As a psychologist-in-training specializing in child trauma, I am constantly looking for reliable ways to assess posttraumatic symptomology, especially in young children who often cannot report their symptoms to adults. Children express distress differently than adults; even the DSM-IV-TR acknowledges that children manifest symptoms differently than adults, and makes special note that “in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.”
Psychologists often refer to this type of play as “posttraumatic play” or as play that includes “posttraumatic play behaviors” or PTPBs. However, identifying and assessing posttraumatic play is much more difficult than simply defining it. If you are a provider looking for an objective measure of posttraumatic play, keep reading.
In 2006, Findling, Bratton and Henson created the Trauma Play Scale (TPS). That study can be accessed here. They based their measure on the hallmarks of posttraumatic play outlined by Terr (1983), and created 5 subscales: intense play, repetitive play, play disruptions, avoidant play behavior, and expression of negative affect (to see a description of each of these hallmarks with examples, click here). Although the subscales were primarily developed based on Terr’s work, many others have also contributed to the field’s conceptualization of posttraumatic play as including these five elements (Erikson, 1963; Eth, 2001; James, 1989; Nader & Pynoos, 1991; Schaefer, 1994).
In order to administer the TPS, the clinician rates consecutive, videotaped play sessions at 5-minute intervals; each item is rated on a 5-point likert scale. The child’s play must be rated across several play observations because posttraumatic play is repetitive by its very nature and this decreases the likelihood of false-positives. The TPS pilot study indicated a high degree of intra- and inter-rater reliability. While this study was promising, I wanted to see a follow-up study demonstrating discriminant validity before introducing this scale into my clinical repertoire.
In the most recent issue of The International Journal for Play Therapy, I found exactly that. Myers, Bratton, Hagen and Findling published a study intended to determine the ability of The Trauma Play Scale to discriminate between traumatized and nontraumatized children. That study can be accessed here.
Results of the 2011 study indicated that traumatized children, on average, scored higher than children considered to be typically developing both on the total TPS score and on each of the five subscales. Of course, other measures can be helpful in assessing young survivors for posttraumatic symptoms, such as the Trauma Symptom Checklist for Young Children (Briere et al., 2001); however, these measures rely on caregiver report. Assessing a young child’s play may offer some additional insight into the absence, presence, or severity of symptoms in young children.