Assessing the Sensitivity and Specificity of the MAYS-2 for Detecting Trauma among Youth in Juvenile...

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Child & Youth Care ForumJournal of Research and Practice inChildren's Services ISSN 1053-1890Volume 40Number 5 Child Youth Care Forum (2011)40:345-362DOI 10.1007/s10566-010-9124-4

Assessing the Sensitivity and Specificity ofthe MAYSI-2 for Detecting Trauma amongYouth in Juvenile Detention

Patricia K. Kerig, Melissa ArnzenMoeddel & Stephen P. Becker

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ORI GIN AL PA PER

Assessing the Sensitivity and Specificity of the MAYSI-2for Detecting Trauma among Youth in JuvenileDetention

Patricia K. Kerig • Melissa Arnzen Moeddel • Stephen P. Becker

Published online: 29 September 2010� Springer Science+Business Media, LLC 2010

Abstract This study investigated the sensitivity and specificity of the most widely used

mental health screening instrument in juvenile detention, the Massachusetts Youth

Screening Instrument (MAYSI-2), for detecting trauma and symptoms of posttraumatic

stress disorder (PTSD) among detained youth. The MAYSI-2 scales measuring Substance

Use, Anger/Irritability, Depression/Anxiety, and Traumatic Experiences contributed to

the prediction of PTSD symptoms; however, only Depression/Anxiety contributed to the

prediction of associated symptoms for girls. The ROC curves technique indicated that the

Traumatic Experiences scale was a moderately accurate predictor of likely Full or Partial

PTSD but not superior to the other MAYSI-2 scales. These results suggest further work is

needed to develop measures that are sensitive to the experiences of delinquent youth with

histories of complex trauma.

Keywords PTSD � Trauma � Delinquency � Gender � Assessment

In recent years, increasing attention has been drawn to the role that trauma might play in

the developmental psychopathology of juvenile delinquency (Ford 2002; Ford et al. 2006;

Greenwald 2002; Kerig and Becker 2010). Across multiple samples and settings, research

confirms that a significant number of youth involved in the juvenile justice system report

exposure to traumatic events (e.g., Cauffman et al. 1998; Dixon et al. 2005; Ford et al.

2008b; Kerig et al. 2009; Lawyer et al. 2006; Martin et al. 2008; Steiner et al. 1997; Wood

et al. 2002). For example, Abram et al. (2004) assessed 898 youth in a short-term detention

facility and found that 93% of the boys and 84% of the girls had experienced a traumatic

P. K. Kerig (&)Department of Psychology, University of Utah, Salt Lake City, UT 84112, USAe-mail: [email protected]

M. A. Moeddel � S. P. BeckerDepartment of Psychology, Miami Unviversity, Oxford, OH 45056, USAe-mail: [email protected]

S. P. Beckere-mail: [email protected]

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Child Youth Care Forum (2011) 40:345–362DOI 10.1007/s10566-010-9124-4

Author's personal copy

life event, with the typical youth having experienced as many as 14 traumatic stressors in

his or her lifetime. Similarly Ford et al. (2008a) found that 61% of a sample of youth drawn

from a pre-trial detention center had experienced a traumatic event consistent with the

DSM-IV (American Psychiatric Association (APA) 2000) criteria. Symptoms of Post-

traumatic Stress Disorder (PTSD) also are prevalent in detained samples, with rates that are

three to eight times higher than those seen in community samples (e.g., Cauffman et al.

1998; Dixon et al. 2005; Wolpaw and Ford 2004).

Further, there is evidence from prospective longitudinal research that exposure to

trauma in early childhood is predictive of engagement in the kind of serious antisocial

behavior that leads to involvement in the juvenile justice system (e.g., Cernkovich et al.

2008; Egeland et al. 2002; Feiring et al. 2007; Lansford et al. 2007; Stewart et al. 2008;

Tyler et al. 2008; Widom et al. 2006). As Putnam (2006) suggests, trauma has significant

effects on neuropsychological and psychosocial development that in turn contribute to

difficulties in emotional, cognitive, and interpersonal functioning that increase the risk of

delinquency (Ford et al. 2006).

Given the prevalence of posttraumatic stress among juvenile justice-involved youth, and

the possible role that trauma plays in delinquent behavior, it is important to develop

strategies for identifying traumatized youth and diverting them to appropriate treatment

programs. The most widely used tool for mental health screening in juvenile justice

facilities is the Massachusetts Youth Screening Instrument (MAYSI-2; Grisso and Barnum

2006). Although the performance of specific items and scales of the MAYSI-2 has varied

in some samples (Cauffman and MacIntosh 2008; Ford et al. 2008a), the measure has

shown evidence for reliability, validity, and clinical utility in samples of detained youth

(Cauffman 2004; Goldstein et al. 2003; Grisso and Barnum 2006; Grisso and Quinlan

2005; Wasserman et al. 2005). The MAYSI-2 also includes a Traumatic Experiences (TE)

scale that was designed to assess lifetime exposure to traumatic events. Although the scale

originally was conceptualized as a screen for PTSD, and was comprised of items assessing

both trauma exposure and posttraumatic stress symptoms, factor analyses of the original

item pool showed that these items failed to cohere on a single factor. Therefore, the

developers caution that the TE scale is not intended to identify the presence of PTSD per

se, just as the other MAYSI-2 scales are designed to screen for mental health problems

rather than to correspond to any specific DSM-IV diagnosis (Grisso and Barnum 2006).

Nevertheless, the TE scale has potential utility as a ‘‘red flag’’ to alert assessors to the

possibility that a given youth has experienced the kinds of traumatic events that might be

associated with posttraumatic stress. However, in contrast to all of the other scales on the

MAYSI-2, which were validated through comparison to comparable scales on other well-

established inventories, the validity of the TE scale has not been substantiated through

comparison with any other measures. The TE scale also is the only MAYSI-2 scale with no

cutoff scores established to identify when a youth’s response indicates a need for further

assessment. Therefore, further research is needed to investigate the sensitivity and speci-

ficity of the TE scale of the MAYSI-2 as a measure for screening for the presence of

trauma and its sequelae among detained youth, and to establish potential benchmarks for

determining when a given TE score contributes to the identification of youth in need of

further mental assessment and services.

Another issue that requires attention is the possibility that trauma is a particularly salient

risk factor for the development of delinquency amongst girls (Acoca 1999; Bloom et al.

2002; Chamberlain and Moore 2002; Kerig and Becker in press). In some studies, detained

girls report exposure to more traumatic experiences and PTSD symptoms than do boys

(Belknap and Holsinger 2006; Ford et al. 2008a; Kerig et al. 2009; Martin et al. 2008;

346 Child Youth Care Forum (2011) 40:345–362

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McCabe et al. 2002; Stewart et al. 2008), although girls are not always more likely than

boys to meet criteria for a PTSD diagnosis (e.g., Abram et al. 2004; Dembo et al. 1998;

Ford et al. 2008b). Alternatively, other research suggests that delinquent girls have been

exposed to different kinds of traumas than boys. A number of investigators have found that

girls have been exposed disproportionately to interpersonal traumas, such as abuse at the

hands of parents or romantic partners (e.g., Cauffman 2004; Chamberlain and Moore 2002;

Steiner et al. 1997; Wood et al. 2002). Gender differences are evident particularly for the

interpersonal trauma of sexual abuse, which consistently is found to be more prevalent for

delinquent girls than boys (e.g., Abram et al. 2004; Belknap and Holsinger 2006; Dembo

et al. 2007; Ford et al. 2008b; Johansson and Kempf-Leonard 2009; Kerig et al. 2009;

Tyler et al. 2008; Wareham and Dembo 2007; Wood et al. 2002). Moreover, sexual abuse

does not comprise a single event for many of these youth: for example, McCabe et al.

(2002) found that detained girls had experienced on average four sexual assaults before the

age of 12.

The importance of attending to these different kinds of traumatic experiences is that

they may be associated with different symptom constellations (Ford 2005). The DSM-IV

diagnosis of PTSD tends to focus on discrete or ‘‘Type I’’ (Terr 1991) traumas such as

natural disasters or accidents; however, the DSM-IV criteria may not capture the devel-

opmental effects of early onset, repeated, interpersonal ‘‘Type II’’ (Terr 1991) traumas

such as chronic childhood maltreatment (Cook et al. 2005; Ford 2005). This more insidious

form of trauma may result in a pervasive and persistent constellation of symptoms which

has been termed complex PTSD (Herman 1992; Ford and Courtois 2009) or Develop-

mental Trauma Disorder (van der Kolk et al. 2005). In the current DSM-IV (APA 2000),

symptoms related to Type II traumas are relegated to a section describing associated

features ‘‘more commonly seen in association with an interpersonal stressor; e.g., child-

hood sexual or physical abuse’’ (p. 425). Given the prevalence of more chronic, early-onset

traumatic experiences among detained youth, it is important to determine whether the

measures used to screen for mental health problems in detention settings are sensitive to

detecting Type II traumas and their sequelae (Ford et al. 2006, 2008a).

To summarize, the primary purpose of the present study was to investigate the sensi-

tivity and specificity of the MAYSI-2 TE scale as a screening device for detecting trauma

exposure and posttraumatic reactions among detained boys and girls. In light of research

suggesting that delinquent girls have experienced more of the kinds of interpersonal

traumas associated with complex PTSD, a second purpose of this study was to examine

possible gender differences in the relationships between the MAYSI-2 scales and measures

of PTSD and associated symptoms.

Method

Participants

Participants in this study included 498 youth remanded to the custody of a county juvenile

detention center in the Midwest. Among the 337 boys and 161 girls, 67% were of European

American descent, 23% were African American, 3% were Hispanic, 3% were multiracial,

1% were American Indian/Pacific Islander, and 0.5% were Asian. Youth ranged in age

from 12 years, 0 months to 17 years, 11 months, with an average age of 15.5. Forty

percent of the youth were charged with violent offenses, such as assault or domestic

violence, 37% were charged with non-violent offenses such as arson or theft, 8% were

Child Youth Care Forum (2011) 40:345–362 347

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charged with sexual offenses, 8% were charged with miscellaneous offenses such as

trespassing, and 6% were charged with status offenses such as truancy or curfew violations.

Measures

Massachusetts Youth Screening Instrument—Second Version (MAYSI-2; Grisso and

Barnum 2006). Designed specifically for use in juvenile detention centers, the MAYSI-2 is

a brief self-report inventory used to screen for mental health problems among detained

youth and to serve an ‘‘alerting function’’ for juvenile justice personnel (Grisso and Bar-

num 2006, p. 38). The MAYSI-2 was designed to be administered by detention center staff

with minimal training, ideally within 24–48 h of a youth’s admission to a juvenile

detention facility. Factor analyses of the 52 items on the MAYSI-2 have confirmed 5 scales

for both boys and girls, including Alcohol/Drug Use (e.g., ‘‘Have you gotten in trouble you

when you’ve been high or have been drinking?’’), Anger-Irritability (e.g., ‘‘When you have

been mad, have you stayed mad for a long time?’’), Depression-Anxiety (e.g., ‘‘Have

nervous or worried feelings kept you from doing things you want to do?’’), Somatic

Complaints (e.g., ‘‘When you have felt nervous or anxious, has your stomach been

upset?’’), Suicide Ideation (e.g., ‘‘Have you felt like life was not worth living?’’). A sixth

scale, Thought Disturbance, has been found to form a reliable subscale only for boys and

therefore, was not included in the present study. Each MAYSI-2 scale contains 5–9 items

requiring a ‘‘yes’’ or ‘‘no’’ response and ‘‘yes’’ responses are tallied to create a total score.

Alpha coefficients for the scales in this sample were as follows: Alcohol/Drug Use,

a = .86; Anger-Irritability, a = 79; Depression-Anxiety, a = 73; Somatic Complaints,

a = 73; and Suicide Ideation, a = 86.

A seventh scale, Traumatic Experiences, provides information about lifetime traumatic

events and posttraumatic reactions. The TE scale was developed through four stages. First,

a pool of potential questions regarding experiences and symptoms known to be associated

with PTSD was compiled (Grisso and Barnum 2006). This pool of potential questions was

submitted for review to experts in the assessment of adolescents and mental health pro-

fessionals in the juvenile justice system. Items were then administered to a small sample of

youth in the Massachusetts Department of Youth Services and assessed for readability and

comprehension. Next, the instrument underwent pilot-testing with an additional sample of

detained youth. Finally, data from these studies were used to finalize the questions to be

used on the MAYSI-2 scale. Analyses of item-total correlations, alpha coefficients, and

factor analyses were used to determine which items in each scale should be retained,

deleted, or added to maximize the scale’s internal consistency. The majority of items

reflecting PTSD symptoms did not cluster with the items related to trauma exposure, and

therefore, the final item pool was reduced substantially and the purpose of the scale recast

as screening for traumatic experiences. The resulting scale includes five items in total, four

items that are identical for boys and girls and one item that is unique to each gender. The

items common to both genders include three questions regarding exposure to traumatic

experiences (e.g., ‘‘Have you ever in your whole life had something very bad or terrifying

happen to you?’’) and one question reflecting posttraumatic reactions (e.g., ‘‘Have you had

a lot of bad thoughts or dreams about a bad or scary event that happened to you?’’). A fifth

item reflecting trauma exposure appears only on the scale for girls, (e.g., ‘‘Have you ever

been raped or been in danger of getting raped?’’) and a fifth item reflecting posttraumatic

hypervigilence appears only scale for boys (e.g., ‘‘Have people talked about you a lot when

you’re not there?’’) In the present sample, the internal consistencies were a = .81 for girls

and .60 for boys.


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With the exception of the TE scale, the other six MAYSI-2 scales have been validated

through comparisons to similar scales on the Millon Adolescent Clinical Inventory (MACI;

Millon 1993) and the Youth Self Report (YSR; Achenbach and Edelbrock 1991). However,

because none of the measures used in those validation studies include scales related to

trauma, there has been no validation performed to date on the TE scale. In addition, norms

for the other six scales have allowed the establishment of ‘‘caution’’ and ‘‘warning’’ cutoff

scores to indicate that the youth’s responses suggest a need for further mental health

evaluation. Scores above the caution cutoff indicate a possible basis for concern whereas

scores above the warning cutoff indicate that a youth has scored exceptionally high in

comparison with other detained youth (Grisso and Barnum 2006). However, because of the

lack of a trauma-related criterion measure in the psychometric research performed with

the MAYSI to date, there are no cut-off scores established for the TE scale. Further, for

the other scales, the MAYSI-2 includes ‘‘secondary screening’’ questions which allow

detention center staff to judge whether high scores warrant particular immediate attention;

however, these secondary questions have not been developed for the TE Scale.

UCLA Posttraumatic Stress Disorder Reaction Index for DSM-IV, Adolescent Version(PTSD-RI; Pynoos et al. 1998). The PTSD-RI is a 49-item measure used to screen for

exposure to traumatic events and symptoms of PTSD among adolescents. Items on the

PTSD-RI map onto DSM-IV and provide information regarding the likelihood that the

youth meets criteria for the diagnosis of PTSD. The first 13 questions on the PTSD-RI

assess trauma exposure by asking the youth to answer ‘‘yes’’ or ‘‘no’’ as to whether he or

she has been exposed to a variety of traumatic events (e.g., ‘‘[Have you ever been] hit,

punched or kicked very hard at home?’’). If a youth answers ‘‘yes’’ to any of the questions

about trauma exposure, question 14 asks the youth to identify the one event that currently

is the most distressing to him or her and to provide a brief description of that event.

Questions 15–21 and 22–27 assess for Criterion A in regard to that event, including the

presence of a real or perceived threat to physical integrity, as well as the youth’s subjective

experience of fear, helplessness, horror, agitation, or disorganization. If Criterion A is met,

the next set of questions on the PTSD-RI assess for the frequency of symptoms experi-

enced in the past month in the three DSM-IV clusters associated with Criterion B (reex-

periencing), Criterion C (avoidance), and Criterion D (arousal). Responses to the questions

are presented in a Likert scale format ranging from 0 = none of the time in the past monthto 4 = most of the time in the past month. Given that the PTSD-RI was being used as a

screening instrument in the present study, a liberal cut-off of a score of ‘‘2’’ was used to

indicate the likely presence of each symptom (Steinberg et al. 2004). The PTSD-RI pro-

vides instructions for calculation of a Total PTSD symptoms score; subscores on symptom

levels for Criteria B, C, and D; and total trauma exposure. For purposes of this study, we

also calculated separately total scores for interpersonal and noninterpersonal trauma

exposure. Additionally, the instrument provides information as to whether a Full or Partial

diagnosis of PTSD is likely (Rodriguez et al. 1999). For a likely Full diagnosis, Criteria A,

B, C, and D must all be met. For a likely Partial diagnosis, Criterion A must be met, as well

as two of the other three criteria.

The PTSD-RI has evidenced convergent validity with other diagnostic interview

measures, including the Schedule for Affective Disorders and Schizophrenia for School-Age Children (r = .70) and the Clinician Administered PTSD Scale for Children andAdolescents (r = .82). Good internal consistency also has been found, with alphas around

.90 (Steinberg et al. 2004). Finally, test–retest reliability of .84 has been reported over a

7-day period (Steinberg et al. 2004). In the current sample, Cronbach’s alphas were


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acceptable to high: a = .84 for Criterion B, a = .78 for Criterion C, a = .69 for Criterion

D, and a = .89 for the Total PTSD score.

Associated Symptoms

A subscale of associated symptoms related to complex PTSD was drawn from the Clini-cian Administered PTSD Scale for Children and Adolescents (CAPS-CA; Newman et al.

2004). The CAPS-CA is a downward extension of the CAPS (Blake et al. 1995), a well-

validated diagnostic tool for PTSD in adults which is considered by many to be the ‘‘gold

standard’’ in the field (Briere and Scott 2006). The associated symptoms subscale includes

7 questions that enquire about associated features of PTSD that are described in DSM-IV

as being likely to arise in response to chronic interpersonal traumas, including guilt, shame,

disrupted attachments, and dissociation (e.g., ‘‘How often during the past month did you

feel spacey or like you had gone away in your mind?’’). Each item is rated by the youth on

a scale ranging from 0 = none of the time to 4 = most of the time. In the current sample,

Cronbach’s alpha for the Associated Symptoms scale was acceptable at a = .73.

Procedure

All procedures followed in this study were reviewed and approved by the Internal Review

Boards of Miami University and the Butler County Juvenile Justice Center and used

de-identified archival data collected as a part of the detention center’s standard mental

health screening for all new admissions. Within 24 h of entry into the detention center,

each remanded youth was administered the MAYSI-2 via the MAYSIWARE Voice For-

mat (Maney and Grisso 2006) on a laptop computer. Youth used the computer touch pad to

indicate yes or no to each question. A staff member was present in the room during the

administration of the measure to answer questions and follow up on critical items, but was

not able to view the screen or to see the youth’s responses.

Subsequently to the administration of the MAYSI-2, within 3 days of admission youth

also were administered the PTSD-RI in an individual interview conducted by a trained

clinician who read the instructions and questions aloud to the adolescents and recorded

their responses. The CAPS Associated Symptoms scale items also were administered orally

in the same session and youth’s Likert scale responses were recorded. All interviewers

underwent extensive training in the administration and scoring of the PTSD-RI and the

application of the DSM-IV diagnostic criteria, including the web-based training devised by

the measure’s developers (http://www.nctsnet.org/nccts/asset.do?id=314), as well as

training from a master clinician who met monthly with the interviewers in order to

recalibrate scoring. Although the PTSD-RI was devised to allow for administration as a

self-report questionnaire or as an interview, the interview format was implemented for

several reasons. Most important were concerns for youth well-being, with the interview

format allowing clinicians to gauge the youth’s reaction to discussing distressing events so

as to respond with the provision of support or intervention as needed. A second reason for

administration by a trained interviewer was to reduce the likelihood that the low literacy

rates among detained youth would not allow questions to be misinterpreted by those with

poor reading skills. A third reason was to ensure that diagnostic criteria were confirmed as

met or not met according to the formal DSM-IV (APA 2000) definitions. A subset of 30

PTSD-RI protocols were randomly selected from interviews performed throughout the

course of the study in order to perform reliability checks on scoring of the diagnostic


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http://www.nctsnet.org/nccts/asset.do?id=314

criteria. Reliability of raters with the master coder ranged from 95 to 100% correct at the

cumulative score level.

Results

Descriptive Statistics and Main Effects of Gender

The proportion of youth meeting criteria for ‘‘Caution’’ and ‘‘Warning’’ cut-offs scores is

reported in Table 1. These proportions correspond to those reported by Grisso and Barnum

(2006) for the original validation sample on the Angry-Irritable scale (e.g., 59% of girls

and 40% of boys in the current sample were at or above the Caution cut-off on, compared

to 54% of girls and 38% of boys in the validation sample). However, the present sample

included a higher percentage of girls who reached the Warning cut-off level on the

Alcohol/Drug Use scale than in the validation sample, as well as higher percentages of

youth who reached cut-offs on the Depressed-Anxious and Somatic Complaints scales. As

Grisso and Barnum (2006) note, differences among samples from diverse geographic

regions were found in their validation studies and are to be expected given the diversity

that exists among subgroups of youth, juvenile justice facilities, intake procedures and

holding criteria, and regional and gender arrest patterns.

Table 1 Gender differences on MAYSI and PTSD scales

Variable Girls Boys v2 (2) Odds ratioa

(95% confidenceinterval)Caution

(%)Warning(%)

Caution(%)

Warning(%)

Percentage of youth scoring at cut-offs on MAYSI scales

MAYSI alcohol/drug use 12.5 22.8.3 14.2 14.5 4.98 1.15 (.76–1.74)

MAYSI Angry-Irritable 38.2 20.6 28.0 12.3 13.76** 1.57 (1.08–2.30)

MAYSI Depressed-Anxious 36.8 23.5 28.9 10.7 20.18*** 1.76 (1.20–2.57)

MAYSI somatic complaints 53.7 25.7 46.9 13.8 18.56*** 1.54 (1.04–2.28)

MAYSI suicidal ideation 5.9 27.9 4.7 13.2 15.11** 1.97 (1.26–3.07)

MAYSI thought disturbance – – 28.3 11.6 – –

Variable M SD M SD F g2

Mean differences on continuous scales

MAYSI traumatic experiences 2.24 1.52 1.99 1.56 -3.78 .010

PTSD-RI total trauma 3.74 2.55 3.03 2.27 -7.65** .020

PTSD-RI interpersonal trauma 2.77 2.02 2.18 1.83 -11.16** .029

PTSD-RI Non-Interpersonal .81 .87 .64 .83 -1.46 .004

PTSD-RI total PTSD symptoms 30.31 17.12 21.81 15.09 -27.54*** .069

PTSD-RI reexperiencing 7.71 5.56 4.91 4.78 -22.04*** .056

PTSD-RI avoidance 11.92 7.70 8.72 6.81 -19.68*** .050

PTSD-RI arousal 10.53 5.78 8.28 5.30 -17.54*** .045

CAPS-CA associated symptoms 12.40 7.71 9.25 6.30 -17.87*** .046

a The odds ratios reflect the proportion of girls above any clinical cut off when compared to boys

** p \ .01; *** p \ .001


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In order to determine whether there were gender differences in the probability that youth

scored at or above the cutoffs for ‘‘caution’’ or ‘‘warning’’ on the five MAYSI-2 scales for

which such cutoffs have been established, v2 analyses were conducted. As the results reported

in Table 1 show, with the exception of the Alcohol/Drug Use scale, girls were more likely

than boys to meet criteria for a cutoff score for each of the MAYSI-2 scales. A MANOVA was

conducted to test for main effects of gender on the measures of traumatic exposure and PTSD.

The results revealed a significant pattern of gender differences across the variables, Wilks’

Lamba (14, 360) = 3.50, p \ .001. Follow-up univariate ANOVAs were performed and the

results of these analyses are reported in Table 1. The results show girls reported significantly

higher scores than boys on the PTSD-RI scales of total trauma exposure, interpersonal

trauma, Total PTSD, reexperiencing, avoidance, and arousal; and the CAPS-CA associated

symptoms scale. However, there were no gender differences on the PTSD-RI scale of non-

interpersonal trauma, nor on the MAYSI scale of Traumatic Experiences.

Gender differences also were found for the prevalence of youth who likely met criteria

for a Full or Partial diagnosis of PTSD. Among the girls in this sample, 85.1% met Criterion

A for exposure to a traumatic event in comparison to 72.1% of the boys, a significant gender

difference v2 (2) = 10.59, p \ .01, Likelihood Ratio = 11.34, p \ .01. Among the youth

who met Criterion A, indicating that they had experienced a traumatic event as defined by

DSM-IV, 44.9% of boys and 60.6% of girls met criteria for a likely diagnosis of Full PTSD,

a significant gender difference, v2 (2) = 10.98, p \ .01, Likelihood Ratio = 12.44,

p \ .01. A further 27.6% of those boys and 24.8% of those girls likely met criteria for

Partial PTSD. Among the youth who likely met criteria for a Partial diagnosis, by definition

100% met Criterion A while 78.4% also met Criterion B (reexperiencing), 37.3% also met

Criterion C (avoidance), and 90.2% also met Criterion D (arousal).

Intercorrelations

Intercorrelations among the variables are reported in Table 2, reported separately by

gender. Neither age nor months since the trauma were correlated with any other variables

and therefore, these scores are not included. With the exception of the Alcohol/Drug Use

scale for girls, each of the MAYSI-2 scales was positively correlated with each of the

PTSD scales. The correspondence between the TE scale and the PTSD indices was

moderate, ranging from .44 to .63 for boys and from .39 to .56 for girls.

Multiple Regressions

Separate all-possible-subsets multiple regression analyses for boys and girls were per-

formed to evaluate the relative contributions of the MAYSI-2 scales to the statistical

prediction of PTSD scores. The first set of regression analyses was conducted to evaluate

the contribution of the MAYSI-2 scales to the statistical prediction of Total PTSD (see

Table 3). For girls, the MAYSI-2 scales together accounted for 60% of the variance in

Total PTSD with scores on the Angry-Irritable, Depressed-Anxious, Somatic Complaints,

and TE scales contributing significantly to the equation, F (6, 120) = 30.01, p \ .001. For

boys, the MAYSI-2 scales together accounted for 42% of the variance in Total PTSD, with

scores on the Angry-Irritable, Depressed-Anxious, and TE scales contributing, F (7,

281) = 29.00, p \ .001.

The second set of regression analyses was conducted to evaluate the relative contri-

bution of the MAYSI-2 scales to the prediction of the Associated Symptoms scale, again

separately for boys and girls. For girls, the MAYSI-2 scales together accounted for 19% of


123


Tab

le2

Inte

rco

rrel

atio

ns

Var

iab

le1

23

45

67

89

10

11

12

13

14

15

1.

Alc

oho

ld

rug

use

–.3

5**

.1

8.

23

*.2

6*

n/a

.44

**

.1

9.2

0.2

4*

.24

*.3

4*

*.3

4**

.23

*.1

8

2.

An

gry

-Irr

itab

le.4

0**

–.6

3**

.5

7*

*.5

5**

n/a

.50

**

.53

**

.56

**

.63

**

.64

**

.49

**

.48

**

.33

**

.42

**

3.

Dep

ress

ed-A

nxio

us

.34

**.6

1**

–.

63

**

.60

**

n/a

.51

**

.68

**

.72

**

.56

**

.74

**

.50

**

.48

**

.35

**

.56

**

4.

So

mat

icco

mp

lain

ts.2

2**

.38

**.5

2**

–.3

7**

n/a

.34

**

.53

**

.46

**

.45

**

.54

**

.40

**

.42

**

.22

**

.36

**

5.

Su

icid

eid

eati

on

.32

**.4

6**

.62

**.3

2*

*–

n/a

.45

**

.46

**

.59

**

.46

**

.57

**

.44

**

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123


the variance in Associated Symptoms with scores only on the Depressed-Anxious scale

contributing to the equation, F (6, 111) = 5.66, p \ .001. For boys, the MAYSI-2 scales

together accounted for 27% of the variance in Associated Symptoms with scores on the

Depressed-Anxious and TE scales contributing to the equation, F (7, 257) = 13.45,

p \ .001.

Receiver Operating Characteristics (ROC) Curves

The ROC curves technique was used to determine how well the MAYSI-2 TE scale

detected the 168 boys and 96 girls who met criteria for either a likely Full or Partial

diagnosis of PTSD as determined by their scores on the PTSD-RI, and to identify the most

effective cutoff score on the TE scale to screen for the probable presence of PTSD among

detained youth. The sensitivity (the ability of the test to accurately detect individuals with

the disorder in question) and 1-specificity (the percentage of false positives) were calcu-

lated for each cut-off score on the MAYSI-2. An optimal cut-off score maximizes the

ability of the test to detect individuals who meet criteria while minimizing the number of

false positives. Table 4 displays the possible cut-off scores for girls and boys, which

yielded similar results. A cut-off score of 1 on the TE scale would accurately identify 89%

of girls and 91% of boys who met criteria for likely Full or Partial PTSD; however, 60% of

girls and 67% of boys who did not meet criteria would be erroneously screened as positive.

A cut-off score of 2 would correctly screen 76% of boys and 72% of girls as likely meeting

criteria for PTSD, but would result in a false positive rate of 37%. In turn, a cut-off score of

3 on the TE scale would accurately screen 55% of girls and 54% of boys who likely met

criteria for PTSD, and would incorrectly screen 15% of youth as being positive for PTSD

when they likely did not meet criteria.

Finally, the sensitivity and 1-specificity for each cut-off score were plotted on graphs in

order to allow for the area under an ROC curve to be calculated (see Fig. 1). The area

under the curve (AUC) statistic measures the probability that the TE scale will yield a

higher score for a randomly chosen youth who likely met criteria for PTSD than for a

randomly chosen youth who likely did not meet criteria for the disorder (Lasko et al. 2005).

The further the ROC curve deviates from the straight line and the closer it appears to the

upper left hand corner, the better the sensitivity and specificity of the test. In the current

sample, the AUC statistic for girls was .754, SE = .045, p \ .001 and for boys was .758,

Table 3 Summary of multiple regression analyses predicting PTSD scores from the MAYSI-2 scales

Predictor entered Girls Boys

B SE B b B SE B b

Dependent variable: Total PTSD-RI score

Angry-Irritable 1.40 .50 .22** 1.06 .33 .20**

Depressed-Anxious 2.00 .60 .30** 2.15 .48 .33***

Somatic complaints 1.28 .61 .15* 0.48 .41 .06

Traumatic experiences 2.25 .97 .20* 1.91 .66 .20**

Dependent variable: associated symptoms

Depressed-Anxious .65 .36 .22** 0.60 .25 .21*

Traumatic experiences .72 .43 .16 1.03 .29 .24**

* p \ .05; ** p \ .01; *** p \ .001


123


Table 4 Sensitivity and (1-Specificity) of MAYSI scale scores for predicting full or partial PTSD diagnosis

Score MAYSI traumatic experiences MAYSI Anger-Irritability MAYSI Depression-Anxiety

Sensitivity 1-Specificity Sensitivity 1-Specificity Sensitivity 1-Specificity

Girls

0 1.00 1.00 1.00 1.00 1.00 1.00

1 .89 .60 .98 .80 .99 .73

2 .73 .38 .94 .70 .83 .55

3 .55 .15 .91 .60 .73 .30

4 .36 .08 .82 .43 .57 .20

5 .13 .03 .70 .33 .42 .15

6 – – .58 .33 .29 .08

7 – – .46 .18 .18 .00

8 – – .26 .08 .08 .00

9 – – .05 .00 .03 .00

Boys

0 1.00 1.00 1.00 1.00 1.00 1.00

1 .91 .67 .95 .75 .95 .53

2 .76 .37 .89 .55 .72 .33

3 .54 .15 .78 .40 .59 .18

4 .33 .06 .70 .30 .41 .09

5 .09 .01 .58 .20 .29 .05

– – .48 .14 .17 .04

– – .30 .09 .10 .03

– – .19 .05 .07 .01

– – .03 .02 .01 .01

Fig. 1 The ROC curves for identifying full or partial PTSD for each score on the MAYSI-2 traumaticexperiences scale


123


SE = .027, p \ .001 and for boys. According to Streiner and Cairney (2007), an AUC

statistic between .70 and .90 is considered moderately accurate.

Because the regression analyses indicated that the MAYSI-2 Angry-Irritable and

Depressed-Anxious Scales were stronger predictors of the Total PTSD-RI score than was

the MAYSI-2 TE score, ROC analyses also were performed to assess the sensitivity and

specificity of these scales for detecting likely Full or Partial PTSD (see Table 4). For the

Angry-Irritable scale, the AUC for girls was .739, SE = .048, p \ .001 and for boys was

.756, SE = .027, p \ .001 and for boys. For the Depression-Anxiety scale, the AUC for

girls was .762, SE = .045, p \ .001 and for boys was .785, SE = .026, p \ .001 and for

boys. These results suggest that likely Full or Partial PTSD can be detected about equally

well by any of these three MAYSI-2 scales and that the TE scale is not a significantly more

sensitive or specific measure than the others.

Discussion

One purpose of this study was to examine gender differences related to trauma and its

sequelae, particularly related to complex PTSD. The results reported here are consistent

with previous research that has found detained girls to evidence more mental health

problems than their male counterparts (e.g., Antonishak et al. 2004; Kerig et al. 2009;

Timmons-Mitchell et al. 1997). Girls in this sample provided higher ratings than boys on

all of the MAYSI-2 scales with the exception of Alcohol/Drug Use and Traumatic

Experiences. Girls also reported exposure to a larger number of traumas overall, as well as

the interpersonal traumas which are associated particularly with complex PTSD. In

addition, consistent with some prior studies (Cauffman et al. 1998; Kerig et al. 2009;

Martin et al. 2008; Wood et al. 2002), girls in this sample also gave significantly higher

ratings than boys on all the symptom clusters associated with PTSD, including symptoms

of reexperiencing, avoidance, arousal, as well as associated symptoms. This gender dif-

ference is one seen across ages and samples, in which females consistently endorse higher

levels of posttraumatic symptoms than males even when controlling for type of traumatic

stressor experienced (Tolin and Foa 2006).

The other main purpose of the study was to examine the effectiveness of the MAYSI-TE

scale for detecting trauma and its sequelae among detained youth. Results of the regression

analyses indicated that the TE scale made a modest contribution to the prediction of Total

PTSD scores, in combination with other mental health problems that likely accompany

posttraumatic stress—specifically, anger and depression for boys, and anger, depression,

and somatic complaints for girls. The finding that somatic complaints were differentially

prevalent among traumatized girls is consistent with other research on adolescents exposed

to or victimized by violence (e.g., Darves-Bornoz et al. 1998; Hilker et al. 2005;

Pat-Horenczyk et al. 2007), including youth in detention settings (Ford et al. 2008a). These

results suggest that symptoms of physical distress may provide a particularly helpful ‘‘red

flag’’ for screening for trauma amongst girls, and that trauma-awareness training for

medical staff in detention settings would be of great value. As Bailey et al. (2005) suggest,

‘‘Children presenting with physical symptoms for which no organic cause is clearly evident

may very well be manifesting problems associated with exposure to violence or some other

trauma causing stress’’ (p. 347).

A more surprising finding is that, for girls, the TE scale was not a contributor to the

prediction of associated symptoms. One possible explanation is that the questions included

in the TE scale more effectively probe for single-incident traumatic events, such as being


123


in a car accident, escaping a fire, or witnessing a deadly fight, rather than the chronic,

pervasive, interpersonal stressors that are associated with complex PTSD (Herman 1992).

Specifically, one form of interpersonal trauma that is consistently found to be more pre-

valent among detained girls is the experience of repeated sexual abuse (e.g., Acoca 1999;

McCabe et al. 2002). Although the MAYSI-2 inquires about such experiences by using the

term ‘‘rape,’’ research has shown that over half of the women who have been forced to have

sex do not label their experience with that word (Littleton et al. 2007). This may have been

true in our sample as well, with many girls denying having been raped on the TE scale and

yet going on to describe on the PTSD-RI unwanted sexual experiences that did not fit their

definition of the term, such as those involving molestation by family members, coercion by

dating partners, gang initiations, or intoxication. For example, one girl interrupted the

MAYSI-2 administration to ask, ‘‘Does it count as rape if you were too drunk to say no?’’

Therefore, screening for traumatic experiences would benefit from the use of language that

avoids stigmatizing or narrowing youths’ response set, such as by replacing the term

‘‘rape’’ with the PTSD-RI’s inquiry regarding someone ‘‘touching your private sexual body

parts when you did not want them to.’’

The ROC analyses also indicated that the TE scale is a moderately accurate predictor of

PTSD symptoms for both boys and girls. If the TE is used as a screening measure designed

to cast a wide net, the results of the present study indicate that a cut-off score of 2 would

accurately identify 80% of youth and would result in false positives about half of the time,

whereas a more stringent cut-off score of 3 would result in false positives in only a quarter

of instances but would accurately identify only 62% of youth. The benefits of ‘‘red-

flagging’’ any youth in need of further evaluation are clear, including the provision of a

more in-depth psychological assessment that could assist the judicial system in developing

an appropriate rehabilitation plan (Ford et al. 2006). Further, the costs associated with

failing to identify youth who suffer from PTSD reactions are high, given that detained

youth whose mental health problems are left untreated are at significant risk for escalating

psychiatric problems, substance abuse, school dropout, and future recidivism (Abram et al.

2004; Ford et al. 2008a; Leve and Chamberlain 2005). However, it is the case that many

jurisdictions have limited resources that would prohibit them from paying the considerable

costs associated with following up with every youth who might benefit from a more

extended professional psychological evaluation. Therefore, a cost-benefit analysis will be

needed to help determine the most appropriate cut-off score for a given detention facility.

As Grisso and Barnum (2006) point out, such decisions require weighing considerations of

responsibility (the obligation to respond to the mental health needs of youth in custody),

responses (the type of intervention best suited to the identified mental health need), and

resources (the financial and administrative support necessary to provide the response).

The potential of the MAYSI-2 TE scale as a screening tool for traumatic exposure is

high, given its ease and cost-effectiveness of administration. However, further consider-

ation will be needed to established benchmarks to enhance its utility. One of the impli-

cations of the present study is that it is important for mental health assessors to view

youths’ responses on the TE scale within a broader context. The results of this study

suggest that many youth evidence posttraumatic symptomatology even when very few TE

items are endorsed and, further, that youth who likely meet criteria for a diagnosis of PTSD

also evidence symptoms in a variety of clusters on the MAYSI-2. Consistent with the

findings of other researchers (e.g., Ford et al. 2008b), youth with extensive trauma histories

may indicate mental health distress through elevated responses on other MAYSI-2 scales,

either independently or in conjunction with the TE scale. Given this, mental health pro-

fessionals working within juvenile justice settings should be sensitive to the possibility that


123


PTSD is revealed in a diverse array of presentations among youth in detention settings.

Screening for trauma among youth in detention, therefore, will require a multi-faceted

approach that attends not only to youth reports of stressful life events, and to DSM-IV

symptoms of PTSD, but also to their endorsement of other symptoms, including depres-

sion, irritability, or somatic complaints, which may emerge when affect modulation and

cognitive processing have been disrupted by adverse experiences in childhood (Ford 2005;

Ford et al. 2008b). In addition, it is noteworthy that other MAYSI-2 scales were at least as

accurate at detecting likely PTSD as was the TE scale. Further refinement of the MAYSI-2

might capitalize on this fact by making those other scales more trauma-informed, such as

by adding to the secondary screening items an inquiry as to whether youth began expe-

riencing those symptoms, or an increase in those symptoms, following a particular life

event. Asking this question in an open-ended format (e.g., ‘‘did anything particularly

stressful or unusual happen around the time you started feeling this way?’’) also may help

to prevent foreclosing youths’ responses in the ways that more stigmatizing language (e.g.,

‘‘were you raped?’’) might.

The findings of the present study also suggest that interventions for delinquent youth

will need to be multi-faceted as well as gender-sensitive. Complex PTSD may be partic-

ularly salient for delinquent girls, who report comparatively higher rates of exposure to the

kinds of interpersonal traumas that are related to the development of DTD (Kerig and

Becker in press). Only recently have delinquent girls been the focus of specific attention

and has consideration been given to the possibility that they may have unique treatment

needs, particularly related to their histories of chronic trauma and disrupted relationships

with caregivers (Bloom et al. 2002; Leve et al. in press).

A number of limitations to this study should be noted. First, this investigation utilized

only self-report measures, which are subject to the unreliability of youths’ recall of their

reactions following traumatic events. Future research would benefit from the use of

multiple measures from multiple perspectives, including caregivers; however, it is worth

noting that parent and teacher ratings may not be as reliable as children’s own reports of

their traumatic experiences (Hill and Jones 1997). In addition, youth completed the

MAYSI-2 and the trauma measures at different time points during their detention stay.

Responses on the MAYSI-2 may have been elevated due to distress youth experienced at

the time of first entering the facility. Another limitation to the generalizability of this study

is that it included only youth remanded to the custody of the detention center. Youth who

are first-time offenders or who are arrested for minor crimes generally are released after

only a few hours and thus do not undergo the mental health screening procedure; conse-

quently, this study includes a subsample of youth comprised of relatively serious offenders,

with relatively high rates of mental health problems. Another limitation concerns the

accuracy of the ROC analysis, which assumes the availability of an instrument comprising

a ‘‘gold standard’’ for diagnosis (Streiner and Cairney 2007). Although there is no defin-

itive gold standard established for the assessment of PTSD among children and adoles-

cents, this study used the most widely used and well validated measures available to date as

an initial step toward achieving this goal. Finally, because these data were gathered in the

context of an intake assessment in the detention setting, time constraints demanded that all

measures be time-efficient to administer and score. The brief index of associated symptoms

used here, although derived from an established measure, cannot claim to fully capture the

construct of complex PTSD (Ford and Courtois 2009). The construct of complex trauma

comprises a constellation of symptoms including sensorimotor difficulties, affect dysreg-

ulation, dissociation, behavioral undercontrol, cognitive distortions, and poor self-concept

(Cook et al. 2005; van der Kolk et al. 2005). As Briere and Spinazzola (2009) note,


123


currently there are no validated measures for youth that encompass the multitude of

dysfunctions implicated in complex PTSD, nor are there measures that clearly distinguish

PTSD-related symptoms from those of other childhood disorders. Although promising

measures for DTD are under development (e.g., Pelcovitz et al. 2004), the length and

extensive training needed to implement such measures may impose an impediment to their

routine use in detention settings. The development of screening tools that are sensitive to

complex trauma and its sequelae likely will be a challenging task but is well-worth pur-

suing. In particular, future research investigating methods for detecting complex PTSD

among detained samples might benefit from an evaluation of the incremental utility of the

PTSD-RI criterion scores for contributing to the prediction of complex PTSD symptoms by

using methods such as the associated symptoms index administered here.

In conclusion, the high rates of traumatic exposure and PTSD symptoms seen among

delinquent youth underscore the need to screen for trauma in detention settings (Ford et al.

2008a, b; Newman 2002). Increasing awareness of the possible role that trauma might play

in delinquent behavior, and the diverse ways in which it is revealed in youths’ mental

health symptoms, will be valuable for improving rehabilitation and treatment planning in

the juvenile justice system. By the same token, recognition of the more subtle and per-

vasive symptom picture related to complex PTSD, and the development of strategies for

assessing Type II traumas, will be of particular importance. In our current diagnostic

system, youth whose behavior problems are related to extensive trauma histories are more

likely to be diagnosed with other disorders, such as anxiety and oppositional defiance,

rather than with PTSD (van der Kolk et al. 2005). By correctly targeting treatment to the

underlying trauma, and particularly to the developmental functions that have been dis-

rupted by pervasive and chronic adverse childhood experiences, efforts to deter youth from

a delinquent trajectory can be made more effective.

References

Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004).Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychi-atry, 61, 403–410.

Achenbach, T. M., & Edelbrock, C. (1991). Manual for the Youth Self-Report and Profile. Burlington,VT: University of Vermont, Department of Psychiatry.

Acoca, L. (1999). Investing in girls: A 21st century strategy. Juvenile Justice, 6, 2–21.American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed.,

text revision). Washington, DC: Author.Antonishak, J., Reppucci, N. D., & Mulford, C. F. (2004). Girls in the justice system: Treatment and

intervention. In M. M. Moretti, C. L. Odgers, & M. A. Jackson (Eds.), Girls and aggression: Con-tributing factors and intervention principles (pp. 165–180). New York: Kluwer.

Bailey, B. N., Delaney-Black, V., Hannigan, J. H., Ager, J., Sokol, R. J., & Covington, C. Y. (2005).Somatic complaints in children and community violence exposure. Developmental and BehavioralPediatrics, 26, 341–348.

Belknap, J., & Holsinger, K. (2006). The gendered nature of risk factors for delinquency. Feminist Crim-inology, 1, 48–71.

Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995).The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.

Bloom, B., Owen, B., Deschenes, E. P., & Rosenbaum, J. (2002). Moving toward justice for female juvenileoffenders. Journal of Contemporary Criminal Justice, 18, 37–56.

Briere, J., & Scott, C. (2006). Principles of trauma therapy. Thousand Oaks, CA: Sage.Briere, J., & Spinazzola, J. (2009). Standardized assessment of complex posttraumatic disturbance in

childhood, adolescence, and adulthood. In C. Courtois & J. Ford (Eds.), Complex traumatic stressdisorders: An evidence-based clinician’s guide. New York: Guilford.


123


Cauffman, E. (2004). A state-wide screening of mental health symptoms among juvenile offenders indetention. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 430–439.

Cauffman, E., Feldman, S., Waterman, J., & Steiner, H. (1998). Posttraumatic stress disorder among femalejuvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 11–23.

Cauffman, E., & MacIntosh, R. (2008). The measurement validity of the Massachusetts youth screeninginstrument (MAYSI-2): An assessment of race and gender item bias among juvenile offenders. Edu-cational and Psychological Measurement, 66, 502–521.

Cernkovich, S. A., Lanctot, N., & Giordano, P. C. (2008). Predicting adolescent and adult antisocialbehavior among adjudicated delinquent females. Crime and Delinquency, 54, 3–33.

Chamberlain, P., & Moore, K. J. (2002). Chaos and trauma in the lives of adolescent females with antisocialbehavior and delinquency. Journal of Aggression, Maltreatment, Trauma, 6, 79–108.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma inchildren and adolescents. Psychiatric Annals, 35, 390–398.

Darves-Bornoz, J.-M., Choquet, M., Ledoux, S., Gasquet, I., & Manfredi, R. (1998). Gender differences insymptoms of adolescents reporting sexual assault. Social Psychiatry and Psychiatric Epidemiology, 33,111–117.

Dembo, R., Pacheco, K., Schmeidler, J., Ramirez, G., Guida, J., & Rahman, A. (1998). A further study ofgender differences in service needs among youths entering a juvenile assessment center. Journal ofChild & Adolescent Substance Abuse, 7, 49–77.

Dembo, R., Schmeidler, J., & Childs, K. (2007). Correlates of male and female juvenile offender abuseexperiences. Journal of Child Sexual Abuse, 16, 75–94.

Dixon, A., Howie, P., & Starling, J. (2005). Trauma exposure, posttraumatic stress, and psychiatriccomorbidity in female juvenile offenders. Journal of the American Academy of Child and AdolescentPsychiatry, 44, 798–806.

Egeland, B., Yates, T., Appleyard, K., & van Dulmen, M. (2002). The long term consequences of mal-treatment in the early years: A developmental pathway model to antisocial behavior. Social Policy,Research, and Practice, 5, 249–260.

Feiring, C., Miller-Johnson, S., & Cleland, C. M. (2007). Potential pathways from stigmatization andinternalizing symptoms to delinquency in sexually abused youth. Child Maltreatment, 12, 220–232.

Ford, J. D. (2002). Traumatic victimization in childhood and persistent problems with oppositional-defiance.In R. Greenwald (Ed.), Trauma and juvenile delinquency (pp. 25–58). Binghamton, NY: Haworth.

Ford, J. D. (2005). Treatment implications of altered affect regulation and information processing followingchild maltreatment. Psychiatric Annals, 35, 410–419.

Ford, J. D., Chapman, J., Mack, M., & Pearson, G. (2006). Pathways from traumatic child victimization todelinquency: Implications for juvenile and permanency court proceedings and decisions. Juvenile andFamily Court Journal, 13–26.

Ford, J. D., Chapman, J. F., Pearson, G., Borum, R., & Wolpaw, J. M. (2008a). Psychometric status andclinical utility of the MAYSI-2 with girls and boys in juvenile detention. Journal of Psychopathologyand Behavioral Assessment, 30, 87–99.

Ford, J. D., & Courtois, C. A. (2009). Defining and understanding complex trauma and complex traumaticstress disorders. In C. A. Courtois & J. D. Ford (Eds.), Treating complex traumatic stress disorders: Anevidence-based guide. New York: Routledge.

Ford, J. D., Hartman, J. K., Hawke, J., & Chapman, J. F. (2008b). Traumatic victimization, posttraumaticstress disorder, suicidal ideation, and substance abuse risk among juvenile justice-involved youth.Journal of Child & Adolescent Trauma, 1, 75–92.

Goldstein, N., Arnold, D., Weil, J., Mesiarik, C., Peuschold, D., Grisso, T., et al. (2003). Comorbid symptompatterns in female juvenile offenders. International Journal of Law and Psychiatry, 26, 565–582.

Greenwald, R. (2002). The role of trauma in conduct disorder. In R. Greenwald (Ed.), Trauma and juveniledelinquency (pp. 5–23). Binghamton, NY: Haworth.

Grisso, T., & Barnum, R. (2006). Massachusetts youth screening instrument version 2: User’s manual andtechnical report. Sarasota, FL: Professional Resource Press.

Grisso, T., & Quinlan, J. C. (2005). Massachusetts youth screening instrument–version 2. In T. Grisso,G. Vincent, & D. Seagrave (Eds.), Mental health screening and assessment in juvenile justice(pp. 99–111). New York: Guilford.

Herman, J. L. (1992). Sequelae of prolonged and repeated trauma: Evidence for a complex posttraumaticsyndrome. In J. R. T. Davidson & E. B. Foa (Eds.), Posttraumatic stress disorder: DSM-IV and beyond(pp. 213–228). Washington, DC: American Psychiatric Publishing.

Hilker, K. A., Murphy, M. A., & Kelley, M. L. (2005). Violence exposure, somatic complaints, and healthcare utilization in a pediatric sample. Children’s Health Care, 34, 35–46.


123


Hill, H., & Jones, L. P. (1997). Children’s and parents’ perceptions of children’s exposure to violence inurban neighborhoods. Journal of the National Medical Association, 89, 270–276.

Johansson, P., & Kempf-Leonard, K. (2009). A gender-specific pathway to serious, violent, and chronicoffending? Crime and Delinquency, 55, 216–240.

Kerig, P. K., & Becker, S. P. (2010). From internalizing to externalizing: Theoretical models of theprocesses linking PTSD to juvenile delinquency. In S. J. Egan (Ed.), Post-traumatic stress disorder(PTSD): Causes, symptoms and treatment. Hauppauge, NY: Nova Science Publishers.

Kerig, P. K., & Becker, S. P. (in press). Trauma and girls’ delinquency. In S. Miller, L. Leve, & P. K. Kerig(Eds.), Girls’ delinquency. New York: Springer Books.

Kerig, P. K., Ward, R. M., Vanderzee, K. L., & Arnzen Moeddel, M. (2009). Posttraumatic stress as amediator of the relationship between trauma and mental health problems among juvenile delinquents.Journal of Youth and Adolescence, 38, 1214–1225.

Lansford, J. E., Miller-Johnson, S., Berlin, L. J., Dodge, K. A., Bates, J. E., & Pettit, G. S. (2007). Earlyphysical abuse and later violent delinquency: A prospective longitudinal study. Child Maltreatment,12, 233–245.

Lasko, T. A., Bhagwat, J. G., Zou, K. H., & Ohno-Machado, L. (2005). The use of receiver operatingcharacteristics curves in biomedical informatics. Journal of Biomedical Information, 38, 404–415.

Lawyer, S. R., Ruggiero, K. J., Resnick, H. S., Kilpatrick, D. G., & Saunders, B. E. (2006). Mental healthcorrelates of the victim-perpetrator relationship among interpersonally victimized adolescents. Journalof Interpersonal Violence, 21, 1333–1353.

Leve, L. D., & Chamberlain, P. (2005). Girls in the juvenile justice system: Risk factors and clinicalimplications. In D. J. Pepler, K. C. Madsen, C. D. Webster, & K. S. Levene (Eds.), The developmentand treatment of girlhood aggression (pp. 191–216). Mahwah, NJ: Erlbaum.

Leve, L. D., Chamberlain, P., Smith, D. K., & Harold, G. T. (in press). Multidimensional treatment fostercare as an intervention for juvenile justice girls in out of home care. In S. Miller, L. Leve, &P. K. Kerig (Eds.), Girls’ delinquency. New York: Springer Books.

Littleton, H. L., Axsom, D., Breitkopf, C. R., & Berenson, A. (2007). Rape acknowledgement and post-assault experiences: How acknowledgement status relates to disclosure, coping, worldview, andreactions received from others. Violence and Victims, 21, 761–778.

Maney, S. M., & Grisso, T. (2006). MAYSIWARE user’s guide. Sarasota, FL: Professional Resource Press.Martin, D., Martin, M., Dell, R., Davis, C., & Guerrieri, K. (2008). Profile of incarcerated juveniles:

Comparison of male and female offenders. Adolescence, 43, 607–622.McCabe, K. M., Lansing, A. E., Garland, A., & Hough, R. (2002). Gender differences in psychopathology,

functional impairment, and familial risk factors among adjudicated delinquents. Journal of theAmerican Academy of Child and Adolescent Psychiatry, 47, 860–868.

Millon, T. (1993). Millon adolescent clinical inventory: Manual. Minneapolis, MN: NCS.Newman, E. (2002). Assessment of PTSD and trauma exposure in adolescents. In R. Greenwald (Ed.),

Trauma and juvenile delinquency (pp. 59–78). Binghamton, NY: Hawthorn Press.Newman, E., Weathers, F. W., Nader, K. O., Kaloupek, D. G., Pynoos, R. S., Blake, D. D., et al. (2004).

Clinician administered PTSD scale for children and adolescents for DSM-IV (CAPS-CA). LosAngeles: Western Psychological Services.

Pat-Horenczyk, R., Abramovitz, R., Peled, O., Brom, D., Daie, A., & Chemtob, C. M. (2007). Adolescentexposure to recurrent terrorism in Israel: Posttraumatic distress and functional impairment. AmericanJournal of Orthopsychiatry, 77, 76–85.

Pelcovitz, D., van der Kolk, B. A., Herman, S., Roth, S., Kaplan, S., et al. (2004). Structured Interview forDisorders of Extreme Stress-NOS Adolescent Version (SIDES-A). Unpublished measure, New YorkUniversity School of Medicine.

Putnam, F. W. (2006). Dissociative disorders. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psy-chopathology. Volume III: Risk, disorder and adaptation (2nd ed., pp. 657–695). New York: Wiley.

Pynoos, R., Rodriguez, N., Steinberg, A., & Stuber, M. (1998). UCLA PTSD index for DSM-IV (Revision 1).Los Angeles, CA: University of California at Los Angeles.

Rodriguez, N., Steinberg, A., & Pynoos, R. S. (1999). UCLA PTSD Index for DSM-IV (Revision 1)Instrument information: Child version, parent version, adolescent version. Los Angeles: University ofCalifornia Los Angeles Trauma Psychiatry Service.

Steinberg, A. M., Brymer, M. J., Decker, K. B., & Pynoos, R. S. (2004). The university of California at LosAngeles posttraumatic stress disorder reaction index. Current Psychiatry Reports, 6, 96–100.

Steiner, H., Garcia, I., & Matthews, Z. (1997). Posttraumatic stress disorder in incarcerated juveniledelinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 357–365.

Stewart, A., Livingston, M., & Dennison, S. (2008). Transitions and turning points: Examining the linksbetween child maltreatment and juvenile offending. Child Abuse and Neglect, 32, 51–66.


123


Streiner, D. L., & Cairney, J. (2007). What’s under the ROC? An introduction to receiver operatingcharacteristic curves. The Canadian Journal of Psychiatry, 52, 121–128.

Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148,10–20.

Timmons-Mitchell, J., Brown, C. S., Schulz, S. C., Webster, S. E., Underwood, L. A., & Semple, W. E.(1997). Comparing the mental health needs of female and male incarcerated juvenile delinquents.Behavioral Sciences and the Law, 15, 195–202.

Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitativereview of 25 years of research. Psychological Bulletin, 132, 959–992.

Tyler, K. A., Johnson, K. A., & Brownridge, D. A. (2008). A longitudinal study of the effects of childmaltreatment on later outcomes among high-risk adolescents. Journal of Youth and Adolescence, 37,506–521.

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extremestress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18,389–399.

Wareham, J., & Dembo, R. (2007). A longitudinal study of psychological functioning among juvenileoffenders: A latent growth model analysis. Criminal Justice and Behavior, 34, 259–273.

Wasserman, G. A., McReyolds, L. S., Ko, S., Katz, L., & Carpenter, J. (2005). Gender differences inpsychiatric disorders at juvenile probation intake. American Journal of Public Health, 95, 131–137.

Widom, C. S., Schuck, A. M., & White, H. R. (2006). An examination of pathways from childhoodvictimization to violence: The role of early aggression and problematic alcohol use. Violence andVictims, 21, 675–690.

Wolpaw, J. M., & Ford, J. D. (2004). Assessing exposure to psychological trauma in the juvenile justicepopulation. Retrieved 5/22/08 from www.nctsnet.org/nctsn_assets/pdfs/edu_materials/assessing_trauma_in_jj_population.pdf.

Wood, J., Foy, D. W., Layne, C., Pynoos, R., & James, C. B. (2002). An examination of the relationshipsbetween violence exposure, posttraumatic stress symptomology, and delinquent activity: An eco-pathological model of delinquent behavior among incarcerated adolescents. Journal of Aggression,Maltreatment & Trauma, 6, 127–147.


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