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The study implements a trauma-related nightmare treatment for children aged 8 to 13 years. Relevant outcome progress and outcome measures on symptoms, nightmare distress and duration, academic indicators, and sleep quality will be examined.
Untreated trauma-related nightmares and sleep-related disorders are associated with chronic health problems, burdening both the suffering individual and the health-care system. The study implements an innovative, cost-efficient, nightmare treatment for trauma-exposed children. It is one of the first randomized clinical trials with children, adapting an efficacious adult therapy to a 5-session nightmare treatment for 8-13 year-olds. Trauma nightmares are a mechanism in development and maintenance of secondary post-trauma psychopathology, medical problems, and family dysfunction. Therefore, this treatment may prevent long-term secondary health and behavioral problems. It provides a viable health care option to Montanans, lessening long-term financial, medical, and behavioral health expenses. Scientific models currently view PTSD treatment as primary, often leaving nightmares untreated. That approach does not address the pernicious impact of trauma-nightmares in individuals with sub-threshold PTSD or whose nightmares are a primary condition. The theoretical innovation of this therapy can advance the field's understanding of the development of trauma sequelae.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exposure, Relaxation, & Rescripting Therapy-Child | Experimental | Exposure, Relaxation, & Rescripting Therapy-Child utilizes behavioral and cognitive therapy techniques of exposure therapy and cognitive restructuring. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exposure, Relaxation, & Rescripting Therapy-Child | Behavioral | Exposure, Relaxation, & Rescripting Therapy (ERRT) will be conducted once a week for five consecutive weeks for approximately two hours per session. Each treatment session focuses on one of the following topics/skills: psycho-education and investment in treatment, psycho-education, Progressive Muscle Relaxation, diaphragmatic breathing, child-friendly exposure to the trauma-nightmare, and rescription. |
| Measure | Description | Time Frame |
|---|---|---|
| Trauma Related Nightmare Survey - Child Version (TRNS-C) Reflecting change in nightmare frequency, severity, and duration | The TRNS-C is a 14-item self-report measure that assesses current sleep quality, frequency, severity, and duration of nightmares, as well as cognitions, emotions, and behaviors related to nightmares in children. | Participants will be assessed immediately after treatment which occurs on average for 5 weeks, and then will be assessed for follow-ups at 3 months & 6 months post treatment. |
| Measure | Description | Time Frame |
|---|---|---|
| University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index for the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (UPID) | The UPID screens for trauma exposure and posttraumatic symptoms among youth 7 to 18 years old. It queries types of trauma exposures, assesses for DSM-IV criteria of traumatic exposure and the past-month frequency of PTSD symptoms and two associated features of PTSD in childhood. |
| Measure | Description | Time Frame |
|---|---|---|
| Trail Making Test | A neuropsychological test of visual attention and task switching. It consists of two parts in which the subject is instructed to connect a set of 25 dots as fast as possible while still maintaining accuracy. It provides information about visual search speed, scanning, speed of processing, mental flexibility, as well as executive functioning. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Cameo Borntrager, Ph.D. | University of Montana | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Montana | Missoula | Montana | 59812 | United States |
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| ID | Term |
|---|---|
| D013313 | Stress Disorders, Post-Traumatic |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D040921 | Stress Disorders, Traumatic |
| D000068099 | Trauma and Stressor Related Disorders |
| D001523 | Mental Disorders |
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| 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Revised Child Anxiety and Depression Scale (RCADS) | The RCADS is a 47-item scale that corresponds to the DSM-IV anxiety disorders and it incorporates a sub scale for major depression. There is a six-factor structure with the following sub scales: Separation Anxiety Disorder, Social Phobia, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, and Major Depressive Disorder. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Nightmare Distress Questionnaire - Modified (NDQ) | The NDQ is a 13-item self-report measure of nightmare related distress. Higher scores are significantly related to interest in therapy for nightmares. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Pittsburgh Sleep Quality Index (PSQI) | The PSQI is a 19-item self-report measure of sleep quality and disturbance. It queries sleep quality and disturbances over the last month. Seven component scores are generated from this measure including: subjective sleep quality, latency, duration, habitual sleep efficiency, sleep problems, use of sleep medications, and daytime dysfunction. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Strength and Difficulties Questionnaire - Child Version (SDQ) | The SDQ is a self-report instrument designed for completion by 11-16 year-olds. Specifically, children respond to 25 attributes (emotional, conduct, hyperactivity, peer relationships, and prosocial behaviors). | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Children's Sleep Habits Questionnaire (CSHQ) | The CSHQ is a 33-item parent-report measure of sleep behavior that can be used by parents of school-aged children. A total score is derived from items from 8 sub scales: Bedtime Resistance, Sleep Onset Delay, Sleep Duration, Sleep Anxiety, Night Wakings, Parasomnias, Sleep-Disordered Breathing, and Daytime Sleepiness. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Strengths and Difficulties Questionnaire - Parent Version (SDQ) | The SDQ has two parent versions designed for 4-10 year-olds and 11-16 year-olds. Specifically, parents respond to 25 attributes (emotional, conduct, hyperactivity, peer relationships, and prosocial behavior). | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| The Parenting Stress Scale (PSS) | The PSS is an 18-item measure that assesses stress related to parenting (e.g., "I am happy in my role as a parent," "Having child(ren) has been a financial burden"). | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Pittsburgh Sleep Quality Index - Parent self-report (PSQI) | Similar to the child version, the adult form of the PSQI is a 19-item self-report measure of sleep quality and disturbance. It queries sleep quality and disturbances over the last month. It will serve as an index of secondary gain from treatment by way of parent's improved sleep quality and quantity. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| The McMaster Family Assessment Device (FAD) | The FAD is a 53-item measure that identifies seven dimensions of family functioning: Problem Solving, Communication, Roles, Affective Responses, Affective Involvement, Behavior Control, and General Functioning. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Academic Grade Point Average (GPA) | GPA will be collected as a measure of academic performance. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Wechsler Intelligence Scale for Children (WISC-IV), Letter-Number Sequencing subtest | A measure of attention, short-term auditory memory, and processing speed. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Wechsler Intelligence Scale for Children (WISC-IV), Digit Span subtest | A measure of auditory short-term memory, attention, and concentration. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Child Attention Network Task | A task designed to test attention shifting, alerting, orienting, and executive control networks. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| A Developmental NEuroPSYchological Assessment (NEPSY-II), Animal Sorting subtest | A measure of attention and executive functions. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| A Developmental NEuroPSYchological Assessment (NEPSY-II), Auditory Attention & Response Set subtest | A measure of attention and executive functions. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| A Developmental NEuroPSYchological Assessment (NEPSY-II), Clocks subtest | A measure of attention and executive functions. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Aimsweb Reading Curriculum-Based Measurement (R-CBM) | A measure designed to be a short (one minute) fluency measure used to regularly monitor the development of early literacy and early reading skills. Results can be used to evaluate individual student development. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Aimsweb MAZE Reading Curriculum-Based Measurement (MAZE-CBM) | A supplemental measure to provide a more complete picture of a child's reading skill. Maze is a multiple-choice task that children complete while reading silently. The first sentence of a 150-400 word passage is left intact. Thereafter, every 7th word is replaced with three words inside parenthesis. The child must choose the correct word. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |
| Peabody Picture Vocabulary Test, Fourth Edition (PPVT-4) | A standardized assessment that evaluates receptive language, as an index of cognitive ability. | 1 wk pre-treatment & 1 wk, 3 mo, 6 mo post-treatment follow-ups |