11 November 2005

Measuring a Child's Distress
MHS helps to create new knowledge.

How do you measure the distress of a child? Indeed, many people might reply with another question: Why would you want to measure it? The capacity to simply and accurately measure an emotional response like distress is critical to defining what the distress is (and isn’t), understanding how it came about, and tracking if and how it changes over time, or in response to different interventions. If we wish to create interventions offering meaningful and reliable help for children suffering from traumatic stress, we will need ways to accurately measure distress in simple and inexpensive ways.

To develop and evaluate a way to measure the trauma-related distress of very young children – ages 2-7 years – was the task undertaken by scholars from two universities, and by Steven M. Friedman, Ph.D., Executive Director of MHS, and Rosemary Creeden, LISW, Manager of MHS services for the Cuyahoga County Children Who Witness Violence (CWWV) program. Results of their study were published in the journal of the Society of Clinical Child and Adolescent Psychology of the American Psychological Association.

The study was based on assessments of children conducted by MHS trauma intervention specialists for the CWWV program. Police officers at the scene of domestic violence incidents call CWWV when children have witnessed assaults and other violent events. CWWV specialists then go to the family’s home to assess the children and offer services when children show signs of being traumatized by what they have seen.

Journal of Clinical Child and Adolescent Psychology,
34 (4), pp. 758-764.

Psychometric Properties of the Pediatric Emotional Distress Scale in a Diverse Sample of Children Exposed to Interpersonal Violence.

James C. Spilsbury and Dennis Drotar
-- Dept. of Pediatrics, Case Western Reserve University

Christopher Burant
-- Dept. of Bioethics, Case Western Reserve University

Daniel Flannery
-- Kent State University's
-- Institute for the Study and Prevention of Violence

Rosemary Creeden and Steven M. Friedman
-- Mental Health Services for Homeless Persons, Inc.,

More than 1,000 children of ages of 2-7 years were seen by CWWV in the first 33 months of the program, an average of about one child each day. The study was based on subset of 383 of these children whose parent had recorded how frequently the child showed each of 17 different behaviors that are associated with distress. The authors conducted sophisticated mathematical analyses of the parents’ ratings on the 17 items. Of the children in the sample, 43% were African-American, and 31% were White. About 89% of the children had witnessed one parent or guardian victimize another parent. The remaining 11% had witnessed a more serious physical or sexual assault, or an attempted or completed suicide. Twenty two children saw an incident in which a firearm was used.

The analyses showed that children generally responded to traumatic events in one of two ways. Some children showed very expressive behavior – they had tempter tantrums, and became whiny or aggressive. The other children became withdrawn, sad, or fearful. The technical analyses showed that the 17-item Pediatric Emotional Distress Scale was a reliable and valid tool for measuring distress in these very young children.

Sixty nine percent (69%) of the children had scores on this scale that indicated clinically-significant levels of distress. These results are consistent with those of prior studies showing that very young children are particularly vulnerable to distress from traumatic events. The intellectual and emotional skills that many older children use to cope with trauma are not yet available to the younger children who were the focus of this study. This underscores the need for early intervention, and for making sure that families of vulnerable children have access to services in their communities.

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Copyright (c) 2005
Mental Health Services for Homeless Persons, Inc. (MHS)
All Rights Reserved.
MHS, 1736 Superior Avenue East, Cleveland, Ohio 44114-2944 U.S.A.
Voice - 216-623-6555 / TDD - 216-623-6540

Julie Rittenhouse, President, Board of Trustees
Steven M. Friedman, Ph.D., Executive Director

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