Rachel Wamser-Nanney | University of Missouri - St. Louis (original) (raw)

Papers by Rachel Wamser-Nanney

Child Abuse & Neglect, 2018

Journal of Interpersonal Violence

Journal of Traumatic Stress

Psychological Trauma: Theory, Research, Practice, and Policy

Journal of Interpersonal Violence

Journal of Traumatic Stress, 2019

A significant body of research has been devoted to demonstrating high rates of sleep impairment, ... more A significant body of research has been devoted to demonstrating high rates of sleep impairment, and the subsequent adverse implications of sleep difficulties, among adult trauma survivors, particularly those diagnosed with posttraumatic stress disorder (PTSD). Yet considerably less work has been focused on sleep disturbances among trauma-exposed children, especially preschoolers. Pediatric research is paramount in light of the numerous developmental and functional implications that may result from sleep impairment. Prior studies have also documented disagreement between caregiver’s and children’s reports of trauma-related symptoms; however, the level of concordance rates regarding sleep difficulties is unknown in this population. The present study investigated the rates of multiple types of sleep disturbances using caregiver’s and children’s reports as well as caregiver-child concordance rates regarding these difficulties. Three hundred and forty-two treatment-seeking children ages of 3–18 years (M = 9.68, SD = 4.00; 61.1% female, 60.4% Black) and their caregivers were included in the study. Sleep disturbances were common in this sample, and children endorsed higher levels of sleep symptoms (range 46–72%) than their caregivers (range 14–51%). Nearly half (47%) of preschool children evinced significant sleep impairment per their caregiver. Inter-rater agreement between caregiver’s and children’s reports for all sleep symptoms were below acceptable levels (range κ = 0.01-.13), indicating that the concordance rate for caregiver-child trauma-related sleep problems is quite low. Findings illustrate the relevance of sleep disturbances among trauma-exposed children and point to the need to assess both caregiver’s and children’s symptoms regarding sleep impairment.

Maternal support has been conceptualized as a key factor in predicting children’s functioning fol... more Maternal support has been conceptualized as a key factor in predicting children’s functioning following sexual abuse; however, empirical evidence for this assumption is rather limited. Prior studies may have failed to find a relationship between maternal support and children’s outcomes due to the methodological weaknesses of the prior literature such as the use of maternal support measures without adequately reported psychometric properties. Moreover, relatively few studies have investigated whether maternal support corresponds with children’s own self-reported symptoms. The aim of the present study was to utilize the only published measure of maternal support with sufficient psychometrics, the Maternal Self-Report Support Questionnaire (MSSQ; Smith et al., 2010), to determine if levels of pre-treatment support are associated with children’s self-reported trauma-related symptoms among 165 treatment-seeking children (M = 10.85, SD = 3.09) and their non-offending mothers. Levels of maternal emotional support corresponded with few of children’s outcomes, and when relationships were observed, emotional support was related to higher levels of symptoms. Maternal levels of blame and doubt were only associated with dissociative symptoms. Maternal support therefore appears to be an ineffective predictor of children’s post-disclosure trajectories and raises the possibility that maternal support is linked with poorer functioning.

The purpose of the present study was to examine the evidence for the complex trauma definition in... more The purpose of the present study was to examine the evidence for the complex trauma definition in children, utilizing children's self-reported trauma-related symptoms. Two hundred and twelve children (ages 8–16) exposed to a traumatic event were included in the study. The symptom reports of children who experienced complex trauma were contrasted with children who experienced a trauma that did not meet the full complex trauma definition: 1) acute noninterpersonal trauma, 2) acute interpersonal trauma, 3) trauma that began early in life (i.e., prior to age 10), and 4) chronic interpersonal trauma that began later in childhood.. Significant differences in children's self-reported symptoms were observed when children who experienced complex trauma were compared to those who experienced a traumatic event that met none of the characteristics of complex trauma exposure. Explanations for the findings are discussed.

The present study aimed to develop a novel, hospital-based motivational interviewing (MI) interve... more The present study aimed to develop a novel, hospital-based motivational interviewing (MI) intervention for victims of armed community violence (MI-VoV) targeting patient-specific risk factors for future violence or violent victimization. Method: This uncontrolled pilot feasibility study examined a sample of patients (n ϭ 71) hospitalized due to violent injury at a Level 1 Trauma Center in [Location . Patients first participated in a brief assessment to identify risk factors for violence/violent injury. A single MI session then targeted risk behaviors identified for each patient. Proximal outcomes, including motivation for change and behaviors to reduce risk, were examined at 2 weeks and 6 -12 weeks postdischarge. Distal outcomes, including fighting, weapon-carrying, and gun-carrying, and other violence risk factors were examined at 6-to 12-week follow-up. Results: An estimated 95 patients were offered participation, 79 (83.2%) agreed to participate, and 73 (76.8%) completed the risk assessment. Of these, 71 had at least 1 violence/violent injury risk factor. Behaviors to reduce risk were significantly greater at 2-week and 6-to 12-week follow-up (p values Ͻ .05). Fighting, weapon-carrying, and gun-carrying were significantly reduced at 6-to 12-week follow-up (p values Ͻ .05). Conclusions: This intervention appears to be feasible to implement and acceptable to patients. A randomized controlled trial evaluating efficacy appears warranted.

Objective: Event centrality, or the extent to which traumatic events are perceived to be integral... more Objective: Event centrality, or the extent to which traumatic events are perceived to be integral to one’s life, has been found to be predictive of trauma-related symptoms, such as posttraumatic stress disorder (PTSD) and depression. Less research has been devoted to whether event centrality is related to adaptive outcomes, such as posttraumatic growth (PTG) and resiliency, and psychological well-being (PWB) has not been investigated. Given the unique circumstances of different types of traumas, the relationship between event centrality and posttrauma functioning may differ by the type of trauma experienced. Method: The present study investigated the direct relationships between event centrality and PTSD, depression, PTG, resiliency, and PWB, and then examined whether type of trauma (i.e., sexual victim- ization, death of a loved one, serious illness/injury, violence exposure) moderated the relationship between event centrality and mental health outcomes among 429 trauma-exposed college students (Mage 19.66, SD 1.65; 78.6% female; 49.9% White). Results: Event centrality was positively related to PTSD, depression, and PTG, inversely linked with multiple indices of PWB, and unrelated to resiliency. Type of traumatic event moderated the relationship between event centrality and PTSD, as well as 4 subscales of PWB. When sexual trauma was the index event, event centrality was more strongly associated with PTSD and aspects of PWB compared to death of a loved one. Conclusions: Findings indicate the importance of trauma type when disentangling the relationships between event centrality and negative and positive outcomes and demonstrate the relevance of event centrality in understanding posttrauma functioning.

Maternal support is touted to play a critical role in predicting children's symptom tra-jectories... more Maternal support is touted to play a critical role in predicting children's symptom tra-jectories following sexual abuse disclosure. Yet, a recent meta-analysis indicates that this widely held belief may actually have limited empirical support. The lack of correspondence between maternal support and children's symptoms may be the result of the limitations of the prior literature including the use of maternal support measures with inadequate psychometric properties. The aim of the present study was to utilize the only published measure with sufficient psychometrics properties, the Maternal Self-Report Support Questionnaire (MSSQ; Smith et al., 2010), to determine the relationships between maternal support and demographic and family characteristics, parent-reported children's symptoms, and aspects of the traumatic event in a treatment-seeking sample. The sample included 252 treatment-seeking children (M = 8.86, SD = 3.85; 67.5% female, 59.5% White) and their mothers, who completed the MSSQ and other measures at pre-treatment. Mothers of older children, White children, and mothers with greater educational attainment reported higher levels of Emotional Support. Single mothers were more likely to report higher levels of Blame/Doubt than married mothers. Characteristics of the traumatic event, such as sexual abuse duration and number of sexual abuse incidents were negatively correlated with Emotional Support. Maternal support was related to relatively few of children's symptoms and was not associated with levels of posttraumatic stress disorder (PTSD) symptoms. Although several demographic and family characteristics may be related to maternal support, it is a relatively weak predictor of children's outcomes.

Trauma-related sleep difficulties are quite common and their functional and clinical importance a... more Trauma-related sleep difficulties are quite common and their functional and clinical importance are increasingly recognized. High rates of sleep problems have been documented among trauma-exposed adults, particularly those diagnosed with posttraumatic stress disorder (PTSD); however, research with trauma-exposed children is relatively limited. Research specifically with child samples is critical due to the numerous developmental and functional implications that may result from sleep impairment. Characteristics of the traumatic event may play a key role in understanding sleep difficulties, yet, these associations are not well understood among trauma-exposed children. The current study therefore investigated whether aspects of the traumatic event (i.e., type, nature, chronicity, age of onset, removal from home, and complex trauma) were related to higher levels of sleep disturbances among 276 treatment-seeking children ages 6–18 years (M = 10.88, SD = 3.39; 63.4% female; 62.7% Black). Sleep problems were common in this sample. Domestic and community violence exposure were associated with higher levels of select sleep difficulties, as were interpersonal trauma, chronic trauma, a trauma that began early in life, and complex trauma. Nonetheless, type of trauma and characteristics of the traumatic event were largely unrelated to sleep problems on either caregiver’s or children’s reports. Removal from the home was not linked with sleep impairment. Although findings signify the relevance of sleep disturbances among trauma-exposed children, trauma characteristics may have limited influence on sleep problems.

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therap... more Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3-18; M = 9.97, SD = 3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver-and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children's caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.

Objectives: Identifying the factors related to premature termination from trauma-focused child th... more Objectives: Identifying the factors related to premature termination from trauma-focused child therapy is an important first step in ultimately preventing attrition in at-risk families. The primary aim of the present study was to investigate whether demographic factors and pretreatment symptom levels were associated with premature termination among children who received trauma-focused treatment. Because different definitions of attrition may influence results, candidate factors were examined in relation to 2 operational definitions of attrition. Method: Four hundred and sixty-six children (ages 2–18 years; M 9.23, SD 3.78; 66.1% females) who were referred to a Child Advocacy Center (CAC) for trauma-focused therapy were included in the study. Demographic and family variables, characteristics of the traumatic event, and caregiver-and child-reported pretreatment symptoms levels were assessed in relation to both clinician-rated treatment status and whether the child received an adequate dose of treatment (i.e., 12 sessions). Results: Several demographic factors (e.g., child's age, minority status, household income, maternal years of education), Child Protective Services (CPS) involvement, type of treatment received, number of traumatic events, and caregiver-rated pretreatment symptom levels were related to clinician-rated treatment status. Relatively fewer factors were associated with the adequate dose operationalization of attrition. Children's symptom reports were unrelated to either attrition definition. Conclusions: Demographic and family factors, trauma characteristics, and level of caregiver-reported symptoms may help identify families at risk for premature termination. Efforts to understand the interactions between attrition factors, as well the use of different operational definitions in relation to premature termination, are warranted.

Child Abuse & Neglect, 2018

Journal of Interpersonal Violence

Journal of Traumatic Stress

Psychological Trauma: Theory, Research, Practice, and Policy

Journal of Interpersonal Violence

Journal of Traumatic Stress, 2019