Self-reported Trauma Memory Quality
At 1-month post-trauma, the Adapted Trauma Memory Quality Questionnaire (ATMQQ; Hiller et al., 2019
) was administered to children, who rated agreement with 18-items on a scale from 1 (disagree a lot) to 4 (agree a lot). The ATMQQ includes all 11 items from the original Trauma Memory Quality Questionnaire (TMQQ; Meiser-Stedman et al., 2007a
), indexing the sensory qualities of the child’s trauma memories and sense of nowness (e.g. “My memories of the frightening event are mostly pictures or images”). The original TMQQ has shown good internal consistency (Cronbach’s alpha of 0.82 in an emergency department sample) and has established construct validity, showing positive correlations with PTSD symptomatology and with re-experiencing symptoms in particular (Meiser-Stedman et al., 2007a
). There is potentially conceptual overlap between TMQQ domains (sensory/intrusive memories) and re-experiencing symptoms. However, TMQQ scores have been found to predict unique variance in PTSS over and above re-experiencing symptoms alone (Meiser-Stedman et al., 2007a
The ATMQQ, used in the current study, includes an additional seven item scale which measures trauma memory disorganisation (e.g. “I get mixed up about what order things happened during the frightening event”), adapted from the adult Trauma Memory Questionnaire (Halligan et al., 2003
). In the current sample, internal consistency was strong for both the sensory qualities (α = 0.80) and disorganisation (α = 0.85) subscales, as well as the overall measure (α = 0.86). We also found that test–retest reliability for the ATMQQ was r
= 0.61 for 1-month to 3-months (an additional data collection point not discussed in this paper, see Hiller et al., 2018
for details) and r
= 0.59 for 3-months to 6-months.
Trauma Narrative Characteristics
At 1-month post-trauma, participants were asked to provide a verbal narrative of the traumatic event they experienced. Participants were instructed to begin their narrative just before the event occurred and include whatever information they thought was important. The researcher did not interrupt the young person during the narrative. However, if they were struggling, basic prompts were used (e.g., “and then what happened”?).
The narrative task was audio recorded and transcribed, and the resultant narrative was coded according to standard procedures (Foa et al., 1995
; Halligan et al., 2003
; Salmond et al., 2011
; Van Minnen et al., 2002
). Only codes from the trauma segment were used. This begins with the first expression of threat in the narrative and ends with the termination of immediate threat. This segment was divided into clauses or “chunks” that contained “only one thought, action or speech utterance”. These “chunks” were then coded as follows:
Repetition. Repeating a previous chunk with no new information (chunks clearly repeated purposefully for emphasis were not coded as repetition).
Organised Thoughts. Attempts to understand what is happening e.g. chunks indicating reasoning, realization, causal elaboration, hypothesis setting, decision-making, or planning. Use of words like ‘I remember’, ‘because’, ‘cos’ when trying to communicate their thinking.
Disorganised Thoughts. Involve/imply confused or disjointed thinking such as muddled thoughts, questioning, being overwhelmed, ambiguousness, expressions of uncertainty about the participant’s memory of events, etc. This code also includes non-consecutive thoughts, which jump around and lack temporal consistency.
Negative Feelings. Unpleasant emotions such as humiliation, fear, shock, and dissociative experiences such as freezing.
Pain Utterances. Utterances expressing pain experienced.
Sensory Utterances. Utterances referring to one of the five senses.
The scores for each coding category were transformed to z scores, to account for differences in verbosity between children. As per existing protocols, coding categories were then combined to create two overall variables of interest. The repetition, organised thoughts (reversed), and disorganised thoughts codes were combined to form the Elements of Disorganisation variable. The pain utterances, sensory utterances and negative feelings categories were combined to create the Sensory-Emotional Qualities variable.
Global Coherence Rating of Narrative.
As well as using the first three coding categories to indicate disorganisation within the narrative (repetition, organised thoughts [reversed], disorganised thoughts), the global coherence of each narrative was also judged using a 10-point disorganisation rating scale (Halligan, et al., 2003
), with 1 indicating a high level of organisation and coherence (Temporally sequential, high amounts of detail relevant to the event and/or reflective thinking) and 10 indicating a complete lack of memory for the event.
Coding Reliability. Coding was conducted by individuals trained in using the manual, and who were unaware of participant’s PTSD symptom severity. One individual coded all narratives and a second rater blind coded 20% of them. For all of the narrative coding categories, there was good agreement between raters (intraclass correlation coefficients [ICCs] = 0.73—0.94).