International Society for Traumatic Stress Studies

The Thinking About Recovery Scale: A New Parent-Report Questionnaire to use after Children are Expos

02/02/2018
by Elizabeth J. Schilpzand, Rowena Conroy, Vicki Anderson, Eva Alisic
Parental responses are thought to be critical to children’s recovery from trauma. Parent and child PTSD often occur together (Morris, Gabert-Quillen, & Delahanty, 2012), parents appear to make important contributions to the treatment of child PTSD (Gutermann et al., 2016), and a range of parenting behaviors are associated with childhood PTSD (Williamson et al., 2017). Despite acknowledgement in the field that parents play an important role in children’s recovery from trauma, we currently have limited understanding about the processes by which parents could influence child outcomes. Improving our understanding of these mechanisms will help us better prevent and treat adverse outcomes for families after a child experiences a traumatic event. In our recent research, we have focused on the role of cognitions.
 
Psychological theories to explain the development and maintenance of PTSD in adults and children emphasize how negative appraisals of the event can contribute to PTSD symptoms. Posttraumatic appraisals such as “I will never be able to lead a normal life again” are thought to maintain a current sense of threat and discourage processing of memories, leading to the maintenance of PTSD (Ehlers & Clark, 2000). Parents’ negative appraisals could be a key factor contributing to the development of posttraumatic stress symptoms in children.  Parent appraisals could impact children’s appraisal after trauma by directly influencing how a parent helps their child appraise the experience in conversations about the event, or indirectly through their influence on parent mental health or compromised parenting practices. A small amount of research has investigated whether parents develop these negative appraisals after their child’s trauma (Morris, Lee, & Delahanty, 2013; Tutus & Goldbeck, 2016).  Together, these studies highlight that parent cognitions are worthy of further investigation.
 
Up until now the research has been limited by a reliance on adult measures of posttraumatic appraisals or single-items to assess multidimensional constructs. A new, multidimensional measure would help gain a better understanding of whether parent posttraumatic cognitions play a role in children’s recovery from trauma. We developed a parent-report questionnaire designed to assess specific posttraumatic cognitions that a parent may have about their child’s recovery from a traumatic event. We generated items from existing theories and adapted existing measures of posttraumatic appraisals, then asked a group of experts in the field of childhood trauma to review the items. This resulted in a 33-item measure, the Thinking About Recovery Scale (TARS), which we found to be acceptable and feasible when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. The TARS measures three domains of parent posttraumatic cognitions: My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance. We anticipate that the TARS will be used in future research to improve understanding of parent influences on children’s recovery from trauma. The TARS could have broad use and we encourage clinicians and researchers to consider using the TARS in clinical settings and in prospective research with children exposed to a range of traumatic events.  
 
To access a copy of the TARS

References:

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319-345.

Gutermann, J., Schreiber, F., Matulis, S., Schwartzkopff, L., Deppe, J., & Steil, R. (2016). Psychological treatments for symptoms of posttraumatic stress disorder in children, adolescents, and young adults: A meta-analysis. Clinical Child and Family Psychology Review, 19(2), 77-93.

Morris, A., Gabert-Quillen, C., & Delahanty, D. (2012). The association between parent PTSD/depression symptoms and child PTSD symptoms: A meta-analysis. Journal of Pediatric Psychology, 37, 1076-1088. doi:http://dx.doi.org/10.1093/jpepsy/jss091

Morris, A., Lee, T., & Delahanty, D. (2013). Interactive relationship between parent and child event appraisals and child PTSD symptoms after an injury. Psychological Trauma: Theory, Research, Practice, and Policy, 5, 554-561. doi:10.1037/a0029894

Tutus, D., & Goldbeck, L. (2016). Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD. European Child and Adolescent Psychiatry, 25, 997-1005. doi:10.1007/s00787-016-0821-x

Williamson, V., Creswell, C., Fearon, P., Hiller, R. M., Walker, J., & Halligan, S. L. (2017). The role of parenting behaviors in childhood post-traumatic stress disorder: A meta-analytic review. Clinical Psychology Review, 53, 1-13. doi:https://doi-org.ezp.lib.unimelb.edu.au/10.1016/j.cpr.2017.01.005

Discussion Questions:

  1. What are the mechanisms by which parents influence children’s recovery after traumatic events?
  2. Could parent posttraumatic appraisals be a key factor in explaining why parents are critical to children’s outcomes after trauma?

Reference Article:

Schilpzand, E. J., Conroy, R., Anderson, V. and Alisic, E. (2018), Development and Evaluation of the Thinking About Recovery Scale: Measure of Parent Posttraumatic Cognitions Following Children's Exposure to Trauma. JOURNAL OF TRAUMATIC STRESS. doi:10.1002/jts.22258

About the Authors:

Elizabeth Schilpzand is a Psychologist and PhD Candidate at The University of Melbourne, Australia. Her PhD research investigated parent posttraumatic cognitions and mental health outcomes in parents and children after children’s experience of serious accidental injuries.
 
Dr. Rowena Conroy, PhD, is a Clinical Psychologist who is Coordinator of Education and Training in Psychology at The Royal Children’s Hospital in Melbourne, Australia; she has expertise as a clinician, researcher, and trainer/educator in the field of Childhood Trauma.
 
Prof. Vicki Anderson, PhD, is is a paediatric neuropsychologist with over 30 years' experience. Her research is focused on improving our understanding of childhood acquired brain injury (e.g., traumatic brain injury, stroke, concussion), chronic illness (e.g., cystic fibrosis, cancer, chronic fatigue) and neurodevelopmental disorders (e.g., ADHD, learning disability). 
 
Dr. Eva Alisic, PhD, is a Psychologist and Senior Research Fellow at Monash University, Australia, where she leads the Trauma Recovery Lab. She studies how children, young people, and families cope with traumatic experiences, and how professionals can support them
 
 

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