Papers by Alan M. M Steinberg, Ph.D.
On April 16, 2007, in the worst campus shooting incident in U.S. history, 49 students and faculty at
Child abuse & neglect, Jan 28, 2018
Building upon prior research documenting differential effects of psychological maltreatment, phys... more Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for y...
Negative Alterations in Cognition and Mood Among Adolescents and Adults After the 2011 Catastrophic Violence in Norway: An investigation of the Proposed Symptoms of PTSD for DSM-5
PsycEXTRA Dataset
Journal of Affective Disorders, 2014
Background: Diagnostic criteria for Posttraumatic Stress Disorder (PTSD) have been revised for DS... more Background: Diagnostic criteria for Posttraumatic Stress Disorder (PTSD) have been revised for DSM-5. Two key changes include alteration of the clustering of PTSD symptoms and new PTSD symptom criteria related to negative alterations in cognition and mood. In this study, we empirically investigated these changes. Methods: We interviewed 325 adolescents and young adults who survived the 2011 youth camp shooting at Utøya Island, Norway. The UCLA PTSD Reaction Index for DSM-IV was used to assess symptoms of PTSD. In addition, 11 questions were added to assess the four new symptom criteria within the new DSM-5 symptom categories. Results: PTSD prevalence did not differ significantly whether DSM-IV (11.1%) or DSM-5 (11.7%) criteria were used and the Cohen's Kappa for consistency between the diagnoses was 0.061. Confirmatory factor analyses showed that the four-factor structure of the DSM-5 fit the data adequately according to the conceptual model outlined. Limitations: The homogeneity of this sample of highly exposed subjects may preclude generalization to less severely exposed groups. Also, we did not assess criterion G in regard to symptoms causing clinically significant distress and functional impairment. Conclusion: The prevalence of PTSD was quite similar regardless of diagnostic system. The relatively low concordance between the diagnoses has implications for eligibility for a diagnosis of PTSD.
Children and disasters: public mental health approaches
Textbook of Disaster Psychiatry
Journal of Affective Disorders, 2015
Journal of affective disorders, 2012
OBJECTIVE: To examine the potential contribution of the serotonin hydroxylase (TPH1 and TPH2) gen... more OBJECTIVE: To examine the potential contribution of the serotonin hydroxylase (TPH1 and TPH2) genes, and the serotonin transporter promoter polymorphism (5HTTLPR) to the unique and pleiotropic risk of PTSD symptoms and depressive symptoms. METHODS: Participants included 200 adults exposed to the 1988 Spitak earthquake from 12 multigenerational families (3 to 5 generations). Severity of trauma exposure, PTSD, and depressive symptoms were assessed using standard psychometric instruments. Pedigree-based variance component analysis was used to assess the association between select genes and the phenotypes. RESULTS: After adjusting for age, sex, exposure and environmental variables, there was a significant association of PTSD symptoms with the 't' allele of TPH1 SNP rs2108977 (p<0.004), explaining 3% of the phenotypic variance. This allele also showed a non-significant trend for an association with depressive symptoms (p=0.08). Also, there was a significant association of PT...
Living and dying well
Evolution and Human Behavior, 1997
Depression and Anxiety, 2000
British Journal of Psychiatry, 1993
One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three... more One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three cities at increasing distances from the epicentre were randomly screened in their schools to determine the frequency and severity of post-traumatic stress reactions, using the Children's Post-traumatic Stress Disorder Reaction Index (CPTSD-RI). A systematic clinical assessment of PTSD based on DSM-III-R criteria was also conducted on approximately half of this sample. A high CPTSD-RI score was strongly correlated with a clinical diagnosis of PTSD. A strong positive correlation was found between proximity to the epicentre and overall severity of post-traumatic stress reaction, as well as severity of core component symptoms of PTSD. High rates of chronic, severe post-traumatic stress reactions were found among children in the two most damaged cities, Spitak and Gumri. Analyses controlling for exposure revealed that girls reported more persistent fears than boys. These findings indicat...
UCLA Post-Traumatic Stress Disorder Reaction Index
PsycTESTS Dataset
Psychological Medicine, 2020
BackgroundThere is a paucity of long-term prospective disaster studies of the psychological seque... more BackgroundThere is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.MethodsAt 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate–severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).Results(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1–22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities...
Journal of the American Academy of Child & Adolescent Psychiatry, 2019
Objective: Children and adolescents who experience potentially traumatic events are at risk for d... more Objective: Children and adolescents who experience potentially traumatic events are at risk for developing posttraumatic stress disorder (PTSD). Although psychometrically sound measures are now available to assess these youths, brief tools are currently needed for screening purposes. Two studies were conducted to develop and validate the UCLA PTSD Reaction Index for DSM-5-Brief Form (RI-5-BF). Method: Study 1 used item response theory models to derive the RI-5-BF from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 486 trauma-exposed youths (mean age ¼ 13.32 years, SD ¼ 2.90) recruited through a practice research network. Study 2 used receiver operating characteristic analyses and diagnostic efficiency statistics to assess the discriminant-groups validity and clinical utility of the RI-5-BF in identifying children at different levels of PTSD risk using a sample of 41 treatment-seeking youths (mean age ¼ 12.44 years, SD ¼ 2.99). Results: In study 1, item response theory models identified the 11 most informative items across their respective subscales. The RI-5-BF exhibited excellent internal consistency in both studies (a > .93). In study 2, receiver operating characteristic analyses indicated that an RI-5-BF score of 21 maximized sensitivity and specificity. Moreover, diagnostic likelihood ratios across multiple levels of scores provided support for the measure's clinical utility in identifying different levels of PTSD risk. Conclusion: These findings provide support for both the psychometric properties of the RI-5-BF as a brief screening measure for PTSD in children and adolescents and its utility for identifying youths meriting further assessment and consideration for treatment.
Journal of the American Academy of Child & Adolescent Psychiatry, 2019
Objective: To describe the test construction procedure and evaluate the internal consistency, cri... more Objective: To describe the test construction procedure and evaluate the internal consistency, criterion-referenced validity, and diagnostic accuracy of the Child/Adolescent Self-Report Version of the UCLA PTSD Reaction Index for DSM-5 (RI-5) across 2 independent samples. Method: Study 1 examined the clarity, developmental appropriateness, acceptability of individual RI-5 items, and internal consistency and criterionreferenced validity of the full test. The study 1 sample included 486 youth recruited from 2 major US cities who completed the RI-5 and a measure of depression. Study 2 evaluated the reliability and diagnostic accuracy of the RI-5 in 41 treatment-seeking youth who completed the RI-5 and a "gold standard" structured diagnostic interview, the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version. Results: RI-5 total scale scores showed excellent internal consistency in the 2 samples. Study 1 provided evidence of criterion-referenced validity, in that total scale scores correlated positively with depressive symptoms. Study 2 provided evidence of diagnostic accuracy (including discriminant-groups validity). RI-5 total scores discriminated youth with from youth without PTSD as benchmarked against the structured diagnostic interview. Further, receiver operating characteristic analyses using a total score of 35 provided excellent diagnostic classification accuracy (area under the curve 0.94). Conclusion: The developmental appropriateness and diagnostic accuracy of the RI-5 support its utility for clinical assessment, case conceptualization, and treatment planning in different child-serving systems, including schools, juvenile justice, child welfare, and mental health.
Psychiatry, 2019
To evaluate potential differences in therapeutic outcomes between youths who completed a full cou... more To evaluate potential differences in therapeutic outcomes between youths who completed a full course of treatment as planned compared to youths who terminated treatment prematurely. Method: Using longitudinal data from the National Child Traumatic Stress Network (NCTSN) Core Data Set, the present study examined demographic characteristics, trauma history, scores on standardized measures, and ratings of functional impairment and behavior problems in a large clinical sample of children and adolescents exposed to trauma who received treatment at NCTSN centers across the United States. Baseline and follow-up data were used to compare treatment completers (n = 3,108) and noncompleters (n = 4,029). Results: Both treatment completers and noncompleters received benefits from treatment by NCTSN mental health providers in that both groups showed significant decreases in mean scores from baseline to followup on all standardized measures. However, compared to noncompleters, treatment completers showed three types of significantly greater benefit at follow-up. These included: (a) greater rates of decline (i.e., steeper slopes) on all outcome measures; (b) greater reductions in the odds of falling within the clinical range on standardized measures; and (c) greater reductions in the odds of exhibiting functional impairment and behavior problems at follow-up. In contrast, compared to treatment completers, noncompleters reported significantly higher rates of lifetime exposure to community violence, psychological maltreatment, physical abuse, neglect, sexual abuse, and sexual assault. Conclusion: These findings underscore the value of incorporating engagement and retention strategies in treatments for traumatized youths to maximize therapeutic benefit and raise the standard of care.
Trauma/Grief-Focused Group Psychotherapy with Adolescents
Psychological Effects of Catastrophic Disasters, 2018
Subjective Features of Traumatic Experiences and PTSD in Adolescents
Journal of Interpersonal Violence, 2006
The 1980s mark the beginning of systematic research and theoretical advances in the field of psyc... more The 1980s mark the beginning of systematic research and theoretical advances in the field of psychic trauma in children. Posttraumatic stress disorder (PTSD) was a diagnosis for adults in the Diagnostic and Statistical Manual of Mental Disorders, DSM-III (American Psychiatric Association, 1980). In a later version, children and adolescents were partially included (American Psychiatric Association, 1987). Since 1980, a range of traumatic events have been identified as having the required stressor characteristics for posttraumatic stress reactions to manifest in children and adolescents.In this study, the role of the stressor and peritraumatic reactions in PTSD of children and adolescents was studied. In addition, co-existing factors were assessed and related to the development and maintenance of PTSD reactions. A cascade of distressing events described the stressor in children who reported sexual abuse in daycare (paper I), and single-incident events were studied in adolescents (paper III). Subjective reactions during or immediately after the traumatic event, such as intense emotions, physiological arousal, dissociation and having thoughts of intervening, were strongly associated to the subsequent development of PTSD reactions in adolescents. The findings indicate that subjective responses to traumatic events play an important role in PTSD etiology. Objective features of the stressor, such as death or physical injury did not relate significantly to the levels of posttraumatic stress reactions. Half the children exposed to the cascade stressor in the case of alleged child sexual abuse, showed significant levels of PTSD reactions four years later. The objective features of the cascade stressor depended on the reported severity of child sexual abuse as well as media exposure, medical examinations, forensic interviews and the court trial. Children with high levels of PTSD reactions reported more severe CSA and were also more exposed to the media and the court trial, but the tendency was not significant.Moreover, co-existing factors not related to the traumatic event may play important roles in the development and maintenance of PTSD reactions. After alleged sexual abuse and subsequent distressing events, older children displayed more PTSD reactions than younger children, which may indicate that younger children were more protected from developing distress in this situation. On the other hand, five weeks after a tram car accident, age was negatively associated with the levels of PTSD reactions in a group of children (paper IV). The findings may be due to the diverse nature of the stressors and methodological issues.Other co-existing factors to PTSD, such as behavior problems in children and adolescents, may represent considerable difficulties in a young person’s life. In the current study, children displayed significant levels of behavioral problems four years after alleged sexual abuse.The impact on parents and the rest of the child’s family cannot be ignored in the assessment of posttraumatic stress reactions of children and adolescents. In this study, comprehensive assessments were made of the parents’ experiences and levels of distress after alleged sexual abuse of their children. The parents were exposed to a cascade of events, including hearing about the sexual abuse, being involved in the police investigation and the court trial and being exposed in media reports. Four years after the events, elements of the stressor were significantly associated to the level of posttraumatic stress reactions. The findings illustrate how child sexual abuse reports may involve the children’s parents and expose them to high levels of distress over a long period of time.In addition, interactions in the family may contribute in the development and maintenance of posttraumatic stress reactions in children and adolescents, and impede the healing processes. After traumatic events in childhood, researchers tend to prefer parental reports of the children’s reactions to spare the children. In this study, children reported significantly higher levels of distress than observed by their parents after a tram car accident (paper IV). These findings indicate that parents unintentionally may bring in a response bias in their reports, which future research and clinical practice should take into account.The study illustrates that traumatic events are complex experiences involving cognitive and emotional reactions, physiological arousal and dissociation, and that these reactions may induce posttraumatic stress reactions in children and adolescents. The cascade stressor subsequent to alleged sexual abuse of children showed how different elements of the stressor may lead to distress over a long period of time. The distress involved both children and parents in this study.
Psychological trauma : theory, research, practice and policy, Jan 6, 2015
The severity of posttraumatic stress disorder (PTSD) symptoms is linked to race and ethnicity, al... more The severity of posttraumatic stress disorder (PTSD) symptoms is linked to race and ethnicity, albeit with contradictory findings (reviewed in Alcántara, Casement, & Lewis-Fernández, 2013; Pole, Gone, & Kulkarni, 2008). We systematically examined Caucasian (n = 3,767) versus non-Caucasian race (n = 2,824) and Hispanic (n = 2,395) versus non-Hispanic ethnicity (n = 3,853) as candidate moderators of PTSD's 5-factor model structural parameters (Elhai et al., 2013). The sample was drawn from the National Child Traumatic Stress Network's Core Data Set, currently the largest national data set of clinic-referred children and adolescents exposed to potentially traumatic events. Using confirmatory factor analysis, we tested the invariance of PTSD symptom structural parameters by race and ethnicity. Chi-square difference tests and goodness-of-fit values showed statistical equivalence across racial and ethnic groups in the factor structure of PTSD and in mean item-level indicators of P...
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Papers by Alan M. M Steinberg, Ph.D.