensitivity and specificity for detecting clinical impairment, it also falls short of being an adequate model in this younger age group.

Objective: The ability to reliably detect posttraumatic stress disorder (PTSD) symptoms that require treatment in young children through screening efforts is a critical step toward providing appropriate treatment. The developmental differences in this age group compared to older youths pose challenges for accurate detection. A brief age-appropriate screen has not yet been quantitatively validated. This study aimed to address that gap by creating a rapid and brief screen based on empirical data that focused on sensitivity and face validity for children aged 3 to 6 years. Methods: A trauma-exposed group (N = 284) and a nontrauma-exposed group (N = 46), aged 3 to 6 years, were assessed using a semistructured diagnostic interview with their primary caregivers. Results: One hundred twenty combinations of items were evaluated for sensitivity, specificity, positive predictive value, negative predictive value, associations with functional impairment, and frequency of false positives. Many combinations of items performed well on these psychometrics, and the final selection of a 6-item screener was influenced by considerations of face validity so that the screen would best reflect the unique symptoms of PTSD. Conclusion: The screener proposed is a promising tool that will benefit from additional research to examine its psychometric properties as a stand-alone PTSD screen. Future research ought to include test-retest reliability and replication of these findings in other samples and settings. Eventual uses of a brief screen for PTSD in young children include screening during primary care visits and large-scale screening efforts following disasters, for which cost and time need to be considered.