Child Traumatic Stress and COVID-19: The Impact of the Pandemic on a Clinical Sample of Children in Trauma Treatment

Given the scope and duration of the COVID-19 pandemic, it is not surprising that research has documented negative effects to youth’s mental health. Yet, there is negligible research on the impact of the pandemic among clinical samples of youth receiving treatment for pre-existing trauma exposure and symptoms. The current study investigates COVID-19 as an index trauma, and if prior traumatic stress scores mediate the relationship between pandemic-related exposure and subsequent traumatic stress. Methods: This is a study of 130 youth ages 7–18 receiving trauma treatment at an academic medical center. The University of California Los Angeles Post-traumatic Stress Disorder-Reaction Index (UCLA-PTSD-RI) was completed by all youth during intake as part of routine data collection. From April, 2020 to March, 2022 the UCLA Brief COVID-19 Screen for Child/Adolescent PTSD was also administered to assess trauma exposures and symptoms specifically-related to the pandemic experience. Univariate and bivariate analyses were conducted on all variables of interest to describe response patterns cross-sectionally and longitudinally; a mediational analysis was used to determine if prior trauma symptoms mediate the relationship between COVID-19 exposure and response. Additionally, interviews were conducted with youth using a series of open-ended questions about their perceptions of safety, threat and coping related to the pandemic. Results: A quarter of the sample reported COVID-19 related exposures that would meet Criterion A for PTSD. Participants whose UCLA-COVID scores that exceeded the clinical cutoff had lower scores on two items measuring social support. There was no evidence of full or partial mediation. Responses to interview questions revealed low levels of threat reactivity, perceptions of no to little impact, positive changes, varying opinions on social isolation, some evidence of inaccurate messaging and adaptive coping using strategies learned in treatment. Implications: The findings broaden our understanding of the impact of COVID-19 on vulnerable children and provide insight into how prior trauma history and the provision of evidence-based trauma treatment impact a youth’s response to pandemic conditions.