This week’s blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master’s degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids.
First, what IS trauma? The DSM-5 definition is easy to find, but the very first requirement for a PTSD diagnosis (“Exposure to actual or threatened death, serious injury, or sexual violence…”) does not capture the broad range of experiences that may lead to a trauma response. Right away, we find the categorical nature of the DSM-5 may not adequately conceptualize or capture the huge continuum of traumatic experiences. I think we can all agree that not all “traumatic” experiences involve exposure to death, serious injury, or sexual violence. What about neglect? What about emotional or psychological abuse? It is necessary to further define trauma and the many ways it can occur. One way to break it down a little further is to distinguish between acute (“Big T”) trauma and developmental or complex (“little T”) trauma.
Acute trauma refers to a discrete event that occurs at a single point in time. With acute trauma, one can generally identify a clear change in functioning from before the event to after the event. An acute trauma may be something like a sexual assault, a car accident, or being held up at gunpoint. Complex trauma is more complicated and refers to ongoing, recurrent traumatic experiences. When these recurrent traumatic experiences happen during childhood, the collective experience is called developmental trauma.
Related post: Assess the impact of the pandemic on kids—the PASS-12 is now available!
Why is this distinction relevant for us as clinicians? Because it affects how we assess and treat individuals. We know that individuals with acute trauma typically may have a quicker path to recovery, while individuals with complex trauma tend to show more chronic symptoms. Acute trauma is also easier to assess in the sense that we are only gathering information about one event, with a relatively clear before and after, while complex trauma tends to be multilayered.
Regarding the assessment process specifically, detailed questions about trauma should be included in nearly all diagnostic interviews. As mentioned earlier, many parents and individuals can overlook or downplay potentially traumatic experiences. Kids also may not share their traumatic experiences with their parents or others unless asked directly. There are a couple of ways to get at these concerns without coming across as too heavy-handed. One is to say something like, “Tell me about some of the most important events in your life” or “What are the top three hardest/worst things that you can remember?” or “Have you held any secrets for a long time that you’d like to share?” Note that forensic interviewing is a clear subspecialty in our field. Do NOT practice outside the scope of your expertise! Another way to explore these questions is to use a broadband questionnaire as a guide for topics/events to inquire about. If your client shares anything that warrants further exploration, you can integrate a narrower questionnaire to drill down on specific trauma symptoms.
Moving further down the path of the assessment process, it is important to think through the relationship between trauma and other mental health diagnoses. A question that comes up often is, how to separate trauma from ADHD/autism/anxiety, etc. As Dr. Maggie Sibley and Dr. Julia Strait noted on past Testing Psychologist podcast episodes, maybe we don’t. Maybe we need to stop thinking about how to separate these diagnoses, because it is nearly impossible to do so, particularly in the case of developmental trauma. Even going by the DSM-5 definition of PTSD or acute stress disorder, there are many PTSD symptoms that occur in other diagnoses. These symptoms include repetitive play (autism), intrusive memories/thoughts (OCD), distress when exposed to certain cues (specific phobia), poor memory (ADHD), and alterations in cognition (depression, anxiety, ADHD), just to name a few. Unless we have a clear picture of functioning before the trauma started, it is extremely challenging to know if these symptoms “belong” to the trauma or something else. In these (and all) cases, gathering an accurate history is crucial to establishing context to interpret an individual’s symptoms and assessment results.
In cases when an accurate history is not available from the primary caregiver, clinicians may need to expand the scope of the evaluation and incorporate a broader record review or interviews with additional people in the client’s life. Even then, we sometimes must simply do our best with what we’ve got to come up with meaningful conceptualization and recommendations.
Ultimately, we want our assessment to guide treatment and provide helpful recommendations for our clients. By conducting a thorough clinical interview; utilizing well-standardized assessment instruments; and providing realistic, evidence-based recommendations, testing psychologists play a vital role in helping individuals identify and heal from their adverse experiences.
Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify.
The PAI Plus takes the existing PAI items and gives users an updated way to interpret the data. Using the original PAI items, the new report offers:
DSM-5® update: Diagnostic possibilities align with the most up-to-date criteria.
Alternative Model for Personality Disorders Profile: An optional new profile scores the PAI in accordance with the model.
Additional supplemental indices: 15 new supplemental indices plus supplemental clinical indicators provide additional profile information.
Context-specific norm groups: Profile overlays for new normative groups can be compared to the examinee’s profile.
Related post: Now on the Training Portal: PAI Plus webinar!
The PAI-SP offers exclusive features
The PAI Plus Interpretive Explorer, only available on the PAI-SP, enables you to interact with PAI reports to access definitions, review supplemental indexes, and compare client data with normative and clinical samples to offer additional insights into your client.
Further additions allow users to compare client scores to context-specific norm groups via z scores.
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Are you doing research with a PAR product and think it could help others? We are looking to gather additional data on our existing tests with the goal of further validating our instruments, identifying and developing product enhancements, or adding features that allow our Customers to better meet the needs of those they serve.
We are inviting clinicians, researchers, and other professionals to partner with us to advance the scope of solutions we can provide, especially focusing on better helping underserved populations.
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School social workers have always played a pivotal role in our schools and communities. Their important role has really come into the spotlight this year, more than ever. With National School Social Work Week occurring this week, we at PAR would like to publicly express our gratitude and thanks for everything school social workers are doing to make our schools better places for all. The theme of this year’s awareness week is “Beacon of Hope: School Social Workers—Lighting the Way.” Thank you to our school social workers for being that beacon of hope during this very unusual time. The work of school social workers goes beyond students, helping administrators, teachers, educators, parents, and the greater community to thrive.
Resources to promote National School Social Work Week
The School Social Work Association of America provides members resources, including posters, images, downloadable materials, and more.
Need some ideas on how to celebrate and acknowledge school social workers? The Illinois Association of School Social Workers provides a downloadable list of fun suggestions as well as a list of ways school social workers can increase the visibility of the field.
The New York State School Social Workers’ Association has put together a list of activities as well as downloadable posters to help school social workers get out the message about the important work they do.
To learn more about PAR products that can be useful in school settings, visit our School Resources page.
Research shows an increase in alcohol use during the pandemic and quarantine. Now, PARiConnect gives you a simple tool to screen for alcohol use disorder with the addition of the Michigan Alcoholism Screening Test (MAST) to the ChecKIT family.
As part of the ChecKIT family, the MAST can be used with other checklists to create a personalized inventory—simply choose the checklists that fit your client needs!
Learn more about ChecKIT and the MAST now!