# Behavioural Difficulties are Linked to Traumatization in Young Children: A Cross-Sectional Study in a Clinical Sample

## TL;DR

This study explores how traumatic experiences in young children are linked to behavioral and emotional difficulties, using a play-based tool to identify signs of trauma.

## Contribution

The study introduces a new play-based method, the Odense Child Trauma Screening (OCTS), to assess traumatization in young children.

## Key findings

- Higher traumatization indicators were significantly linked to increased conduct and externalizing problems in children.
- Traumatization indicators related to children's mental representations of adults predicted conduct problems.
- Caregivers may struggle to recognize internalizing symptoms linked to trauma in young children.

## Abstract

Exposure to traumatic events can have posttraumatic effects in young children. It is challenging to identify posttraumatic symptoms. It is necessary to directly investigate the signs of traumatization in young children. The aim of the study was to investigate the links between children’s externalizing and internalizing symptoms reported by caregivers and indicators of traumatization assessed by using the young children as informants.

Study used data from 110 (59.1% girls) children aged 4 to 9 years. The children have been recruited across the social and mental health services that provide support for abused children in Lithuania. Externalizing and internalizing difficulties measured using caregiver reports with the Strengths and Difficulties Questionnaire (SDQ). Indicators of traumatization were measured with the Odense Child Trauma Screening (OCTS).

The higher levels of indicators of traumatization were significantly related to higher conduct and externalizing problems. The traumatization indicators related to child mental representation of adults were a significant predictor of children’s conduct problems.

The indicators of traumatization could be linked to externalized mental health difficulties of a child after trauma. Also, the findings might indicate that for the parents and caregivers it might be challenging to recognize internalizing symptoms, associated to traumatization.

Traumatic events are extremely difficult and life-threatening experiences that, studies show, may occur at any stage of life and might bring various psychological difficulties. Early recognition and identification of posttraumatic stress might help to prevent mental health difficulties later in life. However, while grown-ups can communicate and reflect on their experiences and feelings, this might be challenging for young children. It is important for practitioners and caregivers to understand better how trauma exposure is related to psychological problems in young children and how these difficulties can be recognized. Thus, this study examined the associations between behavioral and emotional difficulties and indicators of traumatization in young children. A newly developed, play-based, story stem tool, the Odense Child Trauma Screening (OCTS), was used for the recognition of traumatization. It contains LEGO® house and dolls and can be used for young children aged 4 to 8 years. The dyads of 110 children and their caregivers were recruited from institutions that provide social and mental health services for children in Lithuania. The information on demographics and child difficulties were reported by caregivers, and potential indicators of traumatization were evaluated during individual contact with a child using the OCTS. It was found that child conduct problems, reported by the caregivers, were related to medium- and high-risk indicators of traumatization. Also, expectations of adult behaviour and reactions in the OCTS narratives significantly predicted conduct problems. This study broadens the understanding of child difficulties that might be related to the experienced psychological trauma. The findings of this study will benefit the development of psychological support services within countries with similar cultural backgrounds as Lithuania.