Date of Award

2025

Document Type

Thesis

Degree Name

MA in Psychology

Department

Psychology

First Advisor

Elissa J Brown

Second Advisor

William Chaplin

Abstract

The Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-V) includes four symptom clusters that compose Posttraumatic Stress Disorder (PTSD)-- Re-Experiencing, Avoidance, Negative Alterations in Cognitions and Mood ("Cognitive Mood"), and Hyperarousal (American Psychological Association, 2013). In response to findings that PTSD often presents differently in children and adolescents than in adults, the DSM-V now includes developmental considerations for diagnosis (e.g., Cohen et al., 2010; Scheeringa et al., 2012). As research on pediatric PTSD has grown, Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al., 2016) has emerged as the most empirically supported intervention for reducing PTSD symptoms, anxiety, depression, and behavioral problems in youth trauma survivors (e.g., Jensen et al., 2013; Last et al., 2023; Murray et al., 2015). Although TF-CBT is effective across developmental levels (e.g., Peters et al., 2021; Scheeringa et al., 2011), there is little research examining the role of age group in treatment response during each phase of TF-CBT, rather than across the entire intervention. Furthermore, many studies aggregate PTSD symptom clusters into a total severity score, potentially obscuring developmental differences specific to certain treatment phases. The present study examines the moderating role of age group in PTSD symptom cluster changes during TF-CBT. Participants included 126 youth (ages 5-17) receiving TF-CBT at a community mental health clinic following exposure to interpersonal violence. PTSD symptoms were assessed using the Child Posttraumatic Stress Symptom Scale for DSM-V (CPSS-V; Foa et al., 2018) at three time points: pre-treatment ("Pre"), mid-treatment (before trauma narration; "Mid"), and post-treatment ("Post"). For each symptom cluster, we fit a mixed-effects regression model to examine the interaction and main effects of age group (adolescent, child) and time (Pre, Mid, Post) in symptom change. Results indicated that TF-CBT is effective in reducing symptoms from each of the four clusters, regardless of age group. Re-Experiencing and Hyperarousal symptoms improved at similar rates for both children and adolescents. However, moderation and main effects were found for the Avoidance and Cognitive Mood clusters, respectively. Children demonstrated early improvements in Avoidance (Pre to Mid), whereas adolescents showed significant reductions only after trauma narration (Mid to Post). Adolescents, who initially presented with higher Cognitive Mood symptoms, exhibited a steeper reduction from Mid to Post than did children, ultimately reaching similar symptom levels as children by Post. Clinical implications, gender differences, and future research directions are discussed.

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