Publications
Books
1) Scheeringa MS (2016). Treating PTSD in Preschoolers: A Clinical Guide. New York: Guilford Press. ISBN 978-1462522330.
2) Scheeringa MS (2018). They’ll Never Be The Same: A Parent’s Guide to PTSD in Youth. Las Vegas: Central Recovery Press. ISBN 978-1942094616.
3) Scheeringa MS (2022). The Trouble With Trauma: The Search to Discover How Beliefs Become Facts. Las Vegas: Central Recovery Press. ISBN 978-1949481563.
4) Scheeringa MS (2023 4 25). Analysis of The Body Keeps the Score: The Science That Trauma Activists Don’t Want You to Know. Coppell, TX: Self published (Kindle Direct Publishing). ISBN 979-8391790136.
Articles
**Indicates the most important articles.
1) Zeanah CH, Scheeringa MS, Boris NW (1994). Parenting styles and risks in the vulnerable infant. Current Opinion in Pediatrics, 6, 4:406-410.
2) **Scheeringa MS, Zeanah CH, Drell MJ, Larrieu JA (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 2:191-200.
—This was the first study of a group of trauma-exposed children under four years of age (previous articles had been case reports). Although small (N = 12 trauma-exposed children) this established a precedent of using standardized assessment methods in this population and began a programmatic series of studies over nearly three decades to empirically demonstrate the diagnostic validity of developmentally-sensitive criteria for PTSD in children six years of age and younger.
3) Scheeringa MS, Zeanah CH (1995). Symptom differences in traumatized infants and young children. Infant Mental Health Journal, 16, 4:259-270.
4) Zeanah CH, Scheeringa MS (1996). Evaluation of posttraumatic symptomatology in infants and young children exposed to violence. Zero to Three: Special issue on Islands of Safety: Assessing and treating young victims of violence, 16, 5:9-14.
5) Zeanah CH, Boris NW, Scheeringa MS (1997). Psychopathology in Infancy. Journal of Child Psychology and Psychiatry, 38, 1:81-99.
6) Zeanah CH, Boris NW, Scheeringa MS (1997). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman (Eds.), Psychiatry (pp.75-100). Philadelphia: W.B. Saunders Co.
7) Zeanah CH, Scheeringa MS (1997). The experience and effects of violence in infancy. In JD Osofsky (Ed.), Children in a Violent Society (pp. 97-123). New York: Guilford Press.
8) Osofsky JD, Scheeringa MS (1997). Community and domestic violence exposure: Effects on development and psychopathology. In D. Cicchetti, S.L. Toth (Eds.), Rochester Symposium on Developmental Psychopathology, volume 8. Developmental Perspectives on Trauma: Theory, Research, and Intervention (pp. 155-180). Rochester, NY: University of Rochester Press.
9) Boris NW, Zeanah CH, Larrieu JA, Scheeringa MS, Heller SS (1998). Attachment disorders in infancy and early childhood: A preliminary investigation of diagnostic criteria. American Journal of Psychiatry, 155, 2:295-297.
10) Scheeringa MS (1999). Treatment of posttraumatic stress disorder in infants and toddlers. Journal of Systemic Therapies, 18,2:20-31.
—Always wanting to make a real impact on patients’ lives, I jumped at an invitation to write about treatment (as opposed to assessment). While I would later abandon some of this early thinking, much of it would find its way into my later work on cognitive behavioral therapy (CBT).
11) Scheeringa MS, Gaensbauer TJ (2000). Posttraumatic stress disorder. In CH Zeanah (Ed.), Handbook of Infant Mental Health, second edition (pp. 369-381). New York, NY: Guilford Press.
—We laid out for the first time in a systematic fashion the emerging developmental capacities that underlie PTSD symptoms.
12) **Scheeringa MS, Peebles CD, Cook CA, Zeanah CH (2001). Toward establishing procedural, criterion and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1: 52-60.
—This added several elements to the diagnostic validation of PTSD in very young children. Although it was a small sample (N = 15 trauma-exposed and N = 12 controls), the most important element, and probably the most overlooked, was procedural validity, which confirmed what was already known clinically that observation of young children or examiner-directed play reenactments do not add useful information above and beyond parental reports.
13) Scheeringa MS, Zeanah CH (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14(4):799-815.
—This is the only article that I regret publishing. This was the first literature review on the association between parental and family factors with children’s severity of PTSD symptoms. I believe we placed far too much emphasis on a causal theory that parenting can cause or exacerbate symptoms in children, which I stopped believing soon thereafter. And we placed far too little emphasis on shared genetic vulnerability as the probable cause of the positive correlation between parents’ and children’s symptoms. This is unfortunately my most frequently cited paper because many researchers still believe in the unsupported and oft-disproven theory of blaming parents for children’s symptoms.
14) Scheeringa MS (2001). The differential diagnosis of impaired reciprocal social interaction in children: Review of disorders. Child Psychiatry and Human Development, 32(1):71-89.
—I was frustrated by clinicians missing the diagnosis of high-functioning autism in very young children. This would be the only paper I would write on autism.
15) Stafford B, Zeanah CH, Scheeringa M (2003). Exploring psychopathology in early childhood: PTSD and attachment disorders in DC:0-3 and DSM-IV. Infant Mental Health Journal, 24, 398-409.
16) Task Force on Research Diagnostic Criteria: Infancy and Preschool (2003) (Scheeringa, chair and primary author). Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1504-1512.
—With funding support from the American Academy of Child and Adolescent Psychiatry, I put together a group of leaders in infant and preschool psychiatry. We met twice and hashed out a document to try to systematically move forward the research on disorders in this age group. It turned out to be wishful thinking as few researchers would pursue diagnostic validation research.
17) **Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 5:561-570.
—This followed up my 1995 and 2001 studies with a substantially larger sample (N = 62 trauma-exposed and N = 63 controls) to show that children six years and younger could develop PTSD but the diagnostic criteria needed developmental modifications. This was the first paper to examine the comorbid disorders that exist with PTSD in this age group. This paper was given the AACAP Norbert and Charlotte Rieger Award for Scientific Achievement for the most significant paper published in the Journal of the American Academy of Child and Adolescent Psychiatry for the past year.
18) Zeanah CH, Stafford, B, Boris NW, Scheeringa MS (2003). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman (Eds.), Psychiatry, Second Edition (pp.91-117). West Sussex, England: John Wiley & Sons, Ltd.
19) Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2004). Heart period and variability findings in preschool children with posttraumatic stress symptoms. Biological Psychiatry 55(7), 685-691.
—This was the first research to examine a neurobiological correlate of PTSD in very young children. Associations between heart rate variability and PTSD were underwhelming, which started a rocky evolution for me to understand that while neurobiology of course underlies psychopathology, neurobiology can be highly variable in a disorder that is highly variable.
20) Boris NW, Hinshaw-Fuselier SS, Smyke AT, Scheeringa MS, Heller SS, Zeanah CH (2004). Comparing criteria for attachment disorders: Establishing reliability and validity in high-risk samples. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 568-577.
21) Zeanah CH, Scheeringa MS, Boris NW, Heller SS, Smyke AT, Trapani J (2004). Reactive attachment disorder in maltreated toddlers. Child Abuse and Neglect 28(8), 877-888.
22) Scheeringa MS (2004). Posttraumatic Stress Disorder. In R DelCarmen-Wiggins, A Carter (Eds.), Handbook of Infant, Toddler, and Preschool Mental Health Assessment (pp. 377-397). New York, NY: Oxford University Press.
—Building on a prior book chapter (pub 11), I laid out in more detail the emerging developmental capacities that need to be on line for PTSD to develop. I speculated that PTSD could conceivably develop by nine months of age at the earliest. I would later discover empirically that was far off, and would revise the earliest age to around three years.
23) **Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry 44(9), 899-906.
—This was the first prospective longitudinal study of PTSD symptoms in children 6 years and younger. It was important for showing that PTSD severity did not significantly decrease naturally over two years. In a subset that received community treatment-as-usual, severity also did not decrease, most likely suggesting that evidence-based PTSD treatment was not being used in the community.
24) **Scheeringa MS, Wright MJ, Hunt JP, Zeanah CH (2006). Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. American Journal of Psychiatry 163(4), 644-651.
—This was the first study to assess PTSD across the entire age range of childhood with a sample that had experienced similar types of trauma (accidental injuries). For the fourth time, we showed that very young children need developmentally-modified diagnostic criteria. Also, we showed for the first time that 7-11 year-old children probably need developmentally-modified criteria too. In addition, this was the first study to combine child-report with parent-report of PTSD symptoms, and we showed that combined reports produce much higher (and more accurate) estimates of severity and diagnosis compared to child- or parent-report alone (which would be replicated consistently at multiple sites).
25) Dehon C, Scheeringa MS (2006). Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist. Journal of Pediatric Psychology 31(4), 431-435.
—While this was a mildly interesting study to show that a subset of 15 items from the CBCL could correlate with PTSD severity in very young children, I would never recommend the CBCL as a PTSD screen.
26) Scheeringa MS (2006). Posttraumatic Stress Disorder: Clinical Guidelines And Research Findings. In J Luby (Ed.), Handbook of Preschool Mental Health (pp 165-185). New York: Guilford Press.
—In addition to the traditional chapter organization of epidemiology, course, diagnosis, and treatment, I summarized for the first time from four studies the symptoms of PTSD in very young children from most to least frequent.
27) Scheeringa MS, Salloum A, Arnberger RA, Weems CF, Amaya-Jackson L, Cohen JA (2007). Feasibility and Effectiveness of Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder in Preschool Children: Two Case Reports. Journal of Traumatic Stress 20(4), 631-636.
—We presented two treatment cases. These served as proof of concept that treating very young children with key CBT techniques for PTSD was feasible. Prior studies by Cohen, Mannarino, and Deblinger had shown that a CBT package was effective overall, but they had not reported data on children’s cooperation with tasks.
28) Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, Luby JL, Owens J, Scahill LD, Scheeringa MS, Stafford B, Wise B, Zeanah CH (2007). Psychopharmacological treatments for very young children: Contexts and guidelines. Journal of the American Academy of Child and Adolescent Psychiatry 46(12), 1532-1572.
29) Scheeringa MS (2007). CBT Treatment Within the First Month. American Journal of Psychiatry, 164, 8, 1267.
—Letter to the editor which noted that nearly all individuals show PTSD symptoms initially following trauma, but those resolve for most people within the first month. The recommendation for most individuals after trauma is to watch-and-wait for one month before seeking treatment except in severe cases.
30) Scheeringa MS (2007). A Research Agenda for Posttraumatic Stress Disorder in Infants, Toddlers, and Preschool Children. In : Narrow WE, First MB, Sirovatka PJ, Regier DA (eds): Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V (pp. 151-162). Arlington, VA: American Psychiatric Association.
—During the earliest stage of considering revisions to the DSM-IV, I was asked to summarize the state of research for PTSD in young children.
31) Zeanah CH, Stafford, B, Boris NW, Scheeringa MS (2008). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J., Lieberman, M.B. First, & M. Maj (Eds.), Psychiatry, Third Edition. Chichester, UK: John Wiley & Sons, Ltd. doi 10.1002/9780470515167.ch8.
32) Scheeringa MS (2008). Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children. American Journal of Psychiatry 165(10), 1237-1239.
—Invited editorial to comment on an excellent study by Richard Meiser-Stedman and colleagues.
33) **Scheeringa MS, Zeanah CH (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology 37(3), 508-518.
—It had been well-established by other researchers with adults that 80-90% of individuals with PTSD have one or more comorbid psychiatric disorders. For a special issue on PTSD in this journal, I submitted the early results on a subset (Hurricane Katrina victims only) of our larger sample (see pub 45) to examine the key issue of whether comorbid disorders exist prior to trauma exposure or develop after trauma exposure (the answer: it is about 50-50). This was the first study in very young children that tracked the date of onset of comorbid disorders. It was also the first study to replicate McMillen et al.’s (2002) important finding that new comorbid disorders do not arise in isolation from PTSD (i.e., comorbid disorders nearly always arise in parallel with substantial PTSD symptoms). This was my fifth study testing developmentally-modified criteria for PTSD for very young children.
34) Dalton R, Scheeringa MS, Zeanah CH (2008). Did the Prevalence of PTSD Following Hurricane Katrina Match A Rapid Needs Assessment Prediction? A Template for Future Public Planning After Large-Scale Disasters. Psychiatric Annals 38(2), 134-141. PMID: 17721975.
—After living through the Hurricane Katrina disaster, we estimated the scope of PTSD. I had done some of this work in 2005 to plan for a large-scale intervention that I thought I was going to run with federal funding. The funding rug was pulled from under our feet at the last minute by the state, but this got me interested in disaster psychiatry for a brief time.
35) Drury SS, Scheeringa MS, Zeanah CH (2008). The Traumatic Impact Of Hurricane Katrina On Children In New Orleans. Child and Adolescent Psychiatric Clinics of North America 17, 685-702.
36) Scheeringa MS (2009). Posttraumatic stress disorder. In CH Zeanah (Ed.), Handbook of Infant Mental Health, third edition (pp. 345-361). New York, NY: Guilford Press.
—I used this book chapter to expound on the rapidly-changing memory capacities that are developing from birth to seven. Also, I began to grudgingly give up the speculation that PTSD could fully manifest before one year of age, but I had not yet settled on my current thinking that three years is the minimum age.
37) Robinson LR, Morris AS, Heller SS, Scheeringa MS, Boris NW, Smyke AT (2009). Relations between emotion regulation, parenting, and psychopathology in young maltreated children in out of home care. Journal of Child and Family Studies 18 (4), 421-434.
38) Cohen JA, Scheeringa MS (2009). Post-traumatic stress disorder diagnosis in children: Challenges and promises. Dialogues in Clinical Neuroscience 11(1), 91-99.
—Judith Cohen had been invited by this journal to summarize the current state of assessing PTSD in children and she asked me to co-author.
39) Drury SS, Theall KP, Keats BJB, Scheeringa MS (2009). The role of the dopamine transporter (DAT) in PTSD in preschool children. Journal of Traumatic Stress 22,6, 534-539.
—This was the first study of a gene in children of any age with PTSD. We found that an allele of the dopamine transporter was associated with more severe PTSD. Single gene studies, however, were about to become rapidly obsolete with the advent of relatively inexpensive genome-wide association techniques.
40) **Scheeringa MS, Haslett, N (2010). The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment: A new diagnostic instrument for young children. Child Psychiatry & Human Development, 41, 3, 299-312.
—I was so frustrated with the only existing interview (PAPA) for the psychiatric diagnoses of very young children, that I made my own. The PAPA was excessively long, not focused exclusively on psychopathology, and available only for a fee. My interview, the DIPA, was 68% shorter, focused only on psychopathology, organized by DSM disorder, measured impairment specific to each syndrome, and free. The DIPA has become the most widely used interview for psychiatric disorders in very young children in the world.
41) Scheeringa MS, Zeanah CH, Cohen JA (2011). PTSD in children and adolescents: Towards an empirically based algorithm. Depression and Anxiety 28:9, 770-782.
—As the DSM-5 planning committee was reviewing the evidence for possible revisions for the 2013 launch of revisions to the DSM-IV, I was asked to help summarize the state of the evidence on diagnostic validity for children and adolescents.
42) Scheeringa MS (2011). PTSD in Children Younger Than Age of 13: Towards a Developmentally Sensitive Diagnosis. Journal of Child & Adolescent Trauma 4:3, 181-197.
—Kathleen Nader organized a special issue on assessment of PTSD in youth for this journal and she asked me to summarize the evidence for children 13 years and younger. Whereas pub 41 focused on diagnostic validity evidence, this paper focused more on assessment techniques and procedures.
This issue of the journal was later reprinted as a book. My chapter in the book is a duplicate of the journal article. The book chapter citation is: Scheeringa MS (2014). PTSD in Children Younger Than the Age of 13: Towards Developmentally Sensitive Assessment and Management. In K. Nader (Ed.), Assessment of Trauma in Youths: Understanding issues of age, complexity, and associated variables (pp. 21-37). New York, NY: Routledge.
43) **Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52, 8, 853-860. DOI: 10.1111/j.1469-7610.2010.02354.x.
—This was the third randomized controlled trial of a treatment for PTSD in very young children. Cohen & Mannarino (1996) and Deblinger (2001) had conducted the first two studies on sexual-abuse trauma. The inclusion criteria for my study included every type of trauma besides sexual. We showed that not only did the treatment work through a six-month follow-up, but we documented the feasibility of each technique (e.g., narrative recall, relaxation exercises, and doing homework) and tracked comorbid disorders.
44) Drury SS, Scheeringa MS, Schmidt KE, Nelson CA (2011). From biology to behavior to the law: Policy implications of the neurobiology of early adverse experiences. Whittier Journal of Child and Family Advocacy 19(1), 25-51.
—This article is a mixed bag. I no longer would be part of giving such a positive spin on the theory that stress and trauma can permanently damage brains. I did not believe it at the time this was written either but I did not yet realize how this theory was being weaponized as an ideology to promote cultural Marxism (that realization would come in several more years). I naively thought we were still having a debate among scientists. Despite second thoughts about being a co-author, however, I stayed involved for two reasons: (1) I was able to tone down the causal language from “does cause” brain damage to “may cause” in about a dozen places; and (2) I wrote Section IV which exposed the lunacy of the federal government’s mental health response policy following disasters. I had already tried but failed to get an exposé on federal policy published in other outlets because, I believe, it is such a rare experience for most communities that peer reviewers and editors did not understand it and did not quite trust my depiction.
45) **Scheeringa MS, Myers L, Putnam FW, Zeanah CH (2012). Diagnosing PTSD in Early Childhood: An Empirical Assessment of Four Approaches. Journal of Traumatic Stress, 25(4), 359-367.
—This is the largest sample of trauma-exposed children 3- to 6-years (N = 284) ever collected. It was an enormous effort with at least 17 recruitment sites in the New Orleans area. It included 62 children with a single-incident trauma exposure, 85 with repeated trauma exposures (mostly witnessing domestic violence), and 137 exposed to Hurricane Katrina, plus a non-trauma-exposed control group of 46 children. We compared the DSM-IV criteria to three alternative sets of diagnostic criteria being considered for the DSM-5. This study, my sixth to examine developmentally-modified PTSD criteria for this age group, plus similar studies by investigators at several other sites (see pubs 26, 36, and 41), provided the empirical evidence for the DSM-5 to create the new disorder PTSD for children 6 years and younger, the first developmentally-modified criteria for a major psychiatric syndrome in the DSM. Among other findings, we showed that two new symptoms being considered—persistent negative emotional states and reckless/self-destructive behavior—added nothing of value to the diagnostic criteria, which was instrumental in keeping these symptoms out of the final DSM-5 criteria for young children. Unfortunately, research with a similar level of rigor was not conducted in older children and adults and those epically bad symptoms were included in the general PTSD criteria.
46) Weems CF, Scheeringa MS (2013). Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. Journal of Anxiety Disorders 27(1), 140-146.
47) Drury SS, Brett ZH, Henry C, Scheeringa M (2013) The association of a novel haplotype in the dopamine transporter with preschool age PTSD. Child and Adolescent Psychopharmacology 23(4): 236-243. doi:10.1089/cap.2012.0072.
48) Humphreys K, Drury S, Scheeringa MS (2014). Race moderates the association of Catechol-O-methyltransferase genotype and posttraumatic stress disorder in preschool children. Journal of Child and Adolescent Psychopharmacology, 24(8), 454-457.
49) Salloum A, Robst J, Scheeringa MS, Cohen JA, Wang W, Murphy T, Tolin D, & Storch EA (2014). Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children: A Pilot Study. Child Psychiatry and Human Development, 45, 65-77, DOI 10.1007/s10578-013-0378-6.
—Alison Salloum worked with me on my CBT RCT. When she moved to the University of South Florida, she created an innovative stepped care treatment. I helped train her staff to use the DIPA and my CBT manual for part of the intervention.
50) Salloum A, Scheeringa MS, Cohen JA, Storch EA (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive and Behavioral Practice 21(1), 97-108, doi: 10.1016/j.cbpra.2013.07.004.
51) Scheeringa MS, Weems C (2014). Randomized Placebo-Controlled D-Cycloserine with Cognitive Behavior Therapy for Pediatric Posttraumatic Stress. Journal of Child and Adolescent Psychopharmacology, 24(2), 69-77. DOI 10.1089/cap.2013.0106.
—Because individuals with PTSD who benefit from psychotherapy do not achieve full remission, and there is a smaller proportion of individuals who do not benefit much from psychotherapy, and traditional drug treatments seem less effective than psychotherapy, there is a need for new interventions. The novel practice of taking D-cycloserine one hour prior to psychotherapy sessions seemed to work for other anxiety disorders so we tried it with PTSD. Seven- through 18-year-old youths with high levels of PTSD symptoms were randomly allocated to CBT+D-cycloserine or CBT+placebo. The CBT was my Youth PTSD Treatment protocol (YPT). This was the first, and only, trial to try this strategy with children and adolescents. It did not work, unfortunately, because both groups showed large improvements. The evidence with adults with PTSD has been mixed.
52) Scheeringa MS, Cobham VE, McDermott B (2014). Policy and administrative issues for large-scale clinical interventions following disasters. Journal of Child and Adolescent Psychopharmacology 24(1), 39-46, doi: 10.1089/cap.2013.0067.
—In the last hurrah of my interest in disaster psychiatry, we tried to publish something to save future communities from learning lessons about disaster mental health interventions the way we learned (the hard way). Drs. Cobham and McDermott had extensive experience in Australia that complemented my experience with Hurricane Katrina.
53) Weiss, A, Scheeringa, MS (2014). Psychopharmacological Treatment of Delirium: Does Earlier Treatment and Scheduled Dosing Improve Outcomes? Journal of the Louisiana State Medical Society, 166(6), 242-247.
54) Humphreys, KL, Zeanah CH, Scheeringa MS (2015). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman, M.B. First, & M. Maj (Eds.), Psychiatry, Fourth Edition. Chichester, UK: John Wiley & Sons, Ltd., doi 10.1002/9781118753378.ch9.
55) Weems CF, Scott BG, Graham RA, Banks DM, Russell JD. Taylor LK, Cannon M, Varela RE, Scheeringa MS, Perry AM, & Marino RC (2015). Fitting Anxious Emotion Focused Intervention into the Ecology of Schools: Results from a Test Anxiety Program Evaluation. Prevention Science, 16(2), 200-210. DOI 10.1007/s11121-014-0491-1.
56) Salloum, A, Scheeringa, MS, Cohen, JA, & Storch, EA (2015). Responder status criterion for stepped care trauma-focused cognitive behavioral therapy for young children. Child and Youth Care Forum, 44(1), 59-78. DOI 10.1007/s10566-014-9270-1.
57) **Scheeringa MS, Myers L, Putnam FW, Zeanah CH (2015). Maternal Factors as Moderators or Mediators of PTSD Symptoms in Preschool Children: A Two-Year Prospective Study. Journal of Family Violence, 30(5), 633-642, DOI: 10.1007/s10896-015-9695-9.
—This study provided empirical evidence that helped me confirm that my previous support of parent-blaming (pub 13) was wrong. Our study design addressed two major problems of prior research which was nearly all cross-sectional and lacked objective measures of actual parenting skills. By measuring parenting four different ways and following them for two years, we showed that greater maternal emotional sensitivity with their children predicted more, not fewer, PTSD symptoms in children after two years. This is problematic evidence for many experts who view maternal sensitivity as the keystone regulator for better child development and protection against psychopathology.
58) **Scheeringa, MS (2015). Untangling Psychiatric Comorbidity in Young Children Who Experienced Single, Repeated, or Hurricane Katrina Traumatic Events. Child and Youth Care Forum 44(4), 475-492. DOI 10.1007/s10566-014-9293-7.
—(1) As noted in pub 33, an important issue is whether comorbid disorders exist prior to trauma exposure or develop after trauma exposure. Trauma researchers have been strangely uncurious about this; prior to this study there had been only two studies that I am aware of that tracked the dates of onsets of comorbid disorders (and I did one of them). The Repeated Events group had significantly more ODD diagnoses that had onsets prior to the earliest traumatic events compared to both the Single Event Katrina groups, showing that trauma does not happen at random to individuals.
—(2) Another accepted dogma among trauma researchers has been that repeated trauma events cause worse outcomes than single-blow traumas. Contrary to that dogma, we found no difference in severity between the Repeated Events group and the other two groups across five disorders.
—(3) A third accepted dogma has been that interpersonal trauma causes more severe outcomes than non-interpersonal trauma. The Repeated Events group was comprised mostly of interpersonal trauma, so our findings debunked that dogma too.
59) Scheeringa MS (2016). Validity of measurement of suicidal ideas in very young children. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 3, 243.
—Letter to the editor that provided data to counter a claim from a recently published article that greatly overestimated suicidal ideas in young children.
60) Salloum A., Wang W, Robst J, Murphy TK, Scheeringa MS, Cohen JA, Storch EA (2016). Stepped Care Versus Standard Trauma-Focused Cognitive Behavioral Therapy for Young Children. Journal of Child Psychology and Psychiatry, 57(5), 614-22.
61) Wamser R, Weems, CW, Scheeringa MS (2016). Early treatment response in children and adolescents receiving CBT for trauma. Journal of Pediatric Psychology, 41(1), 128-137.
—Using data from my D-cycloserine RCT (pub 51), Rachel Wamser-Nanney investigated the situation that is often seen in trials and daily clinic work in which a subgroup improves more rapidly than others, usually within three- to four-sessions. We showed that 32% were early responders, and they reported lower baseline levels of PTSD, depression, anxiety, rumination, and fewer traumas compared to nonearly responders.
62) Mikolajewski AJ, Scheeringa MS, Weems CF (2017). Evaluating DSM-5 Posttraumatic Stress Disorder Diagnostic Criteria in Older Children and Adolescents. Journal of Child and Adolescent Psychopharmacology 27(4), 374-382. doi: 10.1089/cap.2016.0134.
—Since I first hypothesized that 7-11 year-old children probably needed developmentally-modified PTSD criteria (just like 6 years and younger children) in 2006 (pub 24), I had been wanting to follow this up with another study. The D-cycloserine study finally presented that opportunity. We showed that a significantly higher proportion of 7–12-year-old children met criteria for DSM-5 criteria for very young children (53%) compared to the DSM-IV criteria (37%). However, among 13–18-year-old adolescents, the proportions diagnosed with DSM-5 (73%) and DSM-IV (74%) did not differ. This seemed to confirm my hypothesis.
63) Salloum A, Small BJ, Robst J, Scheeringa MS, Cohen JA, Storch EA. (2017). Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice 27(6):653-663, doi 10.1177/1049731515601898
64) Humphreys K, Weems CF, Scheeringa MS (2017). The role of anxiety control and treatment implications of informant agreement on child PTSD symptoms. Journal of Clinical Child and Adolescent Psychology, 46(6), 903-914. doi: 10.1080/15374416.2015.1094739.
65) **Scheeringa MS, Lilly ME, Staiger AB, Heller ML, Jones EG, Weems CF (2017). Do Children and Adolescents Have Different Types of Trauma Narratives and Does it Matter? Reliability and Face Validation for a Narrative Taxonomy. Journal of Traumatic Stress 30(3), 323-327. DOI: 10.1002/jts.22190.
—Milking another benefit out of the D-cycloserine RCT (pub 51), this was the first study to systematically examine the types of narratives that youths express about their trauma experiences during psychotherapy. First, we showed that there are four types of narratives that can be reliably identified: expressive, avoidant, undemonstrative, and fabricated. Second, we found that, contrary to folklore, patients do not have to be emotionally expressive or fluent about trauma details in order to get better. This also means that, again, contrary to folklore, asking avoidant youths to discuss trauma experiences is not harmful.
66) Matais-Cols D., Fernández de la Cruz L., Monzani B., Rosenfield D., Andersson E., Pérez-Vigil A., and 35 more authors (2017). D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders, JAMA Psychiatry 74(5), 501-510.
67) **Lipschutz R, Gray SAO, Weems CF, Scheeringa MS (2017). Respiratory sinus arrhythmia in cognitive behavioral therapy for posttraumatic stress symptoms in children: Treatment and gender effects. Applied Psychophysiology and Biofeedback 42(4), 309-321, Dec.
—Milking yet another benefit out of the D-cycloserine RCT (pub 51), this study put some more empirical flesh on the bones about my growing awareness that neurobiology of psychopathology is highly variable within a disorder (pub 19), and making black-and-white claims about linear relationships between neurobiology and disorders is overly simplistic. Specifically, the existing evidence appeared to indicate that individuals with PTSD (1) have lower resting RSA, (2) show blunted RSA reactivity to stressors, and (3) should increase both resting RSA and reactivity of RSA in parallel with successful psychotherapy. Long story short, we found that those with higher initial resting RSA decreased their resting RSA by the end of treatment, and those with lower initial resting RSA increased their resting RSA by the end of treatment. In other words, the extremes at both ends converged toward a middle ground. Similarly, those with higher initial resting RSA showed initial net decreased RSA reactivity to stressors and increased their RSA reactivity by the end of treatment, and those with lower initial resting RSA showed initial net increased RSA reactivity to stressors and decreased their RSA reactivity by the end of treatment. Again, the extremes of RSA reactivity at both ends converged toward a middle ground. I do not know if this is just regression to the mean or an accurate reflection of neurobiology profiles. Nevertheless, this may help to explain why so many neurobiology studies have failed to be replicated. Any study that finds a neurobiological variable to be “high” or “low” for an entire group is probably a spurious finding that is missing the bigger picture. This also illustrates the massive weakness of cross-sectional studies.
68) Miron D, Scheeringa MS (2017). Cognitive Behavioral Therapies for Preschool Children. In J Luby (Ed.), Handbook of Preschool Mental Health, Second Edition (pp. 292-310). New York: Guilford Press.
69) De Young AC, Scheeringa MS (2018). Posttraumatic stress disorder in children 6 years and younger. In FJ Stoddard, DM Benedek, MR Milad, & RJ Ursano (Eds.), Primer on Trauma- and Stressor-Related Disorders (pp. 85-102). New York, NY: Oxford University Press.
70) Gray SAO, Lipschutz R, Scheeringa MS (2018) Young children’s physiological reactivity during memory recall: Associations with posttraumatic stress and parent physiology. Journal of Abnormal Child Psychology 46, 871-880 doi 10.1007/s10802-017-0326-1.
—Using my data from the study of 284 trauma-exposed and 46 non-trauma exposed 3- to 6-year-old children (pub 45), Sarah Gray examined RSA reactivity. We showed that RSA reactivity decreased when exposed to three types of stressor stimuli (child recalls pleasant event, child recalls trauma event, and parent recalls trauma event), and there were no differences in reactivity between groups with PTSD, trauma without PTSD, and no trauma exposure with one exception. During one of the stressor stimuli (child recalls trauma event), the PTSD group showed larger decreases in RSA reactivity compared to the trauma without PTSD group.
Sarah also conducted the first examination of parent-child synchrony of RSA in the context of child PTSD. During child recall of trauma event, the trauma without PTSD group showed higher synchrony of RSA with their caregivers compared to the PTSD group and the no trauma group. During parent recalls trauma event, the PTSD and trauma without PTSD groups showed higher synchrony of RSA with their caregivers compared to the no trauma group. The findings were mixed but point in the direction that higher synchrony of RSA between child and caregiver may indicate resilience against developing PTSD.
There are multiple ways one could interpret these findings. Because it is not clear whether synchrony is a good, bad, or neutral thing, and the data were cross-sectional, these findings raise more questions than they answer. The only thing I can say for certain is that better data are needed to untangle the situation.
71) **Mikolajewski AJ, Scheeringa MS (2018). Examining the prospective relationship between pre-disaster respiratory sinus arrhythmia and post-disaster posttraumatic stress disorder symptoms in children. Journal of Abnormal Child Psychology, Vol 46(7), Oct, 2018 pp. 1535-1545, doi 10.1007/s10802-017-0396-0.
—Undoubtedly, the most important question about neurobiology and PTSD is whether neurobiological differences exist prior to trauma exposure and serve as vulnerability factors or neurobiological differences are caused by trauma exposure. Hurricane Katrina gave me a rare opportunity to test this question. During recruitment for my large study of 3- to 6-year-old trauma-exposed children (pub 45), Hurricane Katrina struck smack in the middle. Of the 156 children who had been assessed prior to the disaster, we were able to locate and bring back 36 for a second, post-disaster assessment. Despite the modest size, it was only the third pretrauma prospective study with children, and remains the only one with very young children. When Amy Mikolajewski analyzed the data, lower pretrauma resting RSA and increased pretrauma RSA reactivity predicted the development of more PTSD symptoms. Any changes from pretrauma resting RSA to posttrauma resting RSA did not predict change in PTSD symptoms. Any changes from pretrauma RSA reactivity to posttrauma RSA reactivity did not predict change in PTSD symptoms. Overall, the evidence supports that differences in RSA status (both resting and reactivity) that predicted PTSD symptoms existed prior to trauma exposure.
72) Neill EL, Weems CF, Scheeringa MS (2018). CBT for Child PTSD is Associated with Reductions in Maternal Depression: Evidence for Bidirectional Effects. Journal of Clinical Child and Adolescent Psychology 47(3), 410-420, doi 10.1080/15374416.20161212359.
—Analyzing another aspect of the D-cycloserine study with 7-18-year-old children, Erin Neill found that any causal effects of mothers impacting children, or vice versa, appeared bidirectional. In addition, using a simple measure I created for this study, we asked mothers near the end of treatment who changed first, the mother or the child? Fifty-three percent reported that their child improved first, 17% felt they improved at the same time, and only 25% felt that mothers improved first and then children improved. This was additional evidence—from the mouths of the mothers themselves—against the consensus folklore of universally blaming mothers for children’s symptoms.
73) Scheeringa MS (2018). Review of Posttraumatic Play in Children by Eliana Gil. Journal of the American Academy of Child & Adolescent Psychiatry, 57,11:890-892.
—I was exasperated by reports from parents who came to my clinical practice with stories of their children being treated with endless play therapy for PTSD and never getting better. Play therapy has a small role with nonverbal children below three years of age, but once they become verbal and able to cooperate with cognitive techniques, there is no excuse for not using CBT. In this book review, I debunked multiple nonsensical notions promoted by Eliana Gil.
74) Scheeringa MS, Burns, LC (2018). Generalized anxiety disorder in very young children: First case reports on stability and developmental considerations. Case Reports in Psychiatry, vol. 2018, Article ID 7093178, doi 10.1155/2018/7093178.
75) Scheeringa MS (2019). Development of a brief screen for symptoms of posttraumatic stress disorder in young children: The Young Child PTSD Screen (YCPS). Journal of Developmental & Behavioral Pediatrics, Vol 40(2): 105-111, doi 10.1097/DBP.0000000000000639.
—This reported on the development of a six-item screener for PTSD in very young children. I personally do not advocate using a six-item screener when the full complement of PTSD criteria is only 16 items. But I know people are going to create and use short screeners so I at least wanted one to exist that was empirically based.
76) Miron D, Scheeringa, MS (2019). A Statewide Training of Community Clinicians to Treat Traumatized Youths Involved with Child Welfare. Psychological Services 16(1), 153-161, 2019 Feb., doi 10.1037/ser0000317.
—One of the remarkable stories of the current practice of psychotherapy in the USA is that most clinicians are either unwilling or unable to adopt evidence-based protocols. In a training program we implemented across the state of Louisiana, we documented just how poor the uptake is.
77) McKinnon A, Scheeringa MS, Meiser-Stedman R, Watson P, De Young A, Dalgleish T (2019). The dimensionality of proposed DSM-5 PTSD symptoms in trauma-exposed young children. Journal of Child Psychology and Psychiatry 47:1799-1809, doi 10.1007/s10802-019-00561-2.
—I am a staunch critic of factor analysis as a method of diagnostic validation, but I agreed to let a graduate student in the UK use my dataset if she promised to examine how the factor analysis model results impacted diagnosis rates and functional impairment. None of the models showed adequate statistical fits to the data, which I think just added confusion to an already confusing niche of research.
78) Scheeringa MS, Singer AM, Mai AT, Miron D. (2020, early online 10/26/18). Access to Medicaid Providers: Availability of Mental Health Services for Children and Adolescents in Child Welfare in Louisiana. Journal of Public Child Welfare 14(2):161-173, doi 10.1080/15548732.2018.1537904.
—In a one-off topic of study in my career, I documented the depth of the problem that parents have in finding providers who will take insurance to treat their children with mental health problems. Our focus was constrained to Medicaid providers because the effort was part of a federal grant I received to work with child welfare agencies. We used a mystery shopper model and called every provider in the state of Louisiana who was listed as accepting Medicaid insurance for treating children. We found that only 25% of the advertised network of providers could schedule an appointment. The other 75% was essentially a ghost network of providers on paper that were either duplicate listings at multiple addresses, disconnected phone numbers, did not see children, or had stopped accepting Medicaid patients. Since this study was conducted in 2014-2017, Louisiana cracked down on insurance networks and they are moderately better at maintaining accurate directories.
79) Scheeringa MS (2020). A Different Way to Mind the Gap: Mandated Versus Voluntary Collection of Measures. Journal of the American Academy of Child and Adolescent Psychiatry, May 2020, 59, 5, 576-577.
80) Scheeringa MS (2020). The Diagnostic Infant Preschool Assessment-Likert Version (DIPA-L): Preparation, concurrent construct validation, and test-retest reliability. Journal of Child and Adolescent Psychopharmacology 30(5):326-334, doi 10.1089/cap.2019.0168.
—I updated the DIPA for DSM-5 and changed the rating scale from binary to Likert responses, and gathered new validity data on it.
81) **Scheeringa MS (2021) Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms. International Journal of Methods in Psychiatric Research 30:e1864. doi: 10.1002/mpr.1864.
—This is my favorite paper. At this point in time, it had become clear to me that many of my colleagues in the PTSD research field had either never been capable of or had abandoned equipoise in studying the most important question about neurobiology. A vocal group of researchers claimed that they knew with absolute certainty that neurobiological differences are caused by trauma exposure, when I knew for certain, based on the evidence, this was not true. The manuscript was rejected by six journals before I finally got it published. Some of the rejections by anonymous peer reviewers were surprisingly explicit that they objected to the tone of the manuscript (code for I don’t like your ideology) while expressing no rational objections to the findings.
82) Mai TA, Scheeringa MS (2021; early online 2019 Dec 27). Caregiver and Child Agreement on Traumatic Events, PTSD, Internalizing, Externalizing, and ADHD Problems in a Child Welfare Population. Journal of Public Child Welfare 15(2):251-274, doi 10.1080/15548732.2019.1701612.
83) Salloum A, Lu Y, Ali O, Chen H, Salomon K, Cohen JA, Scheeringa MS, Quast T, & Storch EA (2022 Nov 24 early online). Exploring Treatment Response Predictors of a Parent-Led Therapist-Assisted Treatment for Childhood Trauma. Research on Social Work Practice, 0(0). doi: 10.1177/10497315221137880.
84) Pacheco CR, Scheeringa MS (online 2022 Aug 19). Clinical wisdom in the age of computer apps: A systematic review of mental health apps. the Cognitive Behaviour Therapist 15:e40 doi:10.1017/S1754470X22000368.
85) Salloum A, Lu Y, Chen H, Salomon K, Scheeringa MS, Cohen JA, Swaidan V, & Storch EA (2022). Child and parent secondary outcomes in stepped care versus standard care treatment for childhood trauma. Journal of Affective Disorders, 307 87-96. https://doi.org/10.1016/j.jad.2022.03.049.
86) **Pacheco CR, Scheeringa, MS (2022). Post-traumatic stress and autobiographical memory accuracy in young children: Traumatic events versus stressful and pleasant events. Journal of Aggression, Maltreatment, & Trauma 31(6):695-714, doi: 10.1080/10926771.2021.1994498.
—There is no other psychiatric disorder like PTSD in which memory plays such a central role. This has led to many different speculations, including that trauma memories are remembered more accurately or less accurately than non-trauma memories, and that general memory functions are disrupted. We found the following:
1) Accurate recall of trauma events did not vary with severity of PTSD. This finding was consistent across three types of trauma groups: Single Event, Repeated Events, and Hurricane Katrina. This finding contrasted with most of the prior literature, which we think is due to a key difference in measurement. Prior studies relied on the amount of information recalled and had no independent validity check if the memories were accurate. Because we worked with very young children, we had the advantage of mothers who verified the accuracy of recall. We speculated that some of the memories that were counted as accurate in prior studies were inaccurate.
2) Accurate recall of pleasant events did not vary with severity of PTSD, suggesting that there is no general memory deficit.
3) Trauma-exposed children (regardless of PTSD severity) were less accurate about trauma events compared to pleasant events. Drilling down on this finding, this appeared to be due to the Repeated Events and Hurricane Katrina groups having worse memory of trauma events compared to the Single Event group. This could have been due to the simple fact that Repeated Events and Hurricane Katrina events were complicated and drawn-out affairs that are more difficult to keep organized (and does not reflect an underlying memory problem).
4) Accurate recall of trauma events in the three trauma-exposed groups did not differ compared to recall of stressful events in the non-trauma-exposed control group, suggesting that trauma memories are not remembered with greater or lesser accuracy. A post hoc test, however, showed that the Repeated Events group had worse accuracy of trauma events compared to the Single Event and control groups.
5) There was no difference in accuracy of pleasant events between the three trauma-exposed groups and the non-trauma-exposed group, suggesting that there is no generalized memory deficit.
—Overall, these data ought to provide confidence to clinicians that narrative recall is well within the developmental capacities of this age group, furthering an argument that play therapy needlessly relies on indirect and gradual methods to draw out trauma memories and underestimates the developmental capacities of young children to engage in direct conversations.
87) Mikolajewski AJ, Scheeringa MS (2022). Links between Oppositional Defiant Disorder Dimensions, Psychophysiology, and Interpersonal Versus Non-interpersonal Trauma. Journal of Psychopathology and Behavioral Assessment 44(1): 261-275, doi: 10.1007/s10862-021-09930-y.
88) Salloum A, Lu Y, Chen H, Quast T, Cohen JA, Scheeringa MS, Salomon K, Storch EA (2022). Stepped Care versus Standard Care for Children after Trauma: A Randomized Non-inferiority Clinical Trial. Journal of the American Academy of Child & Adolescent Psychiatry 61(8): 1010-1022.
89) Khunkhun V, Pacheco C, Burns L, Gershen S, Mai TA, Scheeringa MS (2022). Patient preferences for shared decision making in mental health care. Patient Educ Couns. Apr;105(4):1048-1049. doi: 10.1016/j.pec.2021.07.026.
1) Scheeringa MS (2016). Treating PTSD in Preschoolers: A Clinical Guide. New York: Guilford Press. ISBN 978-1462522330.
2) Scheeringa MS (2018). They’ll Never Be The Same: A Parent’s Guide to PTSD in Youth. Las Vegas: Central Recovery Press. ISBN 978-1942094616.
3) Scheeringa MS (2022). The Trouble With Trauma: The Search to Discover How Beliefs Become Facts. Las Vegas: Central Recovery Press. ISBN 978-1949481563.
4) Scheeringa MS (2023 4 25). Analysis of The Body Keeps the Score: The Science That Trauma Activists Don’t Want You to Know. Coppell, TX: Self published (Kindle Direct Publishing). ISBN 979-8391790136.
Articles
**Indicates the most important articles.
1) Zeanah CH, Scheeringa MS, Boris NW (1994). Parenting styles and risks in the vulnerable infant. Current Opinion in Pediatrics, 6, 4:406-410.
2) **Scheeringa MS, Zeanah CH, Drell MJ, Larrieu JA (1995). Two approaches to the diagnosis of posttraumatic stress disorder in infancy and early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 2:191-200.
—This was the first study of a group of trauma-exposed children under four years of age (previous articles had been case reports). Although small (N = 12 trauma-exposed children) this established a precedent of using standardized assessment methods in this population and began a programmatic series of studies over nearly three decades to empirically demonstrate the diagnostic validity of developmentally-sensitive criteria for PTSD in children six years of age and younger.
3) Scheeringa MS, Zeanah CH (1995). Symptom differences in traumatized infants and young children. Infant Mental Health Journal, 16, 4:259-270.
4) Zeanah CH, Scheeringa MS (1996). Evaluation of posttraumatic symptomatology in infants and young children exposed to violence. Zero to Three: Special issue on Islands of Safety: Assessing and treating young victims of violence, 16, 5:9-14.
5) Zeanah CH, Boris NW, Scheeringa MS (1997). Psychopathology in Infancy. Journal of Child Psychology and Psychiatry, 38, 1:81-99.
6) Zeanah CH, Boris NW, Scheeringa MS (1997). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman (Eds.), Psychiatry (pp.75-100). Philadelphia: W.B. Saunders Co.
7) Zeanah CH, Scheeringa MS (1997). The experience and effects of violence in infancy. In JD Osofsky (Ed.), Children in a Violent Society (pp. 97-123). New York: Guilford Press.
8) Osofsky JD, Scheeringa MS (1997). Community and domestic violence exposure: Effects on development and psychopathology. In D. Cicchetti, S.L. Toth (Eds.), Rochester Symposium on Developmental Psychopathology, volume 8. Developmental Perspectives on Trauma: Theory, Research, and Intervention (pp. 155-180). Rochester, NY: University of Rochester Press.
9) Boris NW, Zeanah CH, Larrieu JA, Scheeringa MS, Heller SS (1998). Attachment disorders in infancy and early childhood: A preliminary investigation of diagnostic criteria. American Journal of Psychiatry, 155, 2:295-297.
10) Scheeringa MS (1999). Treatment of posttraumatic stress disorder in infants and toddlers. Journal of Systemic Therapies, 18,2:20-31.
—Always wanting to make a real impact on patients’ lives, I jumped at an invitation to write about treatment (as opposed to assessment). While I would later abandon some of this early thinking, much of it would find its way into my later work on cognitive behavioral therapy (CBT).
11) Scheeringa MS, Gaensbauer TJ (2000). Posttraumatic stress disorder. In CH Zeanah (Ed.), Handbook of Infant Mental Health, second edition (pp. 369-381). New York, NY: Guilford Press.
—We laid out for the first time in a systematic fashion the emerging developmental capacities that underlie PTSD symptoms.
12) **Scheeringa MS, Peebles CD, Cook CA, Zeanah CH (2001). Toward establishing procedural, criterion and discriminant validity for PTSD in early childhood. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1: 52-60.
—This added several elements to the diagnostic validation of PTSD in very young children. Although it was a small sample (N = 15 trauma-exposed and N = 12 controls), the most important element, and probably the most overlooked, was procedural validity, which confirmed what was already known clinically that observation of young children or examiner-directed play reenactments do not add useful information above and beyond parental reports.
13) Scheeringa MS, Zeanah CH (2001). A relational perspective on PTSD in early childhood. Journal of Traumatic Stress, 14(4):799-815.
—This is the only article that I regret publishing. This was the first literature review on the association between parental and family factors with children’s severity of PTSD symptoms. I believe we placed far too much emphasis on a causal theory that parenting can cause or exacerbate symptoms in children, which I stopped believing soon thereafter. And we placed far too little emphasis on shared genetic vulnerability as the probable cause of the positive correlation between parents’ and children’s symptoms. This is unfortunately my most frequently cited paper because many researchers still believe in the unsupported and oft-disproven theory of blaming parents for children’s symptoms.
14) Scheeringa MS (2001). The differential diagnosis of impaired reciprocal social interaction in children: Review of disorders. Child Psychiatry and Human Development, 32(1):71-89.
—I was frustrated by clinicians missing the diagnosis of high-functioning autism in very young children. This would be the only paper I would write on autism.
15) Stafford B, Zeanah CH, Scheeringa M (2003). Exploring psychopathology in early childhood: PTSD and attachment disorders in DC:0-3 and DSM-IV. Infant Mental Health Journal, 24, 398-409.
16) Task Force on Research Diagnostic Criteria: Infancy and Preschool (2003) (Scheeringa, chair and primary author). Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1504-1512.
—With funding support from the American Academy of Child and Adolescent Psychiatry, I put together a group of leaders in infant and preschool psychiatry. We met twice and hashed out a document to try to systematically move forward the research on disorders in this age group. It turned out to be wishful thinking as few researchers would pursue diagnostic validation research.
17) **Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2003). New findings on alternative criteria for PTSD in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 5:561-570.
—This followed up my 1995 and 2001 studies with a substantially larger sample (N = 62 trauma-exposed and N = 63 controls) to show that children six years and younger could develop PTSD but the diagnostic criteria needed developmental modifications. This was the first paper to examine the comorbid disorders that exist with PTSD in this age group. This paper was given the AACAP Norbert and Charlotte Rieger Award for Scientific Achievement for the most significant paper published in the Journal of the American Academy of Child and Adolescent Psychiatry for the past year.
18) Zeanah CH, Stafford, B, Boris NW, Scheeringa MS (2003). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman (Eds.), Psychiatry, Second Edition (pp.91-117). West Sussex, England: John Wiley & Sons, Ltd.
19) Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2004). Heart period and variability findings in preschool children with posttraumatic stress symptoms. Biological Psychiatry 55(7), 685-691.
—This was the first research to examine a neurobiological correlate of PTSD in very young children. Associations between heart rate variability and PTSD were underwhelming, which started a rocky evolution for me to understand that while neurobiology of course underlies psychopathology, neurobiology can be highly variable in a disorder that is highly variable.
20) Boris NW, Hinshaw-Fuselier SS, Smyke AT, Scheeringa MS, Heller SS, Zeanah CH (2004). Comparing criteria for attachment disorders: Establishing reliability and validity in high-risk samples. Journal of the American Academy of Child and Adolescent Psychiatry, 43(5), 568-577.
21) Zeanah CH, Scheeringa MS, Boris NW, Heller SS, Smyke AT, Trapani J (2004). Reactive attachment disorder in maltreated toddlers. Child Abuse and Neglect 28(8), 877-888.
22) Scheeringa MS (2004). Posttraumatic Stress Disorder. In R DelCarmen-Wiggins, A Carter (Eds.), Handbook of Infant, Toddler, and Preschool Mental Health Assessment (pp. 377-397). New York, NY: Oxford University Press.
—Building on a prior book chapter (pub 11), I laid out in more detail the emerging developmental capacities that need to be on line for PTSD to develop. I speculated that PTSD could conceivably develop by nine months of age at the earliest. I would later discover empirically that was far off, and would revise the earliest age to around three years.
23) **Scheeringa MS, Zeanah CH, Myers L, Putnam FW (2005). Predictive validity in a prospective follow-up of PTSD in preschool children. Journal of the American Academy of Child and Adolescent Psychiatry 44(9), 899-906.
—This was the first prospective longitudinal study of PTSD symptoms in children 6 years and younger. It was important for showing that PTSD severity did not significantly decrease naturally over two years. In a subset that received community treatment-as-usual, severity also did not decrease, most likely suggesting that evidence-based PTSD treatment was not being used in the community.
24) **Scheeringa MS, Wright MJ, Hunt JP, Zeanah CH (2006). Factors affecting the diagnosis and prediction of PTSD symptomatology in children and adolescents. American Journal of Psychiatry 163(4), 644-651.
—This was the first study to assess PTSD across the entire age range of childhood with a sample that had experienced similar types of trauma (accidental injuries). For the fourth time, we showed that very young children need developmentally-modified diagnostic criteria. Also, we showed for the first time that 7-11 year-old children probably need developmentally-modified criteria too. In addition, this was the first study to combine child-report with parent-report of PTSD symptoms, and we showed that combined reports produce much higher (and more accurate) estimates of severity and diagnosis compared to child- or parent-report alone (which would be replicated consistently at multiple sites).
25) Dehon C, Scheeringa MS (2006). Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist. Journal of Pediatric Psychology 31(4), 431-435.
—While this was a mildly interesting study to show that a subset of 15 items from the CBCL could correlate with PTSD severity in very young children, I would never recommend the CBCL as a PTSD screen.
26) Scheeringa MS (2006). Posttraumatic Stress Disorder: Clinical Guidelines And Research Findings. In J Luby (Ed.), Handbook of Preschool Mental Health (pp 165-185). New York: Guilford Press.
—In addition to the traditional chapter organization of epidemiology, course, diagnosis, and treatment, I summarized for the first time from four studies the symptoms of PTSD in very young children from most to least frequent.
27) Scheeringa MS, Salloum A, Arnberger RA, Weems CF, Amaya-Jackson L, Cohen JA (2007). Feasibility and Effectiveness of Cognitive-Behavioral Therapy for Posttraumatic Stress Disorder in Preschool Children: Two Case Reports. Journal of Traumatic Stress 20(4), 631-636.
—We presented two treatment cases. These served as proof of concept that treating very young children with key CBT techniques for PTSD was feasible. Prior studies by Cohen, Mannarino, and Deblinger had shown that a CBT package was effective overall, but they had not reported data on children’s cooperation with tasks.
28) Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, Luby JL, Owens J, Scahill LD, Scheeringa MS, Stafford B, Wise B, Zeanah CH (2007). Psychopharmacological treatments for very young children: Contexts and guidelines. Journal of the American Academy of Child and Adolescent Psychiatry 46(12), 1532-1572.
29) Scheeringa MS (2007). CBT Treatment Within the First Month. American Journal of Psychiatry, 164, 8, 1267.
—Letter to the editor which noted that nearly all individuals show PTSD symptoms initially following trauma, but those resolve for most people within the first month. The recommendation for most individuals after trauma is to watch-and-wait for one month before seeking treatment except in severe cases.
30) Scheeringa MS (2007). A Research Agenda for Posttraumatic Stress Disorder in Infants, Toddlers, and Preschool Children. In : Narrow WE, First MB, Sirovatka PJ, Regier DA (eds): Age and Gender Considerations in Psychiatric Diagnosis: A Research Agenda for DSM-V (pp. 151-162). Arlington, VA: American Psychiatric Association.
—During the earliest stage of considering revisions to the DSM-IV, I was asked to summarize the state of research for PTSD in young children.
31) Zeanah CH, Stafford, B, Boris NW, Scheeringa MS (2008). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J., Lieberman, M.B. First, & M. Maj (Eds.), Psychiatry, Third Edition. Chichester, UK: John Wiley & Sons, Ltd. doi 10.1002/9780470515167.ch8.
32) Scheeringa MS (2008). Developmental considerations for diagnosing PTSD and acute stress disorder in preschool and school-age children. American Journal of Psychiatry 165(10), 1237-1239.
—Invited editorial to comment on an excellent study by Richard Meiser-Stedman and colleagues.
33) **Scheeringa MS, Zeanah CH (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology 37(3), 508-518.
—It had been well-established by other researchers with adults that 80-90% of individuals with PTSD have one or more comorbid psychiatric disorders. For a special issue on PTSD in this journal, I submitted the early results on a subset (Hurricane Katrina victims only) of our larger sample (see pub 45) to examine the key issue of whether comorbid disorders exist prior to trauma exposure or develop after trauma exposure (the answer: it is about 50-50). This was the first study in very young children that tracked the date of onset of comorbid disorders. It was also the first study to replicate McMillen et al.’s (2002) important finding that new comorbid disorders do not arise in isolation from PTSD (i.e., comorbid disorders nearly always arise in parallel with substantial PTSD symptoms). This was my fifth study testing developmentally-modified criteria for PTSD for very young children.
34) Dalton R, Scheeringa MS, Zeanah CH (2008). Did the Prevalence of PTSD Following Hurricane Katrina Match A Rapid Needs Assessment Prediction? A Template for Future Public Planning After Large-Scale Disasters. Psychiatric Annals 38(2), 134-141. PMID: 17721975.
—After living through the Hurricane Katrina disaster, we estimated the scope of PTSD. I had done some of this work in 2005 to plan for a large-scale intervention that I thought I was going to run with federal funding. The funding rug was pulled from under our feet at the last minute by the state, but this got me interested in disaster psychiatry for a brief time.
35) Drury SS, Scheeringa MS, Zeanah CH (2008). The Traumatic Impact Of Hurricane Katrina On Children In New Orleans. Child and Adolescent Psychiatric Clinics of North America 17, 685-702.
36) Scheeringa MS (2009). Posttraumatic stress disorder. In CH Zeanah (Ed.), Handbook of Infant Mental Health, third edition (pp. 345-361). New York, NY: Guilford Press.
—I used this book chapter to expound on the rapidly-changing memory capacities that are developing from birth to seven. Also, I began to grudgingly give up the speculation that PTSD could fully manifest before one year of age, but I had not yet settled on my current thinking that three years is the minimum age.
37) Robinson LR, Morris AS, Heller SS, Scheeringa MS, Boris NW, Smyke AT (2009). Relations between emotion regulation, parenting, and psychopathology in young maltreated children in out of home care. Journal of Child and Family Studies 18 (4), 421-434.
38) Cohen JA, Scheeringa MS (2009). Post-traumatic stress disorder diagnosis in children: Challenges and promises. Dialogues in Clinical Neuroscience 11(1), 91-99.
—Judith Cohen had been invited by this journal to summarize the current state of assessing PTSD in children and she asked me to co-author.
39) Drury SS, Theall KP, Keats BJB, Scheeringa MS (2009). The role of the dopamine transporter (DAT) in PTSD in preschool children. Journal of Traumatic Stress 22,6, 534-539.
—This was the first study of a gene in children of any age with PTSD. We found that an allele of the dopamine transporter was associated with more severe PTSD. Single gene studies, however, were about to become rapidly obsolete with the advent of relatively inexpensive genome-wide association techniques.
40) **Scheeringa MS, Haslett, N (2010). The reliability and criterion validity of the Diagnostic Infant and Preschool Assessment: A new diagnostic instrument for young children. Child Psychiatry & Human Development, 41, 3, 299-312.
—I was so frustrated with the only existing interview (PAPA) for the psychiatric diagnoses of very young children, that I made my own. The PAPA was excessively long, not focused exclusively on psychopathology, and available only for a fee. My interview, the DIPA, was 68% shorter, focused only on psychopathology, organized by DSM disorder, measured impairment specific to each syndrome, and free. The DIPA has become the most widely used interview for psychiatric disorders in very young children in the world.
41) Scheeringa MS, Zeanah CH, Cohen JA (2011). PTSD in children and adolescents: Towards an empirically based algorithm. Depression and Anxiety 28:9, 770-782.
—As the DSM-5 planning committee was reviewing the evidence for possible revisions for the 2013 launch of revisions to the DSM-IV, I was asked to help summarize the state of the evidence on diagnostic validity for children and adolescents.
42) Scheeringa MS (2011). PTSD in Children Younger Than Age of 13: Towards a Developmentally Sensitive Diagnosis. Journal of Child & Adolescent Trauma 4:3, 181-197.
—Kathleen Nader organized a special issue on assessment of PTSD in youth for this journal and she asked me to summarize the evidence for children 13 years and younger. Whereas pub 41 focused on diagnostic validity evidence, this paper focused more on assessment techniques and procedures.
This issue of the journal was later reprinted as a book. My chapter in the book is a duplicate of the journal article. The book chapter citation is: Scheeringa MS (2014). PTSD in Children Younger Than the Age of 13: Towards Developmentally Sensitive Assessment and Management. In K. Nader (Ed.), Assessment of Trauma in Youths: Understanding issues of age, complexity, and associated variables (pp. 21-37). New York, NY: Routledge.
43) **Scheeringa MS, Weems CF, Cohen JA, Amaya-Jackson L, Guthrie D (2011). Trauma-focused cognitive-behavioral therapy for posttraumatic stress disorder in three through six year-old children: A randomized clinical trial. Journal of Child Psychology and Psychiatry, 52, 8, 853-860. DOI: 10.1111/j.1469-7610.2010.02354.x.
—This was the third randomized controlled trial of a treatment for PTSD in very young children. Cohen & Mannarino (1996) and Deblinger (2001) had conducted the first two studies on sexual-abuse trauma. The inclusion criteria for my study included every type of trauma besides sexual. We showed that not only did the treatment work through a six-month follow-up, but we documented the feasibility of each technique (e.g., narrative recall, relaxation exercises, and doing homework) and tracked comorbid disorders.
44) Drury SS, Scheeringa MS, Schmidt KE, Nelson CA (2011). From biology to behavior to the law: Policy implications of the neurobiology of early adverse experiences. Whittier Journal of Child and Family Advocacy 19(1), 25-51.
—This article is a mixed bag. I no longer would be part of giving such a positive spin on the theory that stress and trauma can permanently damage brains. I did not believe it at the time this was written either but I did not yet realize how this theory was being weaponized as an ideology to promote cultural Marxism (that realization would come in several more years). I naively thought we were still having a debate among scientists. Despite second thoughts about being a co-author, however, I stayed involved for two reasons: (1) I was able to tone down the causal language from “does cause” brain damage to “may cause” in about a dozen places; and (2) I wrote Section IV which exposed the lunacy of the federal government’s mental health response policy following disasters. I had already tried but failed to get an exposé on federal policy published in other outlets because, I believe, it is such a rare experience for most communities that peer reviewers and editors did not understand it and did not quite trust my depiction.
45) **Scheeringa MS, Myers L, Putnam FW, Zeanah CH (2012). Diagnosing PTSD in Early Childhood: An Empirical Assessment of Four Approaches. Journal of Traumatic Stress, 25(4), 359-367.
—This is the largest sample of trauma-exposed children 3- to 6-years (N = 284) ever collected. It was an enormous effort with at least 17 recruitment sites in the New Orleans area. It included 62 children with a single-incident trauma exposure, 85 with repeated trauma exposures (mostly witnessing domestic violence), and 137 exposed to Hurricane Katrina, plus a non-trauma-exposed control group of 46 children. We compared the DSM-IV criteria to three alternative sets of diagnostic criteria being considered for the DSM-5. This study, my sixth to examine developmentally-modified PTSD criteria for this age group, plus similar studies by investigators at several other sites (see pubs 26, 36, and 41), provided the empirical evidence for the DSM-5 to create the new disorder PTSD for children 6 years and younger, the first developmentally-modified criteria for a major psychiatric syndrome in the DSM. Among other findings, we showed that two new symptoms being considered—persistent negative emotional states and reckless/self-destructive behavior—added nothing of value to the diagnostic criteria, which was instrumental in keeping these symptoms out of the final DSM-5 criteria for young children. Unfortunately, research with a similar level of rigor was not conducted in older children and adults and those epically bad symptoms were included in the general PTSD criteria.
46) Weems CF, Scheeringa MS (2013). Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. Journal of Anxiety Disorders 27(1), 140-146.
47) Drury SS, Brett ZH, Henry C, Scheeringa M (2013) The association of a novel haplotype in the dopamine transporter with preschool age PTSD. Child and Adolescent Psychopharmacology 23(4): 236-243. doi:10.1089/cap.2012.0072.
48) Humphreys K, Drury S, Scheeringa MS (2014). Race moderates the association of Catechol-O-methyltransferase genotype and posttraumatic stress disorder in preschool children. Journal of Child and Adolescent Psychopharmacology, 24(8), 454-457.
49) Salloum A, Robst J, Scheeringa MS, Cohen JA, Wang W, Murphy T, Tolin D, & Storch EA (2014). Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy for Young Children: A Pilot Study. Child Psychiatry and Human Development, 45, 65-77, DOI 10.1007/s10578-013-0378-6.
—Alison Salloum worked with me on my CBT RCT. When she moved to the University of South Florida, she created an innovative stepped care treatment. I helped train her staff to use the DIPA and my CBT manual for part of the intervention.
50) Salloum A, Scheeringa MS, Cohen JA, Storch EA (2014). Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children. Cognitive and Behavioral Practice 21(1), 97-108, doi: 10.1016/j.cbpra.2013.07.004.
51) Scheeringa MS, Weems C (2014). Randomized Placebo-Controlled D-Cycloserine with Cognitive Behavior Therapy for Pediatric Posttraumatic Stress. Journal of Child and Adolescent Psychopharmacology, 24(2), 69-77. DOI 10.1089/cap.2013.0106.
—Because individuals with PTSD who benefit from psychotherapy do not achieve full remission, and there is a smaller proportion of individuals who do not benefit much from psychotherapy, and traditional drug treatments seem less effective than psychotherapy, there is a need for new interventions. The novel practice of taking D-cycloserine one hour prior to psychotherapy sessions seemed to work for other anxiety disorders so we tried it with PTSD. Seven- through 18-year-old youths with high levels of PTSD symptoms were randomly allocated to CBT+D-cycloserine or CBT+placebo. The CBT was my Youth PTSD Treatment protocol (YPT). This was the first, and only, trial to try this strategy with children and adolescents. It did not work, unfortunately, because both groups showed large improvements. The evidence with adults with PTSD has been mixed.
52) Scheeringa MS, Cobham VE, McDermott B (2014). Policy and administrative issues for large-scale clinical interventions following disasters. Journal of Child and Adolescent Psychopharmacology 24(1), 39-46, doi: 10.1089/cap.2013.0067.
—In the last hurrah of my interest in disaster psychiatry, we tried to publish something to save future communities from learning lessons about disaster mental health interventions the way we learned (the hard way). Drs. Cobham and McDermott had extensive experience in Australia that complemented my experience with Hurricane Katrina.
53) Weiss, A, Scheeringa, MS (2014). Psychopharmacological Treatment of Delirium: Does Earlier Treatment and Scheduled Dosing Improve Outcomes? Journal of the Louisiana State Medical Society, 166(6), 242-247.
54) Humphreys, KL, Zeanah CH, Scheeringa MS (2015). Infant development: The first 3 years of life. In A. Tasman, J. Kay, J. Lieberman, M.B. First, & M. Maj (Eds.), Psychiatry, Fourth Edition. Chichester, UK: John Wiley & Sons, Ltd., doi 10.1002/9781118753378.ch9.
55) Weems CF, Scott BG, Graham RA, Banks DM, Russell JD. Taylor LK, Cannon M, Varela RE, Scheeringa MS, Perry AM, & Marino RC (2015). Fitting Anxious Emotion Focused Intervention into the Ecology of Schools: Results from a Test Anxiety Program Evaluation. Prevention Science, 16(2), 200-210. DOI 10.1007/s11121-014-0491-1.
56) Salloum, A, Scheeringa, MS, Cohen, JA, & Storch, EA (2015). Responder status criterion for stepped care trauma-focused cognitive behavioral therapy for young children. Child and Youth Care Forum, 44(1), 59-78. DOI 10.1007/s10566-014-9270-1.
57) **Scheeringa MS, Myers L, Putnam FW, Zeanah CH (2015). Maternal Factors as Moderators or Mediators of PTSD Symptoms in Preschool Children: A Two-Year Prospective Study. Journal of Family Violence, 30(5), 633-642, DOI: 10.1007/s10896-015-9695-9.
—This study provided empirical evidence that helped me confirm that my previous support of parent-blaming (pub 13) was wrong. Our study design addressed two major problems of prior research which was nearly all cross-sectional and lacked objective measures of actual parenting skills. By measuring parenting four different ways and following them for two years, we showed that greater maternal emotional sensitivity with their children predicted more, not fewer, PTSD symptoms in children after two years. This is problematic evidence for many experts who view maternal sensitivity as the keystone regulator for better child development and protection against psychopathology.
58) **Scheeringa, MS (2015). Untangling Psychiatric Comorbidity in Young Children Who Experienced Single, Repeated, or Hurricane Katrina Traumatic Events. Child and Youth Care Forum 44(4), 475-492. DOI 10.1007/s10566-014-9293-7.
—(1) As noted in pub 33, an important issue is whether comorbid disorders exist prior to trauma exposure or develop after trauma exposure. Trauma researchers have been strangely uncurious about this; prior to this study there had been only two studies that I am aware of that tracked the dates of onsets of comorbid disorders (and I did one of them). The Repeated Events group had significantly more ODD diagnoses that had onsets prior to the earliest traumatic events compared to both the Single Event Katrina groups, showing that trauma does not happen at random to individuals.
—(2) Another accepted dogma among trauma researchers has been that repeated trauma events cause worse outcomes than single-blow traumas. Contrary to that dogma, we found no difference in severity between the Repeated Events group and the other two groups across five disorders.
—(3) A third accepted dogma has been that interpersonal trauma causes more severe outcomes than non-interpersonal trauma. The Repeated Events group was comprised mostly of interpersonal trauma, so our findings debunked that dogma too.
59) Scheeringa MS (2016). Validity of measurement of suicidal ideas in very young children. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 3, 243.
—Letter to the editor that provided data to counter a claim from a recently published article that greatly overestimated suicidal ideas in young children.
60) Salloum A., Wang W, Robst J, Murphy TK, Scheeringa MS, Cohen JA, Storch EA (2016). Stepped Care Versus Standard Trauma-Focused Cognitive Behavioral Therapy for Young Children. Journal of Child Psychology and Psychiatry, 57(5), 614-22.
61) Wamser R, Weems, CW, Scheeringa MS (2016). Early treatment response in children and adolescents receiving CBT for trauma. Journal of Pediatric Psychology, 41(1), 128-137.
—Using data from my D-cycloserine RCT (pub 51), Rachel Wamser-Nanney investigated the situation that is often seen in trials and daily clinic work in which a subgroup improves more rapidly than others, usually within three- to four-sessions. We showed that 32% were early responders, and they reported lower baseline levels of PTSD, depression, anxiety, rumination, and fewer traumas compared to nonearly responders.
62) Mikolajewski AJ, Scheeringa MS, Weems CF (2017). Evaluating DSM-5 Posttraumatic Stress Disorder Diagnostic Criteria in Older Children and Adolescents. Journal of Child and Adolescent Psychopharmacology 27(4), 374-382. doi: 10.1089/cap.2016.0134.
—Since I first hypothesized that 7-11 year-old children probably needed developmentally-modified PTSD criteria (just like 6 years and younger children) in 2006 (pub 24), I had been wanting to follow this up with another study. The D-cycloserine study finally presented that opportunity. We showed that a significantly higher proportion of 7–12-year-old children met criteria for DSM-5 criteria for very young children (53%) compared to the DSM-IV criteria (37%). However, among 13–18-year-old adolescents, the proportions diagnosed with DSM-5 (73%) and DSM-IV (74%) did not differ. This seemed to confirm my hypothesis.
63) Salloum A, Small BJ, Robst J, Scheeringa MS, Cohen JA, Storch EA. (2017). Stepped and standard care for childhood trauma: A pilot randomized clinical trial. Research on Social Work Practice 27(6):653-663, doi 10.1177/1049731515601898
64) Humphreys K, Weems CF, Scheeringa MS (2017). The role of anxiety control and treatment implications of informant agreement on child PTSD symptoms. Journal of Clinical Child and Adolescent Psychology, 46(6), 903-914. doi: 10.1080/15374416.2015.1094739.
65) **Scheeringa MS, Lilly ME, Staiger AB, Heller ML, Jones EG, Weems CF (2017). Do Children and Adolescents Have Different Types of Trauma Narratives and Does it Matter? Reliability and Face Validation for a Narrative Taxonomy. Journal of Traumatic Stress 30(3), 323-327. DOI: 10.1002/jts.22190.
—Milking another benefit out of the D-cycloserine RCT (pub 51), this was the first study to systematically examine the types of narratives that youths express about their trauma experiences during psychotherapy. First, we showed that there are four types of narratives that can be reliably identified: expressive, avoidant, undemonstrative, and fabricated. Second, we found that, contrary to folklore, patients do not have to be emotionally expressive or fluent about trauma details in order to get better. This also means that, again, contrary to folklore, asking avoidant youths to discuss trauma experiences is not harmful.
66) Matais-Cols D., Fernández de la Cruz L., Monzani B., Rosenfield D., Andersson E., Pérez-Vigil A., and 35 more authors (2017). D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders, JAMA Psychiatry 74(5), 501-510.
67) **Lipschutz R, Gray SAO, Weems CF, Scheeringa MS (2017). Respiratory sinus arrhythmia in cognitive behavioral therapy for posttraumatic stress symptoms in children: Treatment and gender effects. Applied Psychophysiology and Biofeedback 42(4), 309-321, Dec.
—Milking yet another benefit out of the D-cycloserine RCT (pub 51), this study put some more empirical flesh on the bones about my growing awareness that neurobiology of psychopathology is highly variable within a disorder (pub 19), and making black-and-white claims about linear relationships between neurobiology and disorders is overly simplistic. Specifically, the existing evidence appeared to indicate that individuals with PTSD (1) have lower resting RSA, (2) show blunted RSA reactivity to stressors, and (3) should increase both resting RSA and reactivity of RSA in parallel with successful psychotherapy. Long story short, we found that those with higher initial resting RSA decreased their resting RSA by the end of treatment, and those with lower initial resting RSA increased their resting RSA by the end of treatment. In other words, the extremes at both ends converged toward a middle ground. Similarly, those with higher initial resting RSA showed initial net decreased RSA reactivity to stressors and increased their RSA reactivity by the end of treatment, and those with lower initial resting RSA showed initial net increased RSA reactivity to stressors and decreased their RSA reactivity by the end of treatment. Again, the extremes of RSA reactivity at both ends converged toward a middle ground. I do not know if this is just regression to the mean or an accurate reflection of neurobiology profiles. Nevertheless, this may help to explain why so many neurobiology studies have failed to be replicated. Any study that finds a neurobiological variable to be “high” or “low” for an entire group is probably a spurious finding that is missing the bigger picture. This also illustrates the massive weakness of cross-sectional studies.
68) Miron D, Scheeringa MS (2017). Cognitive Behavioral Therapies for Preschool Children. In J Luby (Ed.), Handbook of Preschool Mental Health, Second Edition (pp. 292-310). New York: Guilford Press.
69) De Young AC, Scheeringa MS (2018). Posttraumatic stress disorder in children 6 years and younger. In FJ Stoddard, DM Benedek, MR Milad, & RJ Ursano (Eds.), Primer on Trauma- and Stressor-Related Disorders (pp. 85-102). New York, NY: Oxford University Press.
70) Gray SAO, Lipschutz R, Scheeringa MS (2018) Young children’s physiological reactivity during memory recall: Associations with posttraumatic stress and parent physiology. Journal of Abnormal Child Psychology 46, 871-880 doi 10.1007/s10802-017-0326-1.
—Using my data from the study of 284 trauma-exposed and 46 non-trauma exposed 3- to 6-year-old children (pub 45), Sarah Gray examined RSA reactivity. We showed that RSA reactivity decreased when exposed to three types of stressor stimuli (child recalls pleasant event, child recalls trauma event, and parent recalls trauma event), and there were no differences in reactivity between groups with PTSD, trauma without PTSD, and no trauma exposure with one exception. During one of the stressor stimuli (child recalls trauma event), the PTSD group showed larger decreases in RSA reactivity compared to the trauma without PTSD group.
Sarah also conducted the first examination of parent-child synchrony of RSA in the context of child PTSD. During child recall of trauma event, the trauma without PTSD group showed higher synchrony of RSA with their caregivers compared to the PTSD group and the no trauma group. During parent recalls trauma event, the PTSD and trauma without PTSD groups showed higher synchrony of RSA with their caregivers compared to the no trauma group. The findings were mixed but point in the direction that higher synchrony of RSA between child and caregiver may indicate resilience against developing PTSD.
There are multiple ways one could interpret these findings. Because it is not clear whether synchrony is a good, bad, or neutral thing, and the data were cross-sectional, these findings raise more questions than they answer. The only thing I can say for certain is that better data are needed to untangle the situation.
71) **Mikolajewski AJ, Scheeringa MS (2018). Examining the prospective relationship between pre-disaster respiratory sinus arrhythmia and post-disaster posttraumatic stress disorder symptoms in children. Journal of Abnormal Child Psychology, Vol 46(7), Oct, 2018 pp. 1535-1545, doi 10.1007/s10802-017-0396-0.
—Undoubtedly, the most important question about neurobiology and PTSD is whether neurobiological differences exist prior to trauma exposure and serve as vulnerability factors or neurobiological differences are caused by trauma exposure. Hurricane Katrina gave me a rare opportunity to test this question. During recruitment for my large study of 3- to 6-year-old trauma-exposed children (pub 45), Hurricane Katrina struck smack in the middle. Of the 156 children who had been assessed prior to the disaster, we were able to locate and bring back 36 for a second, post-disaster assessment. Despite the modest size, it was only the third pretrauma prospective study with children, and remains the only one with very young children. When Amy Mikolajewski analyzed the data, lower pretrauma resting RSA and increased pretrauma RSA reactivity predicted the development of more PTSD symptoms. Any changes from pretrauma resting RSA to posttrauma resting RSA did not predict change in PTSD symptoms. Any changes from pretrauma RSA reactivity to posttrauma RSA reactivity did not predict change in PTSD symptoms. Overall, the evidence supports that differences in RSA status (both resting and reactivity) that predicted PTSD symptoms existed prior to trauma exposure.
72) Neill EL, Weems CF, Scheeringa MS (2018). CBT for Child PTSD is Associated with Reductions in Maternal Depression: Evidence for Bidirectional Effects. Journal of Clinical Child and Adolescent Psychology 47(3), 410-420, doi 10.1080/15374416.20161212359.
—Analyzing another aspect of the D-cycloserine study with 7-18-year-old children, Erin Neill found that any causal effects of mothers impacting children, or vice versa, appeared bidirectional. In addition, using a simple measure I created for this study, we asked mothers near the end of treatment who changed first, the mother or the child? Fifty-three percent reported that their child improved first, 17% felt they improved at the same time, and only 25% felt that mothers improved first and then children improved. This was additional evidence—from the mouths of the mothers themselves—against the consensus folklore of universally blaming mothers for children’s symptoms.
73) Scheeringa MS (2018). Review of Posttraumatic Play in Children by Eliana Gil. Journal of the American Academy of Child & Adolescent Psychiatry, 57,11:890-892.
—I was exasperated by reports from parents who came to my clinical practice with stories of their children being treated with endless play therapy for PTSD and never getting better. Play therapy has a small role with nonverbal children below three years of age, but once they become verbal and able to cooperate with cognitive techniques, there is no excuse for not using CBT. In this book review, I debunked multiple nonsensical notions promoted by Eliana Gil.
74) Scheeringa MS, Burns, LC (2018). Generalized anxiety disorder in very young children: First case reports on stability and developmental considerations. Case Reports in Psychiatry, vol. 2018, Article ID 7093178, doi 10.1155/2018/7093178.
75) Scheeringa MS (2019). Development of a brief screen for symptoms of posttraumatic stress disorder in young children: The Young Child PTSD Screen (YCPS). Journal of Developmental & Behavioral Pediatrics, Vol 40(2): 105-111, doi 10.1097/DBP.0000000000000639.
—This reported on the development of a six-item screener for PTSD in very young children. I personally do not advocate using a six-item screener when the full complement of PTSD criteria is only 16 items. But I know people are going to create and use short screeners so I at least wanted one to exist that was empirically based.
76) Miron D, Scheeringa, MS (2019). A Statewide Training of Community Clinicians to Treat Traumatized Youths Involved with Child Welfare. Psychological Services 16(1), 153-161, 2019 Feb., doi 10.1037/ser0000317.
—One of the remarkable stories of the current practice of psychotherapy in the USA is that most clinicians are either unwilling or unable to adopt evidence-based protocols. In a training program we implemented across the state of Louisiana, we documented just how poor the uptake is.
77) McKinnon A, Scheeringa MS, Meiser-Stedman R, Watson P, De Young A, Dalgleish T (2019). The dimensionality of proposed DSM-5 PTSD symptoms in trauma-exposed young children. Journal of Child Psychology and Psychiatry 47:1799-1809, doi 10.1007/s10802-019-00561-2.
—I am a staunch critic of factor analysis as a method of diagnostic validation, but I agreed to let a graduate student in the UK use my dataset if she promised to examine how the factor analysis model results impacted diagnosis rates and functional impairment. None of the models showed adequate statistical fits to the data, which I think just added confusion to an already confusing niche of research.
78) Scheeringa MS, Singer AM, Mai AT, Miron D. (2020, early online 10/26/18). Access to Medicaid Providers: Availability of Mental Health Services for Children and Adolescents in Child Welfare in Louisiana. Journal of Public Child Welfare 14(2):161-173, doi 10.1080/15548732.2018.1537904.
—In a one-off topic of study in my career, I documented the depth of the problem that parents have in finding providers who will take insurance to treat their children with mental health problems. Our focus was constrained to Medicaid providers because the effort was part of a federal grant I received to work with child welfare agencies. We used a mystery shopper model and called every provider in the state of Louisiana who was listed as accepting Medicaid insurance for treating children. We found that only 25% of the advertised network of providers could schedule an appointment. The other 75% was essentially a ghost network of providers on paper that were either duplicate listings at multiple addresses, disconnected phone numbers, did not see children, or had stopped accepting Medicaid patients. Since this study was conducted in 2014-2017, Louisiana cracked down on insurance networks and they are moderately better at maintaining accurate directories.
79) Scheeringa MS (2020). A Different Way to Mind the Gap: Mandated Versus Voluntary Collection of Measures. Journal of the American Academy of Child and Adolescent Psychiatry, May 2020, 59, 5, 576-577.
80) Scheeringa MS (2020). The Diagnostic Infant Preschool Assessment-Likert Version (DIPA-L): Preparation, concurrent construct validation, and test-retest reliability. Journal of Child and Adolescent Psychopharmacology 30(5):326-334, doi 10.1089/cap.2019.0168.
—I updated the DIPA for DSM-5 and changed the rating scale from binary to Likert responses, and gathered new validity data on it.
81) **Scheeringa MS (2021) Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms. International Journal of Methods in Psychiatric Research 30:e1864. doi: 10.1002/mpr.1864.
—This is my favorite paper. At this point in time, it had become clear to me that many of my colleagues in the PTSD research field had either never been capable of or had abandoned equipoise in studying the most important question about neurobiology. A vocal group of researchers claimed that they knew with absolute certainty that neurobiological differences are caused by trauma exposure, when I knew for certain, based on the evidence, this was not true. The manuscript was rejected by six journals before I finally got it published. Some of the rejections by anonymous peer reviewers were surprisingly explicit that they objected to the tone of the manuscript (code for I don’t like your ideology) while expressing no rational objections to the findings.
82) Mai TA, Scheeringa MS (2021; early online 2019 Dec 27). Caregiver and Child Agreement on Traumatic Events, PTSD, Internalizing, Externalizing, and ADHD Problems in a Child Welfare Population. Journal of Public Child Welfare 15(2):251-274, doi 10.1080/15548732.2019.1701612.
83) Salloum A, Lu Y, Ali O, Chen H, Salomon K, Cohen JA, Scheeringa MS, Quast T, & Storch EA (2022 Nov 24 early online). Exploring Treatment Response Predictors of a Parent-Led Therapist-Assisted Treatment for Childhood Trauma. Research on Social Work Practice, 0(0). doi: 10.1177/10497315221137880.
84) Pacheco CR, Scheeringa MS (online 2022 Aug 19). Clinical wisdom in the age of computer apps: A systematic review of mental health apps. the Cognitive Behaviour Therapist 15:e40 doi:10.1017/S1754470X22000368.
85) Salloum A, Lu Y, Chen H, Salomon K, Scheeringa MS, Cohen JA, Swaidan V, & Storch EA (2022). Child and parent secondary outcomes in stepped care versus standard care treatment for childhood trauma. Journal of Affective Disorders, 307 87-96. https://doi.org/10.1016/j.jad.2022.03.049.
86) **Pacheco CR, Scheeringa, MS (2022). Post-traumatic stress and autobiographical memory accuracy in young children: Traumatic events versus stressful and pleasant events. Journal of Aggression, Maltreatment, & Trauma 31(6):695-714, doi: 10.1080/10926771.2021.1994498.
—There is no other psychiatric disorder like PTSD in which memory plays such a central role. This has led to many different speculations, including that trauma memories are remembered more accurately or less accurately than non-trauma memories, and that general memory functions are disrupted. We found the following:
1) Accurate recall of trauma events did not vary with severity of PTSD. This finding was consistent across three types of trauma groups: Single Event, Repeated Events, and Hurricane Katrina. This finding contrasted with most of the prior literature, which we think is due to a key difference in measurement. Prior studies relied on the amount of information recalled and had no independent validity check if the memories were accurate. Because we worked with very young children, we had the advantage of mothers who verified the accuracy of recall. We speculated that some of the memories that were counted as accurate in prior studies were inaccurate.
2) Accurate recall of pleasant events did not vary with severity of PTSD, suggesting that there is no general memory deficit.
3) Trauma-exposed children (regardless of PTSD severity) were less accurate about trauma events compared to pleasant events. Drilling down on this finding, this appeared to be due to the Repeated Events and Hurricane Katrina groups having worse memory of trauma events compared to the Single Event group. This could have been due to the simple fact that Repeated Events and Hurricane Katrina events were complicated and drawn-out affairs that are more difficult to keep organized (and does not reflect an underlying memory problem).
4) Accurate recall of trauma events in the three trauma-exposed groups did not differ compared to recall of stressful events in the non-trauma-exposed control group, suggesting that trauma memories are not remembered with greater or lesser accuracy. A post hoc test, however, showed that the Repeated Events group had worse accuracy of trauma events compared to the Single Event and control groups.
5) There was no difference in accuracy of pleasant events between the three trauma-exposed groups and the non-trauma-exposed group, suggesting that there is no generalized memory deficit.
—Overall, these data ought to provide confidence to clinicians that narrative recall is well within the developmental capacities of this age group, furthering an argument that play therapy needlessly relies on indirect and gradual methods to draw out trauma memories and underestimates the developmental capacities of young children to engage in direct conversations.
87) Mikolajewski AJ, Scheeringa MS (2022). Links between Oppositional Defiant Disorder Dimensions, Psychophysiology, and Interpersonal Versus Non-interpersonal Trauma. Journal of Psychopathology and Behavioral Assessment 44(1): 261-275, doi: 10.1007/s10862-021-09930-y.
88) Salloum A, Lu Y, Chen H, Quast T, Cohen JA, Scheeringa MS, Salomon K, Storch EA (2022). Stepped Care versus Standard Care for Children after Trauma: A Randomized Non-inferiority Clinical Trial. Journal of the American Academy of Child & Adolescent Psychiatry 61(8): 1010-1022.
89) Khunkhun V, Pacheco C, Burns L, Gershen S, Mai TA, Scheeringa MS (2022). Patient preferences for shared decision making in mental health care. Patient Educ Couns. Apr;105(4):1048-1049. doi: 10.1016/j.pec.2021.07.026.