Is Trauma Hidden Behind the Referral Question?

This week's blog was contributed by Maegan Sady, PhD, ABPP-CN. Maegan is a project director in PAR's research and development department in addition to being a licensed psychologist and board-certified neuropsychologist. She worked as a pediatric neuropsychologist for nearly a decade before joining PAR.

Assessment clinicians are trained to look for hidden problems, and we all know the common ones. If a child comes in with a referral for an ADHD evaluation, we screen for anxiety and sleep problems. When an older adult complains of memory problems, we inquire about symptoms of depression. There's a new kid on the block, though, trauma. Trauma isn't new, of course, but more clients may be experiencing its effects along with whatever brought them to you for assessment.

Trauma is a broad term for experiences that are dangerous or threatening. Although abuse or violence quickly come to mind, experiences of losing a loved one, food insecurity, or chronic social isolation can just as readily result in symptoms. The COVID-19 pandemic has increased these experiences, and some argue the pandemic itself may be a form of trauma. The impact of multiple stressful events say, experiencing displacement due to a wildfire during the pandemic can be multiplicative. Similarly, existing health and economic disparities have been exacerbated by pandemic-related stressors.

Because traumatic experiences have increased, it makes sense that more clients are experiencing trauma effects. Trauma symptoms can mimic other disorders, including anxiety, depression, and even psychosis or personality disorder. Untreated, trauma effects can negatively impact physical health and lead to higher rates of suicide and substance abuse.

To decrease the chance that you miss trauma as a comorbid cause of your client's problems, make it routine to ask about trauma history. A written checklist (e.g., the Adverse Childhood Experiences Questionnaire) can help clients feel more comfortable disclosing their history. Unless you are specifically trained in trauma-related care, do not ask your client for details, but assure them you will provide resources.

If there is a positive history of trauma, assess for associated symptoms to guide recommendations; structured checklists can identify the severity and breadth. No matter the age of the client, PAR has you covered with the TSCYC, TSCC, TSI-2, FACT, and the DAPS. When time is short, screening versions are also available for most of these measures. And because many digital options are available on PARiConnect, it's easy to add a variety of administrations to your inventory when you need them.

When trauma is a contributing factor for your patient, you can provide a referral for evidence-based treatment and/or educational resources. For children, the American Academy of Child and Adolescent Psychiatry and The National Child Traumatic Stress Network have handouts and book recommendations. For adults, visit the National Center for PTSD. For individuals of all ages, see the website for the International Society for Traumatic Stress Studies.

Making trauma screening a routine part of your clinical assessment may uncover important treatment targets, helping your client deal more effectively with their original presenting concerns.