Little research has investigated psychotherapy attrition among child victims of violence, and no studies have evaluated the role of trauma characteristics (e.g., level of threat or injury, trauma frequency, perpetrator relationship, victim type, and trauma type). The current study evaluated premature psychotherapy termination with 134 child victims (ages 5–19 years) who were referred for exposure-based cognitive-behavioral therapy. Results indicated that premature treatment termination was associated with children who experienced (a) a single incident of trauma (compared to multiple), (b) neither life threat nor physical injury during the victimization, (c) and an incident that was perpetrated by an older child compared to a parental figure. Certain trauma characteristics may be important factors for identifying children at risk for terminating treatment prematurely.
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References
1.
American Psychiatric Association. (2000) Diagnostic and statistical manual of mental disorders IV–TR. (4th ed.) Washington, DC: Author.
2.
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders. (5th ed.) Washington, DC: Author.
3.
AndersenR. M. (1968) Behavioral model of families' use of health services. Research Series No. 25. Chicago, IL: Center for Health Administration Studies, Univer. of Chicago.
4.
AndersenR. M. (1995) Revisiting the behavioral model and access to medical care: does it matter?Journal of Health and Social Behavior, 36, 1–10.
5.
BarnardJ.RubinD. B. (1999) Small-sample degrees of freedom with multiple imputation. Biometrika, 86, 948–955.
6.
BarrettM. S.ChuaW.Crits-ChristophP.GibbonsM. B.ThompsonD. (2008) Early withdrawal from mental health treatment: implications for psychotherapy practice. Psychotherapy Theory, Research, Practice, Training, 45, 247–267.
7.
BattleJ. V. (1998) Structural equation modeling of child and adolescent reactions to violent victimization: the mediational role of self-esteem. Ph.D. dissertation presented at Univer. of Houston, Houston, TX.
8.
BeckA.WardC.MendelsonM.MockJ.ErbaughJ. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
9.
BenjaminiY.HochbergY. (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B (Methodological), 57(1), 289–300.
10.
Boney-McCoyS.FinkelhorD. (1995) Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology, 63, 726–736.
11.
BrowneA.FinkelhorD. (1986) Impact of child sexual abuse: a review of the research. Psychological Bulletin, 99, 66–77.
12.
CalamR.HorneL.GlasgowD.CoxA. (1998) Psychological disturbance and child sexual abuse: a follow-up study. Child Abuse & Neglect, 22(9), 901–913.
13.
ChassonG. S.VincentJ. P.HarrisG. E. (2008) The use of symptom severity measured just before termination to predict child treatment dropout. Journal of Clinical Psychology, 64(7), 1–14.
14.
ChaviraD. A.SteinM. B.BaileyK.SteinM. T. (2004) Child anxiety in primary care: prevalent but untreated. Depression and Anxiety, 20, 155–164.
15.
ClearP. J.VincentJ. P.HarrisG. E. (2006) Ethnic differences in symptom presentation of sexually abused girls. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations For Victims, Survivors, & Offenders, 15(3), 79–98.
16.
DierkerL.NargisoJ.WisemanR.HoffD. (2001) Factors predicting attrition within a community initiated system of care. Journal of Child and Family Studies, 10(3), 367–383.
17.
EndersC. K. (2010) Applied missing data analysis. (1st ed.) New York: Guilford Press.
18.
FinkelhorD.OrmrodR. K.TurnerH. A.HambyS. L. (2005) Measuring poly-victimization using the Juvenile Victimization Questionnaire. Child Abuse and Neglect, 29(11), 1297–1312.
19.
GarfieldS. L. (1994) Research on client variables in psychotherapy. In BergenA. E.GarfieldS. L. (Eds.), Handbook of psychotherapy and behavior change. (4th ed.) Oxford, UK: John Wiley. Pp. 190–228.
20.
HansonR. F.SaundersB.KilpatrickD.ResnickH.CrouchJ. A.DuncanR. (2001) Impact of childhood rape and aggravated assault on adult mental health. American Journal of Orthopsychiatry, 71(1), 108–119.
21.
HébertM.Collin-VézinaD.DaigneaultI.ParentN.TremblayC. (2006) Factors linked to outcomes in sexually abused girls: a regression tree analysis. Comprehensive Psychiatry, 47(6), 443–455.
22.
HorowitzM. (1982) Stress response syndromes and their treatment. In GoldbergerL.BreznitzS. (Eds.), Handbook of stress: theoretical and clinical aspects. New York: Free Press.
23.
HorowitzM.WilnerN.AlvarezW. (1979) Impact of Event Scale: a measure of subjective stress. Psychosomatic Medicine, 41, 209–218.
24.
HuangM. C.SchwandtM. L.RamchandaniV. A.GeorgeD. T.HeligM. (2012) Impact of multiple types of childhood trauma exposure on risk of psychiatric comorbidity among alcoholic inpatients. Alcoholism: Clinical and Experimental Research, 36, 1099–1107.
25.
KataokaS. H.SteinB. D.JaycoxL. H.WongM.EscuderoP.TuW.ZaragozaC.FinkA. (2003) A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 311–318.
26.
KazdinA. E.FrenchN. H.UnisA. S. (1983) Child, mother, and father evaluations of depression in psychiatric inpatient children. Journal of Abnormal Child Psychology, 11(2), 167–179.
27.
KazdinA. E.WassellG. (2000) Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Mental Health Services Research, 2, 27–40.
28.
KendallP. C.SugarmanA. (1997) Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 65(5), 883–888.
29.
Kendall-TackettK. A.WilliamsL. M.FinkelhorD. (1993) Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychological Bulletin, 113, 164–180.
30.
KimB. N.KimJ. W.KimH. W.ShinM. S.ChoS. C.ChoiN. H.AhnH.LeeS. Y.RyuJ.YunM. J. (2009) A 6-mo. follow-up study of posttraumatic stress and anxiety/depressive symptoms in Korean children after direct or indirect exposure to a single incident of trauma. Journal of Clinical Psychiatry, 70, 1148–1154.
31.
KovacsM. (1992) The Children's Depression Inventory (CDI). North Tonawanda, NY: Multihealth Systems.
32.
LawyerS. R.RuggieroK. J.ResnickH. S.KilpatrickD. J.SaundersB. E. (2006) Mental health correlates of the victim-perpetrator relationship among interpersonally victimized adolescents. Journal of Interpersonal Violence, 21(10), 1333–1353.
33.
LehmannP. (1997) The development of posttraumatic stress disorder (PTSD) in a sample of child witnesses to mother assault. Journal of Family Violence, 12(3), 241–257.
34.
LoganD. E.KingC. A. (2002) Parental identification of depression and mental health service use among depressed adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 296–304.
35.
LuthraR.AbramovitzR.GreenbergR.SchoorA.NewcornJ.SchmeidlerJ.LevineP.NomuraY.ChemtobC. M. (2009) Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents. Journal of Interpersonal Violence, 24(11), 1919–1927.
36.
MalmquistC. P. (1986) Children who witness parental murder: posttraumatic aspects. Journal of the American Academy of Child Psychiatry, 25(3), 320–325.
37.
McLeerS. V.DeblingerE.AtkinsM. S.FoaE.RalpheD. L. (1988) Post-traumatic stress disorder in sexually abused children. Journal of the Academy of Child & Adolescent Psychiatry, 27, 650–654.
38.
McNamaraJ. M. D. (2000) Child maltreatment: parenting stress, child symptomatology and treatment attrition. Dissertation presented at the Univer. of California, Santa Barbara, Santa Barbara, CA.
39.
MennenF. E. (1995) The relationship of race/ethnicity to symptoms in childhood sexual abuse. Child Abuse and Neglect, 19, 115–124.
40.
MennenF. E.MeadowD. (1995) The relationship of abuse characteristics to symptoms in sexually abused girls. Journal of Interpersonal Violence, 19, 259–274.
41.
OwensP. L.HoagwoodK.HorwitzS. M.LeafP. J.PoduskaJ. M.KellamS. G.IalongoN. S. (2002) Barriers to children's mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 731–738.
42.
PekarikG.StephensonL. A. (1988) Adult and child client differences in therapy dropout research. Journal of Clinical Child Psychology, 17(4), 316–321.
43.
PineD. S.CostelloJ.MastenA. (2005) Trauma, proximity, and developmental psychopathology: the effects of war and terrorism on children. Neuropsychopharmacology, 30, 1781–1792.
44.
PynoosR. S.SorensonS. B.SteinbergA. M. (1993) Interpersonal violence and traumatic stress reactions. In GoldbergerL.BreznitzS. (Eds.), Handbook of stress: theoretical and clinical aspects. New York: Free Press. Pp. 573–590.
45.
ReiterJ. P. (2007) Small-sample degrees of freedom for multi-component significance tests with multiple imputation for missing data. Biometrika, 94(2), 502–508.
46.
RomanoB. A.NelsonR. O. (1988) Discriminant and concurrent validity of measures of children's depression. Journal of Clinical Child Psychology, 17(3), 255–259.
47.
RossmanB. B. R.HughesH. M.HansonK. L. (1998) The victimization of school-age children. Journal of Aggression, Maltreatment, & Trauma, 2(1), 87–106.
48.
RubinD. B. (1976) Inference and missing data. Biometrika, 63, 581–592.
49.
RuggieroK. J.McLeerS. V.DixonJ. F. (2000) Sexual abuse characteristics associated with survivor psychopathology. Child Abuse and Neglect, 24, 951–964.
50.
SansoneR. A.ButlerM.DakroubH.PoleM. (2006) The relationship between number of types of childhood trauma, number of psychophysiological disorders, and length of medical disability. Traumatology, 12, 143–147.
51.
SaylorC.FinchA. J.SpiritoA.BennettB. (1984) The Children's Depression Inventory: a systematic evaluation of psychometric properties. Journal of Consulting and Clinical Psychology, 52, 955–967.
52.
SelyaA. S.RoseJ. S.DierkerL. C.HedekerD.MermelsteinR. J. (2012) A practical guide to calculating Cohen's f2, a measure of local effect size, from PROC MIXED. Frontiers In Psychology, 3(Apr.), DOI: 10.3389/fpsyg.2012.00111.
53.
SinghH.JanesC. L.SchechtmanJ. M. (1982) Problem children's treatment attrition and parents' perception of the diagnostic evaluations. Journal of Psychiatric Treatment Evaluation, 4, 257–263.
54.
ThienkruaW.CardozoB. L.ChakkrabandM. I. L. S.GuadamuzT. E.PengjuntrW.TantipiwatanaskulP.SakornsatianS.EkassawinS.PanyayongB.VarangratA.TapperoJ. W.SchreiberM.van GriensvenF. (2006) Symptoms of posttraumatic stress disorder and depression among children in tsunami-affected areas in southern Thailand. Journal of the American Medical Association, 296(5), 549–559.
55.
ToddD. M.DeaneF. P.BragdonR. A. (2003) Client and therapist reasons for termination: a conceptualization and preliminary validation. Journal of Clinical Psychology, 59, 133–147.
WarnickE. M.GonzalezA.WeersingV.ScahillL.WoolstonJ. (2012) Defining dropout from youth psychotherapy: how definitions shape the prevalence and predictors of attrition. Child and Adolescent Mental Health, 17(2), 76–85.
58.
WierzbickiM.PekarikG. (1993) A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195.
59.
YuleW. (1992) Post-traumatic stress disorder in child survivors of shipping disasters: the sinking of the “Jupiter.”Psychotherapy and Psychosomatics, 57, 200–205.
60.
YuleW.UdwinO. (1991) Screening child survivors for post-traumatic stress disorders: experiences from the ‘Jupiter’ sinking. British Journal of Clinical Psychology, 30, 131–138.
61.
YuleW.WilliamsR. (1990) Post-traumatic stress reactions in children. Journal of Traumatic Stress, 3, 279–295.
