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Psychosocial correlates of fire disaster among children and adolescents

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Title:
Psychosocial correlates of fire disaster among children and adolescents
Series Title:
Quick response research report ;
Physical Description:
34, 13 p. : ill. ; 28 cm.
Language:
English
Creator:
Jones, Russell T., 1950-
Ribbe, David Paul, 1959-
Cunningham, Phillippe Belton, 1958-
University of Colorado, Boulder -- Natural Hazards Research and Applications Information Center
Publisher:
Natural Hazards Research & Applications Information Center
Place of Publication:
Boulder, Colo.
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Subjects / Keywords:
Post-traumatic stress disorder in children   ( lcsh )
Wildfires -- Psychological aspects -- California   ( lcsh )
Child psychology   ( lcsh )
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government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Bibliography:
Includes bibliographical references (p. 31-33).
Statement of Responsibility:
by Russell T. Jones, David P. Ribbe, Phillippe Cunningham.

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All applicable rights reserved by the source institution and holding location.
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aleph - 001971252
oclc - 277005088
usfldc doi - F57-00001
usfldc handle - f57.1
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Psychosocial correlates of fire disaster among children and adolescents
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PSYCHOSOCIALCORRELATESOFFIRE DISASTERAMONGCHILDREN AND ADOLESCENTSByRussellT.JonesDavidP.RibbePhillippeCunninghamDepartmentofPsychologyVirginiaPolytechnicInstituteandstateUniversityBlacksburg,VA24061-0436703-231-5934QUICKRESPONSERESEARCHREPORT #46 1991This publication is partofthe Natural Hazards Research&Applications Information Center's ongoing Quick Response Research Report Series. http://wvN.J.colorado.edu/hazards TheviewsexpressedinthisreportarethoseoftheauthorsandnotnecessarilythoseoftheNaturalHazardsCenterortheUniversityofColorado.

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PsychosocialCorrelatesofFireDisasterAmongChildrenandAdolescentsRussellT.Jones1DavidP.RibbePhillippeCunninghamDepartmentofPsychologyVirginiaPolytechnicInstituteandstateUniversityBlacksburg,VA24061-0436703-231-5934RunningHead:FireDisaster1

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2AbstractThisstudyexaminedtheextentofchildren'sandadolescents'psychosocialmaladjustmentassociatedwithanaturaldisaster,namely,wildfire.Thecourseofpsychopathologywasassessedtwomonthsafteramajorwildfiredestroyed420homes.Notonlywerevictims'individualresponsesevaluated,butalsotheirfunctioningrelativetotheirparentsandtoacomparisongroupfromthesamecommunity,matchedforage,gender,socioeconomicstatus,andfireinsurance.Themajorgoalofthisstudywastoassesssystematicallytheshort-termmentalhealthconsequencesofawildfiredisasteramongchildrenandadolescents.Thisgoalwasachievedthroughtheuseofstandardizedassessmentprocedures.Theresultsofthisstudyaddusefulinformationtotheliteratureconcerningtheimpactofdisasteramongchildrenandadolescentsandprovideamethodologicalframeworkforfutureeffortsinthisarea.KeyWords:Child,adolescent,disaster,post-traumaticstressdisorder

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3Whiletheimpactofdisasteronchildren'spsychologicalfunctioninghasbeenaddressed(seeDavidson&Baum,1990,forareview),muchambiguityandspeculationremainconcerningthenatureanddegreeofresultingtrauma.Studieswhichhaveexaminedchildvictimsofdisastertargetingfloods(Newman,1976),andnuclearaccidents(ThreeMileIsland;Handford,Mayes,Mattison,Humphrey,Bagnato,Bixler,&Kales,1986)reportsymptomsincludingnightmares,inabilitytosleep,anxiety,depression,actingout,guilt,andfear.Althoughsometheoristshavemaintainedthatthedisturbancesfollowingsucheventsareoftenminimalandshortlived(Garmezy&Rutter,1985),othershavestatedthatsuchconsequencesarerelativelydramaticandlonglasting(Yule&Williams,1990).Theneedforcontinuedstudyinthisareatodefinemorepreciselytheconsequencesandidentifymediatorsandmoderators{i.e.,thecommunity,personvariablesnatureoftheevent,degreeofexposuretotheevent)ofchildren'sfunctioningfollowingdisasterisquiteobvious.Attentiontoseveralmethodologicalshortcomingswhichhaveplaguedbothchild-andadult-focuseddisasterstudiesmayenhancetheaccuracyofconclusionsdrawnfromfutureefforts.Inthecontextofthispilotinvestigationdesignedtoassesstheconsequencesofwildfireonchildrenandtheirparents,shortcomingsfoundinmanyearlierstudieswillbeaddressed.Amongthosetargetedare:1)lackofstandardizedassessmentmeasuresandprocedures,2)inabilitytoaccountforpre-existinglevelsofpsychopathologyindisastervictims,and3)failuretoutilizecontrolgroups.Eachwillbedealtwithinturn.Althoughsomeinnovationshaveledtoagradualemergenceofstandardizedassessmentbatteries(Lyons,1991),muchcontinuedprogress

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4iswarranted.Forexample,thelackofstandardizedassessmentbatteriesconsistingofpsychometricallysoundinstrumentsandstandardclinicalinterviewsadministeredbyexperiencedclinicianscontinuestoleadtoinvalidconclusions.Green(1982)andothersviewthisshortcomingasamajorproblemplaguingthefield.Unfortunately,theseshortcomingsarenotuniquetostudiestargetingchildrenbutalsosurfaceintheadultdisasterliterature(Solomon,1989).Arelatedproblemconcerningassessmentproceduresistherelianceonadultstoreportchildren'sreactionstodisaster.Severalresearchershavelimitedtheirassessmentofchildren'sreactionstodisastertoparentand/orteacherreports.Inmanyinstances,thedegreeofseverityexperiencedbychildrenoftenhasbeenunderestimated(Earls,Smith,Reich,&Jung,1988;McFarlane,1987).DiscrepanciesinchildandadultreportshavebeenshownbyHandfordetal.,(1986)wheretheyconcludethatchildren'sandparents'perceptionsoftheseverityoftraumadiffer.Thesefindingsattesttothenecessityofassessingchildvictimsthemselves.A commonthreattofindingsresultingfromtraumaticeventsisresearchers'lackofattemptstoaccountforvictims'pre-existingpsychopathology.Datahaveshownthatchildrenwithpre-existingpsychiatricdisordersarevulnerabletothedevelopmentofotherpsychiatricsymptoms(Earlsetal.,1988).Ourfindingsinapreviousinvestigationsupporttheseconclusions(Jones&Ribbe,1991).Whileexplanationsforthisphenomenonexistsuchasthediathesis-stressviewofpsychopathology(Zubin&Spring,1977),assessmentstrategieswhichtappreviousand/orpresentpsychopathologyareessential.

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Theneedforwell-controlledandwell-designedresearchinthescientificstudyoftheconsequencesofdisasterisobvious.Theuseofmatchedcontrolgroupsprovidesonesteptowardachievingthisobjective.Thebenefitofcontrolgroupshasbeendocumentedbynumerousauthorswhencarryingoutclinicalresearch(Aptekar&Boore,1990).Indeed,acompellingcasecanbemadefortheinclusionofcontrolgroupsinstudiesexaminingtheconsequencesofdisaster.Whileresearchershaveexaminedchildren'sreactionstoavarietyofmanmadeandnaturaldisasters(Handfordetal.,1986;Newman,1976;Saigh,1985),othereventsrequireinvestigation.Relativelylittleresearchhasbeencarriedoutregardingtheimpactoffire(Jones&Haney,1984;Jones&Ribbe,1991).Giventhatthedevastatingconsequencesoffiresandburnsrankedsixthamongthemajorcausesofinjuryanddeathamongpersonsfrombirthtoage19years(DivisionofInjuryControl,CenterfortheEnvironmentalHealthandInjuryControl,CentersforDiseaseControl,1990),researchofthisnatureiswarranted.5WhiletheclassicworkbyMcFarlaneandhiscolleaguesprovideddataattestingtotheconsequencesofbushfiresinAustralia,nosingleinvestigationexistswhichspecificallytargetschildrenwhoexperiencedfireintheUnitedStates.OneofthefewstudiesdesignedtoexaminethementalhealthimpactoffireemergenciesonadultsandchildrenwascarriedoutbyKrim(1983).Withregardtoimmediateimpact,thementalhealthstatesofmotherandchildweresignificantlyrelatedtotheextentofdamageorlossincurred.Avarietyofbehavioralsymptomsincludinginabilitytoeatorsleep,nervousness,anxiety,depression,anddenialwerereported.Additionally,parentswereoftenemotionally

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unresponsivetotheirchildrenafterthefire.Itisinterestingtonotethatmanyofthesereactionsparallelthoseresultingfrommorelarge-scaledisastersreportedinthedisasterliterature(TrainingManualforHumanServiceWorkersinMajorDisasters,1983).Thoughthesedataareanecdotalinnatureandrequiremoresystematicstudy,theydoshedsomelightonmentalhealthconsequencesoffire.Thus,theprimarygoalofthisstudywastoidentifychildren'sreactionstofiredisasterwhileaddressingshortcomingsofpreviousattemptsindisasterresearch.Aspecificresearchquestiontobeexploredwas:towhatextentdosymptomsofpost-traumaticstressdisorder(PTSD)resultfromafirerelateddisaster.AlthoughtheassessmentofPTSDsymptomsinchildrenhasbeenrareuntilrecently,severalinvestigationshavesuggestedthatchildrenaresusceptibiletodevelopingPTSDsymptomsfollowingtraumaticevents.Forexample,PTSDsymptomshaveresultedfrombushfires(McFarlane,Policansky,&Irwin,1987),fatalsniperattack(Pynoos,Nader,Frederick,Gonda,&Stuber1988),witnessingofparentalmurder(Malmquist,1986),floods(Earlsetal.,1988),anddeathofasibling(Applebaum&Burns,1991).Morerecently,residentialfirehasbeenshowntoproducesimilarsymptomsinadolescentboys(Jones&Ribbe,1991).Tothisend,children,adolescents,andparents2wereindividuallyinterviewed.Objectiveclassificationofresponsesusingamulti-methodstrategyemployingstandardizeddiagnosticassessmentinstrumentsaswellaswidelyusedself-reportmeasureswereengaged.Anattemptwasmadetoaccountformajortypesofpre-existingandpresentpsychopathologyoftenrelatedtoPTSD,andtomatchfirevictimswith6

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7controlsubjectsonvariablesincludingincomelevel,insurancecoverage,age,andgender.DescriptionoftheDisasterSiteOnJune27,1990,adevastatingwildfirespreadthroughasmallcityinsouthernCalifornia.Thefirestruckatapproximatelysixo'clockintheevening.Manyresidentslearnedaboutthewildfireastheywerepreparingtheeveningmealandwatchingtheeveningnewsontelevision.Initialnewsreportssuggestedtoviewersthatthefirehadoriginatedatthecitylandfill,andthatitwasbeingcontrolledbyfirefighters.However,subsequentreportsindicatedthatasecondfirehaddevelopedhighonthemountainrangewhichabutsthecityandresidentialareas.Viewerswereconfusedaboutthelocationofthefireandthedegreetowhichtheirhomeswerethreatened.Manytooknoactionuntiltheycouldseethefireracingtowardtheirhomes,justablockortwoaway.Thesecondfiresweptdownthedrybrushonthemountainside,fueledbywindgustingupto60milesanhourandtemperaturesexceeding100F.Inaddition,theareahadbeenexperiencingaseveredroughtforthepastfiveyears,andconditionswereverydry.Thefirequicklyreachedtheoutskirtsofthecity,whereitproceededtocutaswaththroughsingle-familydwellingsthroughtoamajorhighway,whereitwasfinallyhaltedonJuly1.Amajorevacuationofseveralthousandresidentscausedconsiderabledifficultyforthefirefightingteamsandfirefightingequipment.Lossesincludedonefatality,420single-familyhomes,4publicbuildings,1mobilehome,2farmbuildings,10businessstructures,and26apartmentunits.Asofthelastreport,propertydamageestimatesexceeded$250million.

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8MethodsSubjectsAllsubjectsresidedintheaffectedcity.TheywereinterviewedbetweenAugust13and19,1990.victims,definedasindividualswhosehomehadsustainedsignificantdamageortotaldestructionasaresultofthewildfire,wereidentifiedandrecruitedprimarilywiththeaidofthelocalchapteroftheAmericanRedCross.Othersourcesincludedindividualcommunitymembers,localfiredepartments,churches,schools,newspaperreports,journalists,andnationaltelevisionnewscasts.TheRedCrossassistedinrecruitingsubjectsbydistributingbriefscreeningquestionnairestofamiliesand/orindividualswhocametotheofficetoapplyforvarioustypesofvolunteerandgovernmentassistanceforvictims.Familieswhoreportedhavingchildrenbetweentheagesof6and18whowereaffectedbythefirewerecontactedbytelephonetoscheduleaninterview.Anumberofnon-victimized(control)subjectswererecruitedwiththeaidofnewspaperarticles,schools,andindividualreferrals.Theinformationfromtheseindividualsservedascomparisondatatoassistinassessingthedegreeofimpactofthewildfireonvictims'psychosocialfunctioning.Toenhancethehomogeneityofthesample,weattemptedtoincludecontrolfamiliesandindividualswithcompatibledemographicvariablesincludingage,gender,incomelevel,andinsurancecoverage.Thedemographiccharacteristicsofthevictimandcontrolgroupswerequitesimilar.Mostparticipantswereofmiddleclassstatus.Therewere13childreninthevictimgroup.Theyrangedinagefrom7to11yearsofage,withameanageof9.1years.Fourweremale,and

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9ninewerefemale.ThereweretenwhiteandthreeMexican-Americanchildren.Therewereninechildreninthecontrolgroup.Theyrangedinagefrom7to12yearsofage,withameanageof9.8years.Fourweremale,andfivewerefemale.TwochildrenwereAfrican-American,threewereMexican-American,andfourwerewhite.Thereweretenadolescentsinthevictimgroup.Theyrangedinagefrom13to18yearsofage,withameanageof14.5years.Threeweremale,andsevenwerefemale.Sevenwerewhite,twowereAfricanAmerican,andonewasMexican-American.Therewasonlyone13year-old,African-Mexican-Americanadolescentmaleinthecontrolgroup.ProceduresThemethodofinterviewinginvolvedasystematicassessmentofthepsychosocialconsequencesofexperiencingthefire.Inthecontextofacross-sectionaldesign,amulti-methodstrategywasemployedtoexaminethepsychosocialadjustmentofchildrenandadolescentsusingselectedportionsofastructureddiagnosticinterview(DICA-R;Reich&Welner,1990),theHorowitzImpactofEventsScale(HIES;Horowitz,Wilner,&Alvarez,1979),theState-TraitAnxietyInventoryforChildren(STAI-C;Speilberger,Gorsuch,Lushene,Vagg,&Jacobs,1977),theChildren'sBehavioralQuestionnaireforCompletionbyParents(CBQ;Rutter,1967),andtheFireQuestionnaire-ChildForm(FQ-C;Jones&Ribbe,1990).DICA-R.TheDICA-RisarevisedversionoftheDiagnosticInterviewforChildrenandAdolescents,whichisasemi-structuredpsychiatricinterviewmodeledaftertheadultDiagnosticInterviewSchedule(DIS;Robins,Helzer,Croughan,Williams,&Spitzer,1981).TheDICA-Rwasdesignedtoidentifypsychiatricsymptomsandmake

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10psychiatricdiagnosesinchildrenandadolescentsasspecifiedbytheOSM-III-R(AmericanPsychiatricAssociation,1987).Themajorityofthequestionscanbeansweredyesorno,withyesindicatingapositivesymptom.OICA-Rsymptomsassessedwerethoseofpastmajoraffectivedisorder(PastMAD),presentmajoraffectivedisorder(PresentMAD),conductdisorder(CD),oppositionaldefiantdisorder(ODD),overanxiousdisorder(OAD),andpost-traumaticstressdisorder(PTSO).ThesedisorderswereselectedinasmuchassymptomsofdepressionandanxietyarecommonlyassociatedwithPTSO(AmericanPsychiatricAssociation,1987).Inaddition,impulsivebehaviorscommonamongconductdisorderedindividualshavebeenobservedinchildrenfollowingtraumaticevents(Davidson&Baum,1990;Saigh,1985).Itwasconsideredimportanttoascertaintheextenttowhichanyofthesesymptomswerepresentpriortothefire,inordertoisolatetheimpactofthefire.HIES.TheHIESisa15-item,self-reportquestionnairedesignedtoprovideacross-sectionalpictureofsubjectivepsychologicalresponsestostressfullifeevents.Factoranalysisidentifiedtwofactors:1)intrusivethoughtsandaffects;and2)avoidancebehaviors.Withinthisstudy,thewildfireservedasthereferentforbothvictimsandcontrolsubjects.Responsesareindicatedonafour-pointscalerangingfrom"notatall"(scored0),"rarely'(scored1),"sometimes"(scored3),and"often"(scored5).Forthepurposesofthisstudy,asimplifiedversionoftheHIESwasdevelopedforusewithchildrenbetweentheagesof6and12.Children'sBehaviourQuestionnaireforCompletion Qy Parents(CBQ).TheCBQisa31-itemparentself-reportscale.Itisprimarily

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11usedtodiscriminatebetweentypesofbehavioralandemotionaldisordersaswellasdifferentiatechildrenwhoshowordonotshowdisorder.Twosubscalesarederived,namely,neuroticandantisocial.Thetest-retestreliability is .74andinter-raterreliability is .64(Rutter,1967).FireQuestionnaire-ChildForm.ThechildversionoftheFireQuestionnaire(FQ-C;Jones&Ribbe,1990)consistsofthreesections:(1)demographics,(2)stressfullifeevents,whichincludeschecklistsanddescriptionsofnaturaldisastersandtraumaticevents,and(3)orientation,which is composedof13questionspertainingtofirerelatedevents,thoughts,feelings,losses,andotherconsequencesofthefire.Thetest-retest reliability oftheFQ is .87.InterviewsIndividualinterviewswerecarriedoutateithertheRedCrossheadquartersoroneoftwolocalchurchesneartheaffectedarea.Eachinterviewlastedapproximately60minutes,witharangeof45to90minutes.Approximatelyhalfofthetimewasspentcompletingtheselfreportinstruments;theotherhalf,interviewing.Breakswereprovidedasneeded.Priortotheinterview,allparticipantswerereadaconsentformdescribingthepurposeandparametersofthestudy.Familieswerereimbursed$25.00fortheirparticipation.Followingeachinterview,informationconcerninglocalmentalhealthagencieswereprovided.Thoseindividualswhoappearedtobehavingsevereadjustmentproblemswereencouragedtoseekprofessionalhelpthroughtheseagencies.InterviewerTrainingDatawerecollectedbyateamoffourtrainedinterviewers.Twointerviewerswerethird-andfourth-yeargraduatestudentsinthe

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12clinicalpsychologyprogramatVirginiaPolytechnicInstitute&stateUniversity.BothhadMaster'sdegreesatthetimeoftheinterviewsandhadbeentrainedtwiceaweekforatotalofatleast51hours.Trainingsessionsconsistedofbecomingfamiliarwitheachmeasure,videotapingandcritiquingrole-playsandinterviews,observationsoftheinterviewgivenatleastonce,detailedinstructionsaboutadministration,testingoverpresentedmaterial,andreliabilitychecks.Bothgraduateinterviewershadpreviousexperiencecollectingsimilardatafrom15to20victimsofanotherfire.Thethirdinterviewerwasanadvancedundergraduatepsychologymajorwhounderwentextensivetrainingaswell.Hewastrainedinmultiplesessionsaccordingtoaninterviewtrainingprotocoldevelopedbythegraduateinterviewers,andunderwentnumerousinter-raterreliabilitycheckswiththeotherinterviewers.Inadditiontoothertraining,eachstudentinterviewerlearnedtheDSM-III-Rdiagnosticcriteriaforeachdisorderofinterestinthisstudy.Attheendoftraining,inter-raterreliabilityaveraged.91.ThefourthinterviewerwastheprincipalinvestigatorwhohasaPh.D.andisalicensedClinicalPsychologist.Hesupervisedtheinterviewers'trainingandtheactualimplementationofthestudy.ResultsTheanalysesofdatafromtheCaliforniawildfirefocusedon:(1)between-groupcomparisonsofdemographiccharacteristics;(2)abetweengroupcomparisonofPTSDdiagnosisandsymptompatternsasmeasuredbyDICA-R;(3)between-groupcomparisonsofshort-termstress-relatedpsychopathologyandoveralllevelsofPTSDandstress-relatedsymptomatology(HIESandSTAI-C);(4)degreeofPTSDsymptomagreement

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inparent-childdyads(DISandDICA-R);(5)therelationshipofpreexistingpsychopathologytoshort-termstresslevels(DICA-RandCBQ);and(6)therelationshipofpreviousstressorstoshort-termstresslevels(HIES,DICA-R,andSTAI-C).DemographicsStatisticalanalysesconfirmedthatthevictimandcontrolgroupsdidnotdifferonanyofthefollowingdemographiccharacteristics:incomelevel,fireinsurance,age,andgender.DICA-RPTSDDiagnosisThreesubjectsmetthediagnosticcriteriaforPTSD.Onewasana-yearoldgirl,anotherwasa7-yearoldmale,andthethirdwasa15yearoldgirlfromagrouphomefortroubledadolescentswhoalsometthediagnosticcriteriaforpreexistingoppositionaldefiantdisorder.Thetwogirlswereinthevictimgroup;theboyinthecontrolgroup.AllthreewereMexican-American.13AnexaminationoftheDICA-RsymptompatternsreportedbythethreePTSOcasesrevealedpositivesymptomsonthefirst(recurrentandintrusivedistressingrecollectionsoftheevent),second(recurrentdistressingdreamsoftheevent),fifth(effortstoavoidthoughtsorfeelingsassociatedwiththetrauma),sixth(effortstoavoidactivitiesorsituationsthatarouserecollectionsofthetrauma),eighth(markedlydiminishedinterestinsignificantactivities),twelfth(difficultyfallingorstayingasleep),andsixteenth(exaggeratedstartleresponse)DICA-Ritems.

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14DICA-RSymptomsVictimsandcontrolswerecomparedonthenumberofsymptomsreportedoneachofthefivepsychiatricdiagnosticcategories,includingODD,CD, OAD,pastandpresentMAD,andPTSD.Duetothelackofadolescentcontrolsubjects(N=l)andthefactthatnoagedifferenceswerefoundonnumberofDICA-Rsymptoms,childandadolescentdatawerecombinedandanalyzedoneachdependentvariable.Aseriesofunivariateanalysesofvariance(ANOVAs)wereperformed,oneonthenumberofsymptomsandcriteriaofeachoftheDICA-Rdisordersassessed.Theeffectforgroupwasfoundtobenonsignificant(p>.05)3forthenumberofsymptomsreportedonODD, CD,OAD,pastMAD,orpresentMAD.NodifferenceinthenumberofsymptomsendorsedbythetwogroupswasfoundforPTSD, K(1,31) =0.04, P =.84.Thevictimsendorsedanaverageof4.4PTSDsymptoms,comparedto4.1symptomsendorsedbycontrols(TableI).TableIIshowsthepercentageofvictimsversuscontrolsreportingindividualPTSDsymptoms.InsertTablesIandIIabouthereTherewas,however,asignificantdifferenceinthenumberofPTSDcriteriamet,F(l,31)=5.44, P =.03.Victimsmetanaverageof2.8outof5 PTSDcriteriacomparedtoanaverageof1.6criteriametbythecontrols.Ofthe23victims,twometthecriteriafordiagnosablePTSD,whileoneofthe10controlswasdiagnosedassufferingfromPTSD.ThesignificantdifferencebetweengroupsonPTSDmayhavebeenduetopreexistinggroupdifferencesonthefirst,inclusionarycriterion(experiencedtraumaticevent).Thus,two-by-twofrequency

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tableswereconstitutedtoreflectthenumberofsubjectsqualifyingornotqualifyingundereachcriterionaccordingtogroupmembership.Fisher'sExactTest(left-tail)showedthatonlythefirstcriterion(experiencedtraumaticeventasdefinedbylosingahometofire)significantlydiscriminatedbetweengroups, =.001.Thenumberofsubjectsmeetingtheremainingcriteriadidnotdiffersignificantlybetweengroups:forthesecondcriterion(intrusion), =.25,thethirdcriterion(avoidance), =.85,thefourthcriterion(increasedarousal), =.60,andthefifthcriterion(duration), =.09.Atwowayfactorialmultivariateanalysisofvariance(MANOVA)withgroupandgenderastheindependentvariablesandthenumberofpsychiatricrelatedcriteria(intrusion,avoidance,andarousal)asthedependentvariables.revealednosignificanteffectsforgroup,gender,orinteraction.HIESSymptomsDuetoreasonsstatedearlier,childandadolescentdatawerecombined.Atwo-wayfactorialMANOVAwasperformedonthesummatedintrusionandavoidancesubscalescoreswithgroupandgenderastheindependentvariables.Therewasasignificantmaineffectforgroup, f(2, 28)=3.39, =.048,butneitherthemaineffectforgender,nor15theinteractionwassignificant.Intrusionsubscale.Two-wayfactorialANOVAswereperformedusingthemodeldescribedabove.Ontheintrusionsubscale,effectsforgroupandgenderwerenotsifnificantnorwasthereasifnificantinteraction.Thevictimgroupscoredanaverageof15.1ontheintrusionsubscalecomparedto11.6scoredbythecontrolgroup.

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Avoidancesubscale.Ontheavoidancesubscale,therewasa16significantmaineffectforgroup, E(1, 29)=5.96, 2 =.02.Effectsforgenderandtheinteractionwerenotsignificant.Thevictimgroupscoredanaverageof20.2ontheavoidancesubscalecomparedto10.4scoredbythecontrolgroup.Themeansandstandarddeviationsforthe1-monthpost-disastersubscoresforchildrenaresummarizedinTableIII,andthemeansandstandarddeviationsforthe1-monthpost-disastersubscoresforchildrenandadolescentsaresummarizedinTableIV.InsertTablesIIIandIVabouthere Horowitz(1982)suggestedcutoffscoresfordetermininglow,medium,andhighsymptomlevelsusingthetotalscores8.5=low;8.6-19.0=medium;and>19.0=high).Therefore,atwo-wayfactorialANOVAwasperformedonthecombinedchildandadolescentdatawithgroupandgenderastheindependentvariablesandthetotalscalescoreasthedependentvariable.Whiletheeffectforgenderandtheinteractionwerenon-significant,theeffectforgroupapproximatedsignificance, E(1, 29)=4.02, =.054.Subjectsinboththevictimgroupandthecontrolgroupscoredinthe"high"rangeasdefinedbyHorowitz(1982),withthevictimsaveraging35.3totalpoints,andthecontrolsaveraging22.0.TableVreflectsthepercentageofchildrenwhohadexperiencedsymptomsatleastonceinthesevendayspriortothedateofassessment.TableVIreflectsthepercentageofadolescentvictimsalonewhohadexperiencedthesesymptoms.InsertTablesVandVIabouthere

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Atwo-wayfactorialANOVAwasperformedonthecombinedchildandadolescentdatawithgroupandgenderastheindependentvariablesand17thetotalnumberofendorseditemsasthedependentvariable.Therewasasignificanteffectforgroup, E(l, 29)=4.27, E =.048,buttheeffectforgenderandtheinteractionwerenon-significant.Atwo-wayfactorialMANOVAwasperformedwithgroupandgenderastheindependentvariablesandthestateandtraitsubscalescoresasthedependentvariables.Childandadolescentdatawerecombinedfortheseanalyses.Theeffectforgroupwasnotsignificant,buttheeffectforgenderwassignificant, E(2, 26)=5.64, E =.009.Theinteractionwasnon-significant.TwofactorialANOVAswereperformedusingthemodeldescribedabove.Group,genderandinteractioneffectswerenotsignificantonthestateortraitportionsoftheSTAI-C.ThedatafromtheSTAI-Cindicatedthatanxietylevelswerenearnormalforbothvictims(meanstateanxietyscore=33.7;meantraitanxietyscore=36.5),andcontrols(meanstateanxietyscore=30.6;meantraitanxietyscore=36.6)(SeeTableVII).InsertTableVIIabouthereParent-ChildPTSDComparisonsParents,children,andadolescentswerecomparedintermsofthenumberofPTSDsymptomsreportedontheDISandtheDICA-R.Anindependentt-testshowedthat,asagroup,parentsreportedsignificantlymorePTSDsymptomsthandidchildren, =2.07, E =.04.Whenparent-childdyadswerecomparedintermsofthetotalnumberof

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18PTSDsymptomsreported,adependentt-testbasedondifferencescoresrevealedthat,onaverage,parentsreported1.9moresymptomsthantheirchildren,whichwassignificant, =2.63, H =.048.Toexaminefurtherthedegreeofassociationbetweensymptomagreementinparent-childdyads,thenumbersofPTSDsymptomsreportedbyparentsandtheirchildrenwerecorrelated.Therewasasignificant,butnotverystrong,associationbetweenthenumberofPTSDsymptomsreportedbyparentsandchildren, =.39, H =.05.Inaddition,another,morespecificmeansofassessingthedegreeofagreementonindividualPTSDsymptomsbetweenparent-childdyadswasemployed.BecausetheDICA-RandDISyield"yes"or"no"(dichotomous)data,thephi-coefficientwasusedtodeterminethestrengthofassociationbetweenparents'responsestoindividualPTSDsymptomsandthoseoftheirchildren.ThisstatisticwasemployedtoexaminethedegreetowhichspecificPTSDsymptomcontagionexistedbetweenparentsandtheirchildreninthisdisastersample.Foreachparent-childdyad(N=26),aphicoefficientwasdeterminedbyconstituting2x2matricesofyes-noresponsesforallPTSDsymptoms.Themeanphi-coefficientwasonly.048,indicatingnoagreementwithinparentsandchildrendyadsoneitherthepresenceorabsenceofspecificPTSDsymptoms.Whenthismeanwastestedagainstthehypothesisthatitwasequalto0,theWilcoxonsigned-ranktestshowedthatthedegreeofagreementbetweenparent-childdyadsonPTSDsymptomswasnotsignificant, =0.75, H =.23.Pre-existingPsychiatricDisordersDICA-Rdata.Again,therewerenosignificantdifferencesbetweengroupsintermsofthenumberofpre-existingpsychiatricsymptoms.The

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19DICA-Rdatarevealedthatfourchildrenandfouradolescentscouldbediagnosedwithpreexistingpsychopathology.Ofthechildren,threemetthediagnosticcriteriaforoveranxiousdisorder.ThefourthchildmetthecriteriaforpreviousPTSDresultingfromasevereinjury.Ofthetwoadolescentswhometthediagnosticcriteriaforoppositionaldefiantdisorder,onemetthecriteriaforconductdisorder,aswell.Anadditionaladolescentmetthecriteriaforconductdisorderalone,andthefourthadolescentmetthecriteriaforoveranxiousdisorder.OfthethreechildrenwithdiagnosablePTSD,onehadnopreexistingpsychiatricdisorders,onehadpreexistingPTSDfromasevereinjury,andthethirdcouldbediagnosedwithpreexistingoppositionaldefiantdisorder.CBQdata.Accordingtoparents'ratingsontheCBQ,sixsubjectsinthesamplescored13ormore,acut-offpointwhichusuallyindicatesahighriskofpsychiatricdisorder.Fourofthesubjectsabovethecut-offwerechildren;twowereadolescents,bothofwhichwerefromagroup-homefortroubledgirls.TheirCBQswerecompletedbythegrouphomeparentwhoaccompaniedthemtotheinterview.Threesubjectswerefromthefirevictimgroup(includingtheadolescents),andthreewerecontrolsubjects.ThemeantotalscoreontheCBQwas7.36forthechildandadolescentvictims,and8.22forthechildandadolescentcontrols.PreviousStressorsChildrenandadolescentswereaskediftheyhadeverexperiencedstressfullifeeventssuchasanotherdisasterorseveretraumaotherthanthewildfire.Eventsincluded:earthquake,otherfire,flood,mudslide,severestorm,toxicwaste,severeinjury,caraccident,"gettingbeatup",witnessinjurytoother,severeillness,or"other."

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20Ofthe22childrenages7to12,9saidtheyhadneverexperiencedanotherstressfulevent,elevenreportedonestressfulevent,andtworeportedtwostressfulevents.Fourofthechildrenwhoreportedpreviousstressfuleventshadexperiencedanearthquake,fourhadexperiencedorwitnessedacaraccident,tworeportedasevereinjury,andoneeachreportedastormandfire,brokenarm,HurricaneHugo,and"gettingbeatup".Oneofthechildrenwhohadexperiencedasevereinjury(abrokenarmfromfallingoutofatreeontoconcrete)alsoreportedmultiplePTSDsymptomsfollowingtheinjury,includingseveralreexperiencing,avoidance,andarousalsymptoms.Ofthe11adolescents,5saidthattheyhadneverexperiencedanotherstressfulevent,and6reportedonestressfulevent.Twohadexperiencedanearthquake;twowitnessedaninjury;andoneeachreported"gettingbeatup"andhavingacaraccident.Comparisonsweremadebetweenthosechildrenandadolescentswhodidnotreportpreviousstressorsandthosewhoreportedoneortwopreviousstressors.One-wayanalysesofvariance(ANOVAs)wereperformedwithpreviousstressorastheindependentvariable,andstress-relatedscoresorsymptomsasthedependentvariables.OntheHIES,therewasnomaineffectofpreviousstressorstatusforeithertheintrusionoravoidancesubscalescoresorthetotalscore.WiththeDICA PTSDdata,therewasnomaineffectforthenumberofintrusion,avoidance,arousal,ortotalPTSDsymptoms.Similarly,withtheSTAI-C,therewasnomaineffectforeitherstateortraitanxietyscore.DiscussionConsistentwithanearlierstudy,varyingdegreesofpsychosocialdistressresultfromafiredisaster(McFarlane,1987).Whilethe

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21samplesizeofchildrenandadolescentswasquitesmall,resultsparallelthosefoundinotherdisaster-relatedresearch(Earlsetal.,1988;Handfordetal.,1986;Yule & Williams,1990).Severalattemptsweremadetoenhancethemethodologicalsophisticationofthisstudythroughtheemploymentofmultimethodassessmentstrategyandtheuseofacontrolgroup.Additionally,theuseofastructuredinterview(OleAR)assistedinisolatingtheimpactofthefirebyaccountingforseveraltypesofpre-existingpsychopathologyintheformofPTSD,ODD,CD, OAD,pastandpresent MAD, andprevioustraumaexperienced.AlthoughthreeindividualsmetthecriteriaforPTSD(twochildrenandoneadolescent),extremecautionmustbetakenwheninterpretingthesefindings.Twoofthechildrenwerequiteyoung,ages7and8.AspointedoutbyGreenetal.(inpress)andothers,youngchildrenmayhavedifficultyinexpressingtheirreactionstodisaster.Thismaybeduetoseveralfactors,includinginabilitytoperceiveaneventasharmfuland/orphysicallythreatening,inabilitytoprocesstheeventasafunctionofcognitivedeficiencies,inabilitytounderstandinterviewquestions,inabilitytoverbalizetheirfeelings,and/orculturaldifferences.Afterexaminingtranscriptsoftheinterviews,severalofthesehypothesesmaybeplausible.ThefactthatbothchildrenandadolescentswereMexican-Americanenhancesthelikelihoodofdifficultyinexpressingreactionsduetolanguageand/orculturaldifferences.Theneedtoconsiderculturalissueswhenassessingtheimpactofdisasteronculturallydifferentgroupsis,hence,importantinfutureresearch.Themediatingfactorscontributingtothedevelopmentofpsychopathologyindisastersituationsmayhaveanintrinsicculturalmeaning(Bravo,Rubio-Stipec, & Canino,1990).Anotherreasonto

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22interpretthesedatacautiously is duetothepresenceofpreviouspsychiatricdisorders.Theeight-year-oldchildhadexperiencedatraumaticevent(afallresultinginabrokenarm)whichappearedtohavebeenofsufficientintensitytoleadtoPTSD.Theadolescenthadbeenpreviouslydiagnosedwithoppositionaldefiantdisorder.Weareuncertainofthedegreetowhichpreviousstressorsmayhavecontributedtotheseindividuals'presentlevelofPTSDsymptomatology.ThesefindingsshedlightontheissueraisedbySolomonandCanino(1990)concerningtheextenttowhichpsychiatricsequelaeresultingfromexposuretoanextraordinarytraumaticevent,suchasafiredisasterinthisinstance,differfromthesequelaeresultingfromexposuretomorecommonstressors(injury).Obviously,thisissueshouldbepursuedfurther.AlthoughitisfairlyclearthatamajorproportionofthevictimsdidnotexperiencediagnosablePTSD,theconsistentlevelofPTSDsymptoms(victims4.4totalsymptoms,controls4.1totalsymptoms)suggeststhatthefiredidnegativelyimpacttheirbehavior.ThenonsignificantdifferencesacrossthesixtypesofdisorderandprevioustraumasuggestthatPTSDsymptomatologywasprimarilyduetothefire.Ofcourse,furtherwell-designedresearchisneededtoexplorethishypothesis.Wheninterpretingthedata,itisimportanttoconsidertherelativelycomparablelevelsofPTSDsymptomsontheDICA-Rendorsedbyboththevictimandcontrolgroups,afindingobtainedbyJonesandRibbe(1991).Whiletheseresultsmayseemcounterintuitive,uponcloserexaminationtheymaybequitereasonable.Giventhatmostresidentswerehighlyawareofthewildfirebecauseofitsmagnitudeand

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23extentof Lrnmediate mediacoverage,itislikelythatallindividualswereaffectedbythisevent.Whilewecontendthatvictimsmayhaveexperiencedagreaterleveloftrauma,whichisparticularlysupportedbyouradultdata,wealsomaintainthatallresidentsofthiscommunitywerenegativelyaffectedtosomedegreebythefire.Severalresearchershaveprovidedheuristicframeworksinwhichthesefindingsmightbeinterpreted.Oneframeworkconcernsdegreeofexposuretotheeventwhichhascorrelatedwithindividuals'reactionstotrauma.Theimpactofexposurecanbegarneredfrominvestigationsofseveralevents,includingThreeMileIsland(Bromet,1980),thesniperattackatschool(pynoosetal.,1988)alludedtoearlier,andfire(Maida,Gordon,Steinberg,&Gordon,1989)wheregreaterexposuretothetraumaticeventledtogreaterlevelsofPTSDsymptoms.TheHIESrevealedasignificantdifferenceontheavoidancesubscalebetweenthevictimizedandcontrolgroups.Therelativelyhighelevationsonthissubscaleforvictimssuggestthatthefiredidproduceemotionalreactions.Uponcloserinspectionofsubjects'responses,agreaterpercentofvictimsendorsedalleightitemsthandidcontrolsubjects.Itisinterestingtonotethatthegreatestdiscrepancybetweengroupswas-ontheitem,"Istayedawayfromthingsthatremindedmeofit."Oneratherparsimoniousexplanationforthisdifferencewasthatvictimsand/ortheirparentsmayhaveactivelyavoidedthesiteoftheirdestroyedhome.Atatheoreticallevel,thesefindingsareconsistentwithearlierreportswhichmaintainthatchildrenmayavoidremindersofthetraumaticeventbecausetheirreactionsmayintensifyundersuchcircumstances(Davidson&Baum,1990).WeconcludeasdoDavidsonandBaum(1990)thatitisimportant

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24toviewtheoutcomeofstressfuleventsasafunctionofaninteractionamongcharacteristicsoftheperson,theenvironment,aswellastheevent.Concerningtheintrusionsubscale,substantialbutnonsignificantdifferenceswereobservedbetweenvictimsandcontrolsonsixofthesevensymptoms.Nevertheless,thevictimsagainevidencedgreaterlevelsofPTSDsymptomatology.Particularsymptomswhichsuggestagreaterlevelofdistressamongthevictimsinclude,"IthoughtaboutitwhenIdidn'tmeanto,""Ihadstrongfeelingsaboutit,""Ihaddreamsaboutit,"and"Otherthingskeptmakingmethinkaboutit."Perhapsthemosttellingsymptom,"Ikeptseeingitoverandoverinmymind,"evincedthegreatestdiscrepancybetweengroups.Thesepatternsareconsistentwithotherinvestigationsdocumentingtheimpactoftraumaonchildrenandadolescents(Greenetal.,inpress).TheanalysisofthetotalHIESscoreyieldedsimilarresults.Thebetween-groupdifferenceontheavoidancesubscaleoftheHIESdoesnotsquarewiththefailuretofindadifferencebetweengroupsonthenumberofavoidancesymptomsreportedontheDICA-R.Thisfindinghighlightstheneedforfurtherattentiontoassessmentissuesinthisarea.AplausibleexplanationofthisapparentincongruityisthattheHIESandDICAmeasuredifferentaspectsoftheconstructofavoidance.TheavoidanceconstructassessedwiththeHIESisbasedonthepre-DSMIIInotionsoftrauma-relatedavoidanceor"numbing-of-responsivenessto-the-externalworld"symptoms(Brett,Spitzer,&Williams,1988).TheavoidancesymptomsassessedwiththeorCAarebasedontheOSM-III-RPTSOclassification.

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25Brettetale(1988)pointedoutthatHorowitzetale(1979)focusedtheHIESmainlyona two-dLmensional conceptofavoidancethatreferstoconsciousattemptstodispelthoughtsandfeelingsassociatedwiththetrauma.Bycontrast,theDSM-III-RexpandedtheDSM-III"numbing"categorytoincludeavoidance,amnesia,andnumbingsymptoms.AnexaminationoftherespectiveitemsoftheHIESandtheDICA-C-RinTableVIIIrevealedthatsixoftheeightHIES"avoidance"itemsdidindeedappeartoloadononeofthetwoDSM-III-Rsymptomsrelatedtoeffortstodealwiththoughtsandfeelingsassociatedwiththedisaster,butnoneoftheHIESavoidanceitemslinedupwithanyofthefiveremainingDSM-III-Ravoidancesymptoms.InsertTableVIIIabouthereWhilethemeaningofthesediscrepantfindingsisnottotallyclear,itdoes,however,underscorethenecessityofexaminingcloselythedifferencesandsimilaritiesofinstrumentshypothesizedtoassesssymptomsaroundthedimensionsofthestressresponse.Heuristically,Horowitzetale(1987)haveshownthattheavoidanceconceptasmeasuredbytheHIESdoesdifferentiatestressedfromnormalindividuals,andbetweenstressedindividualswhoseektreatmentandthosestressedindividualswhodonotseektreatment.ItmaybethatvictimsscoringhigheronHIESavoidancewouldbemoreresponsivetoclinicalintervention;thus,theHIESavoidancescores,althoughlimitedinthescopeoftheirassessmentofPTSD-relatedavoidancesymptoms,havesignificantclinicalutility.

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26AnotherdifferencebetweenthefindingasassessedbytheHIESandDICA-Risinthemagnitudeofthesymptomsreported.Childreninboththevictimandcontrolgroupsscoredinthe"high"rangeonthetotalHIESscore,asdefinedbyHorowitz.NosuchcutoffcategorieshavebeenreportedforthenumberofPTSDsymptomsendorsed,butitseemsthatbothgroupsreportedamildnumberofPTSDsymptomsontheDICA-R(themeannumbersofsymptomsreportedbythevictimsandcontrolswere4.4and4.1,respectively).Itisclearthatthereisadifferenceinstress-relatedsymptomsasassessedbythetwoinstruments.Lyons(1991)hasrecommendedthatintheassessmentofPTSDtheprimaryemphasisbeplacedontheresultsofaclinicalinterview,andthatrelianceonanysinglemeasuresuchasascoreonapsychometricindexshouldbeavoided.Inaddition,Weisenberg,Solomon,&Schwarzwaldt(1987)foundonlya 75% agreementbetweendiagnosesbasedonpsychometricindicesandthosebasedonclinicalinterviews.ItisclearthattheHIESassessestheintensityofsomeaspectsofPTSDsymptomatology,whereastheDICA-RprimarilyassessesthepresenceorabsenceofPTSDsymptoms,representingtwomodesofassessingPTSD.Itmaybethatasolutiontothisassessmentdifficultyistodevelopanintegratedassessmentprotocolthatassessesbothsymptompresenceandintensity.Concerningthemediatingroleofparents'behavioronchildren'sandadolescents'functioning,Rutter,Cox,Tupling,Berger,andYule(1975)hypothesizedthatthreefactorsamelioratedtheconsequenceofstressinchildren:personality,familycohesion,andsupportoutsidethefamilyenvironment.Whilethescopeofthisstudydidnotallowus

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toassessobjectivelythesefactors,wewereabletogainsomeinsightonthemediatingroleofparents.Severalrecentstudieshavefoundthatparentalbehaviorduringdisastermayhaveanegativeimpactontheiroffspring'sbehavior.Indeed,McFarlane(1987)reportedthatmothers'reactionstodisasterwerebetterpredictorsofchildrenhavingPTSDthanchildren'sdirectexposuretothedisasteritself.MelamedandSiegel(1988)reportedthatparentalanxietywascorrelatedwithpooradjustmentofchildren.Similarly,pynoos,etale(1988)statedthatchildrenarelikelytorespondsimilarlytoadultsinboththenatureandfrequencyofgriefreactionsuptooneyearfollowingtheincident.Thisphenomenonwasalsoobservedbyotherinvestigators(Parkes,1970;Rosenbeck&Natan,1985).Inthepresentstudy,thesefindingsweretentativelysupportedinthatalowcorrelationwasfoundbetweenthenumberofsymptomsofchild/adolescentandparentsacrossbothtargetgroups.However,therewassomeevidencetosuggestthatcontagionofspecificPTSDsymptomswasnon-existentwithintheparent-childdyadsinthissample.Inanattempttoenhancethevalidityofchildrenandadolescentreactions,weallowedchildrentoreportobjectivelytheirexperiencesduringandaftertheevent.Previousinvestigationsinthisarearelyingheavilyonparentand/orteacherreports(Benedek,1985;Eth,Silverstein,&Pynoos,1985)havebeenshowntounderestimatechildren'slevelofstresssignificantly.Inexaminingtheyoungster'sresponses,itisevidentthatvaryinglevelsofsymptomatologywereobtained.27Conversely,parents'perceptionsofchildandadolescentreactionsusingtheCBQsuggestedasomewhatdifferentconclusion.Parents

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28reportedextremelylowlevelsofendorsementofitemsonboththeantisocialandneuroticsubscalesforsubjectsinbothfireandcontrolgroups,whichsuggeststhatparentsmayhavebeenunawareoftheirchildren'slevelofsymptomatology.Whenexaminingtheseresultsinlightofchildren'selevatedlevelsofdistress,asindicatedbytheavoidancedimensionoftheHIESandtheOrCAPTSDscale,thediscrepanciesbetweenchildren'sreportsandparents'reportsofchildrenareclear.Thesefindingsmaybesupportiveofotherinvestigationswhichclaimthatparentsdoinfactunder-reportseverityofchildren'sreactionstothesetypesofevents(Handfordetal.,1985;McFarlane,1987;Earlsetal.,1988).Obviously,wearelimitedinourconclusionshere,inasmuchasnoconfirmingreportswereobtainedfromothermeaningfulsourcessuchasschoolteacher(duetosummervacation);theneedforfutureempiricalresearchisquiteapparent.Whenexaminingthesefindings,itisinterestingtoseehowtheycomparewithrelatedstudiesassessingchildren'sandadolescents'reactiontodisaster.FromTablesIXandXitisclearthatreactionsmaybecloselyrelatedtotheseverityoftheconsequencesoftheevent.Forexample,reactionsweresignificantlyloweramongboyswhoexperiencedanighttimedormfirewherethemajorconsequenceswerelossofpersonalbelongingsversusmoreintensereactionsbyindividualsfollowingtheHeraldofFreeEnterprisesinkingwhereseveralcasualtiesresulted.Thisfindinghighlightstheneedtonotonlyexaminethetypeofevent(i.e.,fire,shooting,earthquake)butalsothepotentialmoderatingormediatingeffectoftheseverityoftheconsequencesoftheevent.

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InsertTablesIXandXabouthere29AnobviousquestionariseswhensummarizingtheresultsofthisstudyaswellasseveralotherswhererelativelymildlevelsofPTSDresultfromsimilardisasters:WhyistheresuchalowlevelofPTSDsymptomatologyreportedbychildrenandadolescents?Severalexplanationshavebeenproffered.Oneexplanationstemsfromthefactthatnoresidentswereinjuredorkilled.Inthosedisasterswhereinjuryand/ordeathoccur,orthefearofeitherissignificant,thelikelihoodofPTSDbecomesincreasinglyprobable.Futureinvestigationsshouldincludeoruseonlythosefamilieswhereinjuryand/ordeathorthefearofeitherisreported.Anotherexplanationconcernschildren'sdevelopmentallevelasitinteractswiththeirabilitytoperceiveaneventasharmfuland/orphysicallythreateningorasrelativelyharmlessandnon-threatening.Ithasbeenpositedthatyoungchildrenmaylackthecapacitytobetraumatizedbycertainevents(Gomes-Schwartz,Horowitz,Sauzier,1985).Conversely,aschildrencontinuetodevelop,theydevelopthecognitiveweaponrytocopeeffectivelywithatraumaticevent.Thisfindingisconsistentwithseveralgainedfromthestressandcopingliterature.Compas,Malcarne,&Fondacaro(1988)andothersmaintainthatolderchildren(12to14)ascomparedtoyoungerchildrenhavegreaterproblem-solvingabilitiesandcapacitytogeneratealternativewaysofcoping,bothofwhicharecorrelatedwithpositiveoutcomes.Theapparentcohesivenessofthiscommunitymayhaveservedanimportantprotectiverole.Inasmuchastheroleofcommunityhasbeen

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hypothesizedtoimpactindividuals'recoveryrate(Erikson,1976),theneedtoexaminethisfactorinfutureinvestigationsisessential.Notwithstandingtheabove-mentionedhypotheses,perhapsthemostparsimoniousexplanationsfortherelativelymildlevelsofPTSDsymptomatologyareconsistentwithGarmezy's(1983)conclusionthataccompanyingdisturbancesfollowingthepsychologicalsequelaeofmanmadeandnaturaldisastersareoftenminimalandshortlived.Selectingonlythosesubjectsreportingdifficultyincopingfollowingdisastermaybeamorepreciseandfruitfulmethodofexaminingthepsychosocialconsequencesoffire.30

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ReferencesAmericanPsychiatricAssociation(1987). Diagnoscic and Scaciscical Manualof Mencal Disorders(ThirdEdition-Revised).Washington,DC:Author.Applebaum,D.R.,&Bruns,G.L.(1991).Unexpectedchildhooddeath:Posttraumaticstressdisorderinsurvivingsiblingsandparents.JournalofClinicalChildPsychology,20,114-120.31Bravo,M.,Rubio-Stipec,M.,&canino,G.(1990).Methodologicalaspectsofdisastermentalhealthresearch. Incernacional Journalof MencalHealch, 19,37-50.Brett,E.A.,Spitzer,R.L.,&Williams,J.B.W.criteriaforposttraumaticstressdisorder.Psychology,145,1232-1236.(1988).DSM-III-RAmericanJournalofCarroll,E.M.,Foy,D.W.,Cannon,B.J.,&Zwier,G.(1991).Assessmentissuesinvolvingthefamiliesoftraumavictims.Journalof TraumacicScress,!, 25-40.Compas,B.E.,Malcarne,V.L.,&Fondacaro,K.M.(1988).copingwithstresseventsinolderchildrenandyoungadolescents.Journalof Consulcing andClinicalPsychology,55,405-411.Davidson,L.M.,&Baum,A.(1990).Posttraumaticstressinchildrenfollowingnaturalandhuman-madetrauma.InM.Lewis&S.M.Miller(Eds.),Handbookof developmencalpsychopachology (pp.251259).NewYork:Plenum.DivisionofInjuryControl,CenterforEnvironmentalHealthandInjuryControl,CenterforDiseaseControl(1990).ChildhoodinjuriesintheUnitedStates.AmericanJournalofDiseasesofChildren,144,627-646.Earls,F.,Smith,E.,Reich,W.,&Jung,K.G.(1988).Investigatingpsychopathologicalconsequencesofadisasterinchildren:Apilotstudyincorporatingastructureddiagnosticinterview.Journalof che AmericanAcademyofChildand Adolescencpsychiacry, 27,90-95.Erikson,K.T.(1976).LossofcommunityatBuffaloCreek.AmericanJournalof Psychiacry, 133,302.Garmezy,H.,&Rutter,M.(1985).Acutereactionstostress.InM.Rutter&L.Hersov(Eds.),Childand adolescencpsychiacry: Modernapproaches(2ndEd.)(pp.152-176).Publisher:Green,B.L.(1982).Assessinglevelsofpsychologicalimpairmentfollowingdisaster.JournalofNervousandMentalDisease,170,544-552.

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Green,B.L.,Korol,M.,Grace,M.C.,Vary,M.G.,Leonard,A.C.,Blaser,G.C.,&Smitson-Cohen,S.(inpress).Childrenanddisaster:AgeandgendereffectsonPTSDsymptoms.JournaloftheAmericanAcademyofChildandAdolescentpsychiatry.Handford,H.A.,Mayes,S.D.,Mattison,R.H.,Humphrey,F.J.,Bagnato,S.,Bixler,E.0.,&Kales,J.D.(1986).ChildandparentreactiontotheThreeMileIslandnuclearaccident.JournaloftheAmericanAcademyofChildPsychiatry,25,346-356.Herjanic,B.,&Reich,W.(1982).Developmentofastructuredpsychiatricinterviewforchildren:Agreementbetweenchildandparentonindividualsymptoms.JournalofAbnormalChildPsychology,10,307-324.Horowitz,M.,Wilner,N.,&Alvarez,w.(1979).Impactofeventscale:Ameasureofsubjectivestress.PsychomaticMedicine,41,209218.Jones,R.T.,&Haney,J.I.(1984).Behaviortherapyandfireemergencies:Conceptualization,assessment,andintervention.ProgressinBehaviorModification,19,177-216.32Jones,R.T.,&Ribbe,D.P.(1991).Child,adolescent,andadultvictimsofresidentialfire.BehaviorModification,139,560-580.Jones,R.T.,&Ribbe,D.P.(1990).TheAdultandChildFireQuestionnaire.Unpublishedmanuscript,VirginiaPolytechnicInstituteandStateUniversity,Blacksburg,VA.Klein,H.(1974).Childvictimsoftheholocaust.JournalofClinicalChildPsychology, 1, 44-47.Krim,A.(1983).(MH29197).Familiesafterurbanfire:DisasterinterventionWashington,DC:NationalInstituteofMentalHealth.Lyons,J.A.(1991).Issuestoconsiderinassessingtheeffectsoftrauma:Introduction.JournalofTraumaticStress, i, 3-6.Maida,C.A.,Gordon,N.S.,steinberg,A.,&Gordon,G.(1989).Psychosocialimpactofdisasters:VictimsoftheBaldwinHillsfire.JournalofTraumaticStress, 37-47.Malmquist,C.P.(1986).Childrenwhowitnessparentalmurder:Posttraumaticaspects.JournaloftheAmericanAcademyofChildPsychiatry,25,320-325.McFarlane,A.C.(1987).Familyfunctioningandoverprotectionfollowinganaturaldisaster:Thelongitudinaleffectsofposttraumaticmorbidity.Australianand New ZealandJournalofpsychiatry, 210-216.

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33McFarlane,A.C.,Policansky,S.K.,&Irwin,C.(1987).Alongitudinalstudyofthepsychologicalmorbidityinchildrenduetoanaturaldisaster.PsychologicalMedicine,17,727-730.Melamed,B.G.,& SiegeJ, L. J_ (1988).Copingbehaviorsinchildrenfacingmedicalstress.InT.Field,P.McCabe,&N.Schneiderman(Eds.),Stressandcopingacrossdevelopment,Vol.2(pp.109138).NewYork:LawrenceErlbaum.Newman,C.J.(1976).BuffaloCreek.Childrenofdisaster:ClinicalobservationsatAmericanJournalofPsychiatry,133,306-312.pynoos,R.S.,Nader,K.,Frederick,C.,Gonda,L.,&Stuber,M.(1988).Griefreactionsinschool-agechildrenfollowingasniperattackatschool.InE.Chigier(Ed.),Griefandbereavementincontemporarysociety,Vol.1:Psychodynamics(pp.29-41).London:FreundPublishingHouse.Reich,W.,&WeIner,Z.(1990).DiagnosticInterviewforChildrenandAdolescents-Revised.St.Louis:WashingtonUniversity.Robins,L.M.,Helzer,J.E.,Croughan,J.,&Ratcliff,K.S.(1981).NationalInstituteofMentalHealthDiagnosticInterviewSchedule.ArchivesofGeneralPsychiatry,38,381-389.Rosenbeck,R.,&Nathan,P.(1985).childrenofVietnamveterans.36,538-539.SecondarytraumatizationinHospitalandCommunitypsychiatry,Rutter,M.,Cox,A.,Tipling,C.,Berger,M.,&Yule,W.(1975).Attainmentandadjustmentintwogeographicalareas.BritishJournalofPsychiatry,126,493-509.Saigh,P.A.(1985).Onthenatureandetiologyoftraumaticstress.BehaviorTherapy,16,423-426.Solomon,S.D.(1989).Researchissuesinassessingdisaster'seffects.InR.M.Gist&B.Lubin,Psychosocialaspectsofdisaster(pp.308-340).NewYork:JohnWiley.Solomon,S.D.,&Canino,G.J.(1990).criteriaforposttraumaticstressPsychiatry,31,227-237.AppropriatenessofDSM-III-Rdisorder.ComprehensiveWeisenberg,M.,Solomon,severityofPTSD:measures.Journal434.z.,&Schwarzwaldt,J.(1987).AssessingtheRelationbetweendichotomousandcontinuousofClinicalandConsultingPsychology,55,432-Yule,W.,&Williams,R.M.(1990).Post-traumaticstressreactionsinchildren.JournalofTraumaticStress, 1, 279-295.

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Footnote1ThisresearchwasfundedbytwograntsawardedtothefirstauthorfromtheNationalHazardsCenterattheUniversityofColoradoinBoulderandvirginiaTechUniversity.Portionsofthismanuscriptwerepresentedatthe99thAnnualAmericanPsychologicalAssociationconvention,August,1991,inSanFrancisco,CA.specialthankstoJudyLeeattheNationalAmericanRedCrossofficeinWashington,DC,andthefollowingstaffmembersattheSantaBarbaraRedCrosschapter:LouisePetersonandAbbyKeith.Also,specialthankstomembersofourresearchteam,especiallyJohnBenesekandAnthonyconstantino,andtoBobFraryforhisstatisticalassistance.ThanksarealsoextendedtoWendyRiechandSamTurnerforcommentsonanearlierversionofthemanuscript.AllcorrespondenceshouldbesenttoRussellT.Jones,VirginiaTechDepartmentofPsychology,StressandCopingLab,4102DerringHall,Blacksburg,VA24061-0436.2Adultdata,withtheexceptionofparent-childdyaddata,arenotincludedinthisreport.3significancelevelforallfindingswas<.05.34

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TableI NumberofSymptomsReportedontheDlCA-.RbyChildrenandAdolescentsDisorderGroupaNXSDF-value p-valueOppositionalDefiant1221.181.591.21.28Disorder2100.600.70ConductDisorder1220.681.210.44.512100.400.84OveranxiousDisorder1231.26 1.250.35.56(past)2101.602.01MajorAffectiveDisorder1232.57 2.190.32.57(past)2103.103.07MajorAffectiveDisorder1232.001.982.70.ll(present)2100.901.10Post-TraumaticStress1234.433.800.04.84Disorder2104.105.07 1=VictimGroup2=Control

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TableII ofChildrenandAdolescentsReportingPTSDSymptomsonthe FollowingDisaster:Victimsvs.Controls PI'SD SymptomsVictims(%)Controls(%)(n=23)(n=10).'Reexperiencing1.Thinkingaboutitalot65.040.02.Dreamingaboutitrepeatedly30.430.03.Senseofeventrecurring21.730.04.Upsetbyremindersoffire45.520.0Avoidance5.Thinkingaboutit when tryingnotto39.130.06.Avoidedthingsassociated with fire26.130.07.Amnesiafordetailsoffire13.010.08.Lossofinterestinusualactivities17.420.0-9.Lossofinterestinpeople13.610.010.Lossofcaringfeelings4.40II.Outlookonfuturechanged4.410.0IncreasedArousal12.Troublefalling/stayingasleep47.840.013.Increasedirritability&temperoutbursts26.1 20.014.Decreasedattention13.650.015.Increasedrestlessness13.040.016.Increasedstartlereflex34.830.017.Increasedautonomicactivity34.80

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TableIII.MeansandStandardDeviationsofl-MonthPost-DisasterHIESSubscales:ChildrenAges 7.-12Subscale Group
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TableIV Means -andStandardDeviationsofI-MonthPost-DisasterHIESSubscales:ChildrenandAdolescentsSubscale Groupa NXSDIntrusion1 2315.16.621011.68.7Avoidance1 2320.29.2210lOA11.1Total1 2335.314.321022.019.1 1=VictimGroup2=Control

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Table .v ReportedFrequency{%}ofHorowitzImpactof Eventsr SCale:ChildrenAges7-12VictimsControlsSubscale{n=13} {n=9}IntrusionIthoughtaboutitwhen Ididn'tmeantoIhadtroublefallingasleeporstayingasleepbecausepicturesorth:mghtsaboutitcameintomymindihadstrongfeelingaboutitIhad dreams aboutitIkeptseeingitoverandoverinmymindOtherthingskeptmakingmethinkaboutitAny reminder broughtbackfeelingsaboutit 100.0% 88.9%53.9%55.6%92.3%66.7%61.6%44.4%92.3%44.4%69.2%66.7% 69.2% 55.6%AvoidanceIstoppedlettingmyselfgetupsetwhen Ithoughtaboutitorwasremindedofit84.6%Itriednottoremember84.6%Istayedawayfromthingsthatremindedmeofit69.2%Ifeltthatitdidnothappenorthatitwasmake-believe84.6%Itriednottotalkaboutit84.6%I knewthatI 6till hadalotoffeelingsaboutit,butIdidn'tdealwiththem69.2%Itriednottothinkaboutit84.6%Idon'thavefeelingsaboutitanymore84.6%44.4%55.6%22.2%44.4%44.4%55.6% 55.6%66.7%

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TableVIReportedFrequency (%) ofHorowitzImpactofEventsscale:AdolescentVictimsVictimsSubscale (%) (n=10)IntrusionIthought aoout itwhen Ididn't meanto70Ihadtroublefallingasleeporstayingasleepbecauseofpicturesorthoughts aoout itthatcameintomymind40Ihadwavesofstrong"feelings aoout it80Ihaddreamsaboutit30Pictures aoout itpoppedintomymind90Otherthingskeptmakingmethink aoout it90Anyreminderbroughtbackfeelings aoout it90AvoidanceIavoidedlettingmyselfgetupsetwhenIthought aoout itor was remindedofitItriedtoremoveit fr?m memory Istayed away fromremindersofitIfeltasifithadn'thappenedoritwasn'trealItriednottotalk aoout itI was awarethatIstillhadalotoffeelings aoout it,butIdidn'tdealwiththemItriednottothinkaboutitMyfeelingsaboutitwerekindofnumb8080807050709080

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TableVIIMeansandStandardDeviationsontheState-TraitAnxietyInventory:ChildrenandAdolescentsI-MonthPost-DisasterPaintedcaveFireElementarySchoolChildrenSTAI-eVictimsControlsMalesFemalesScale (n=-2l) (n=lO) (n=456) (n""'457) StateX33.730.631.030.7SD8.13.25.76.0TraitX36.536.636.738.0SD7.77.56.36.7

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TableVIIIComparisonofDICA-R PTSDQuestionsandHIESItemsbyDSM-III-R PTSDCriteriaandSymptomsCRITERION B: INTRUSIONDSMIIIRSYMPTOMS DICA-R QUESTIONS HIES ITEMSRecurrent and intrusive distressing Afterthe_,didyouthink aboutita lot? I thought aboutitwhen I didn't meantorecollections oftheevent Pictures aboutitpopped intomymind Ihadtrouble falling asleeporstaying asleep because of picturesorthoughts aboutitthat came intomymind(ARouSf,L)Recurrent distressing dreams oftheAfterthe_,didyoudream about it over Ihaddreams aboutiteventandover? Sudden actingorfeelingasiftheAfterthe_ wereyoueverina situation Other things kept makingmethink traumatic event were recurring where maybe justfora minuteorsoyouabout W(INTRUSION) feltasifitwere happening all over again? Ihadwaves of strong feelings aboutit--Intense psychological distressatHaveyoueverbeen really upset becauseAnyreminder brought back feelings exposuretoevents that symbolize oryousaworheard something that reminded aboutitresembleanaspect ofthetraumaticyouofthe_?event,including anniversaries ofthetrauma Other things kept makingmethink about ir,INTRUSION)-

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DSM-III-RSYMPTOMSEfforts to avoid thoughtsorfeelings associated with the trauma Effortstoavoid activities or that arouse recollections of the traumc Inabilitytorecallanimportant aspect of the traumaCRITERION C: AVOIDANCE DICA-R QUESTIONSDid you think aboutiteven when you tried not to? Have you ever stayed away from lhings that reminded you of the_?After the was over, did you ever find that you couldn't remember some things about the ?HIESITEMS==========I tried nottothink aboutitI avoided letting myself get upset whenIthought aboutitor was reminded ofitI was aware that I still had a lot of feelings about it, but I didn't deal with them I tried10removeitfrom memory I stayed away from reminders ofitI tried nottotalk aboutitMarkedly diminished interestinsignificantactivitiesFeeling of detachment or estrange ment from others Restricted range of affect, e.g., unabletohave loving feelings, I _._ rI ----.....-After the was over, did you feel that you just couldn't get interestedinthings that you usedtolike? After the did you ever feel that you weren't that interested inwhalpeople said or did?,)I I----.-Afler Ihe did you ever feel Ihal you just couldn't really love anybody; that you really didn't have caring feelings about anyone any more?) I _

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AVOIDANCE(continued)DICA-RQUESTIONSDSM-III-R '-SYMPTOMS Sense of foreshortened future, e.g., does notexpecttohave a career, marriage, or children, or a long life HIES ITEMS ====r===========-.--------..====Afterthe-doyouremember feeling l -----.......-.-.----..-thatyouhadnothingtolook forwardtointhefuture? ==============.{==.. .:--=-'.,"; .. I feltasifithadn't happenedoritwasn'trealMyfeelings aboutitwere kindofnumb CRITERIOND:AROUSAL Difficulty falling or staying asleep Afterthe_didyoufind thatyouwere I had trouble falling asleeporstaying asleep having alotmore troublethanusual because of pictures or thoughts aboutitthat either falling asleep or staying asleep? came intomymind'(INTRuSION) Irritability or outbursts of anger After the didyoufeel very irritable aJQ.1 morethanusual?Didyoulose your temper aJQ.1 more Ihan usual? --.. Difficulty concentrating Afterthe_doyourememberthetimes whenyouhada great deal of difficulty'..concentrating aJQl morethanusual?..HypervigilanceDidyoufeelrestlessoronedge?

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DSM-III-RSVMPTOMSExaggerated startle response Physiologic reactivity upon exposuretoevents that symbolizeorresembleanaspectofthetraumatic event AROUSAL(continued)DICARQUESTIONSDoyou remember ever "jumping" whenyouheard a door slam,orifsomeone cameupbehindyouwithoutyourealizing it?Didyouever break into a sweat, orfeelteary whenyousaw something that remindedyouofthe __ ? HIESITEMS:=========NOTE.OSM-III-R symptomsarelistedinthe left-hand columnbyPTSOcriteriaS,C.&0 (Intrusion, Avoidance,&Arousal); corresponding' OICAR questions,inthecenter column,andrelated HIES items.intheright-hand column. Individual symptomsareseparatedbydouble underlining. Items that direclly relatetotheOSM-IIIR symptom definition are grouped withtheOSM-III-R symptom. Those items thatareindirectly, but closely relatedtothe OSM-III-R symptom definition are separated by single underlining. HIES items that relatetomore than one OSMIII-R symptomaremarked withanasterisk andthesymptom clusterwithwhichitoverlaps (e.g..-INTRUSION).

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TableIXPercentageofSubjects EndorsingHIESIntrusionandAvoidanceItemsandMeanHIESSubscaleandTotal Scores AcrossFourStudiesJones&Ribbe (1990) Malmquist Jones&Ribbe (1991) Yule&Williams Ages 14-19 Ages 5-10 Ages 7-12 Ages 5-15VictimsControlsVictimsVictimsControlsVictims(n=25) (n=13) (n=6) (n=13) (n=9) (n=13)INT% % % % %180.053.888.010088.9432.030.888.053.955.6564.069.210092.366.7640.038.581.061.644.41080.084.688.092.344.41184.076.910069.266.71472.085.656.069.255.6AVO276.061.550.084.644.4368.061.550.084.655.6752.038.569.069.222.2848.030.863.084.644.4948.057.198.084.644.41256.038.563.0 69.255.61364.053.875.084.655.61552.061.550.084.666.7----xxxxxtNT13.411.317.112.019.3AVO14.610.922.811.427.6Tor28.022.239.823.446.9

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Comparisonof-HIESScoresAcross3Studies5aII IrI I I I I I I I I I t IiYule & Williams(1990) r--Jones& Ribbe (1991)--, INTAVD TO'rAL INTAVDTOTAL GroupsBySubscale r--Jones& Ribbe (1990)---"1 5oI 1((/'(((1(({'l'c 1V{{({{1 IC 10251 f0:i20-1t; 15 +-!---.........-40\ 4 5;,30-1-,--------------------1 35I t;(/)cu'ou(j)(j)wI