Journal of Autism and Developmental Disorders

, Volume 49, Issue 4, pp 1686–1692 | Cite as

The Interactive Trauma Scale: A Web-Based Measure for Children with Autism

  • Daniel W. HooverEmail author
  • Elizabeth M. G. Romero
Original Paper


This study examined the feasibility, acceptability, and psychometric characteristics of a web-based touchscreen app prototype designed to assess self-reported trauma exposure and symptoms in children with autism spectrum disorder (ASD). The prototype was piloted with 20 clinically referred children previously diagnosed with ASD and having various known trauma exposures. User satisfaction and reported ease of use was high. The measure was sensitive to reports of teasing and bullying, endorsed by 75% and 70% of participants, respectively. Validity was assessed via comparisons with the UCLA Posttraumatic Stress Disorder Reaction Index and analysis of participants’ trauma exposures and symptoms. Clinical implications are discussed including issues of trauma screening, diagnosis, and treatment planning for traumatized youth with ASD.


Autism Trauma Measure Web-based 



Measure development and this research were supported by a grant from the Verizon Wireless Company.

Author Contributions

DWH conceived of the study and the measure and drafted the manuscript. EMGR participated in the design of the study, coordinated the research, and helped to draft the manuscript.


  1. Adams, R. E., Fredstrom, B. K., Duncan, A. W., Holleb, L. J., & Bishop, S. L. (2014). Using self- and parent-reports to test the association between peer victimization and internalizing symptoms in verbally fluent adolescents with ASD. Journal of Autism and Developmental Disorders, 44(4), 861–872. Scholar
  2. Akshoomoff, N., Beaumont, J. L., Bauer, P. J., Dikmen, S. S., Gershon, R. C., Mungas, D., … Zelazo, P. D. (2013). VIII. NIH toolbox cognition battery (CB): Composite scores of crystallized, fluid, and overall cognition. Monographs of the Society for Research in Child Development, 78(4), 119–132.Google Scholar
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington: American Psychiatric Publishing.Google Scholar
  4. Baio, J., Wiggins, L., Christensen, D. L., et al. (2018). Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 Sites, United States, 2014. MMWR Surveill Summ, 67(SS-6):1–23. Scholar
  5. Becker, A., Hagenberg, N., Roessner, V., Woerner, W., & Rothenberger, A. (2004). Evaluation of the self-reported SDQ in a clinical setting: Do self-reports tell us more than ratings by adult informants? European Child & Adolescent Psychiatry, 13, II17–II24.Google Scholar
  6. Berg, K. L., Shiu, C., Acharya, K., Stolbach, B. C., & Msall, M. E. (2016). Disparities in adversity among children with autism spectrum disorder: A population-based study. Developmental Medicine & Child Neurology, 58(11), 1124–1131. Scholar
  7. Bleil Walters, J., Hughes, T. L., Sutton, L. R., Marshall, S. N., Crothers, L. M., Lehman, C., … Huang, A. (2013). Maltreatment and depression in adolescent sexual offenders with an autism spectrum disorder. Journal of Child Sexual Abuse, 22(1), 72–89. Scholar
  8. Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, J., Gil, E., … Ernst, V. (2001). The trauma symptom checklist for young children (TSCYC): Reliability and association with abuse exposure in a multi-site study. Child Abuse & Neglect, 25(8), 1001–1014. Scholar
  9. Brooks, B. A., Haynes, K., Smith, J., McFadden, T., & Robins, D. L. (2016). Implementation of web-based autism screening in an urban clinic. Clinical Pediatrics, 55(10), 927–934. Scholar
  10. Cohen, J. A., Bukstein, O., Walter, H., Benson, R. S., Chrisman, A., Farchione, T. R., … Stock, S. (2010). Practice parameter for the assessment and treatment of children and adolescent with posttraumatic stress disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49(4), 414–430. Scholar
  11. Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64(5), 577–584. Scholar
  12. Eklund, K., Rossen, E., Koriakin, T., Chafouleas, S. M., & Resnick, C. (2018). A systematic review of trauma screening measures for children and adolescents. School Psychology Quarterly, 33(1), 30–43. Scholar
  13. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258.Google Scholar
  14. Geller, P. A., Neugebauer, R., Possemato, A. K., Walter, P., Dummit, E. S., & Silva, R. R. (2007). Psychometric properties of darryl, a cartoon based measure to assess community violence-related PTSD in children. Psychiatric Quarterly, 78(2), 157–168. Scholar
  15. Hoover, D. W. (2015). The effects of psychological trauma on children with autism spectrum disorders: A research review. Review Journal of Autism and Developmental Disorders, 2(3), 287–299.Google Scholar
  16. Hoover, D. W., & Kaufman, J. (2018). Adverse childhood experiences in children with autism spectrum disorder. Current Opinion in Psychiatry, 31(2), 128–132. [doi].Google Scholar
  17. Kaat, A. J., & Lecavalier, L. (2015). Reliability and validity of parent- and child-rated anxiety measures in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3219–3231. Scholar
  18. Kerns, C. M., Kendall, P. C., Zickgraf, H., Franklin, M. E., Miller, J., & Herrington, J. (2015). Not to be overshadowed or overlooked: Functional impairments associated with comorbid anxiety disorders in youth with ASD. Behavior Therapy, 46(1), 29–39. [doi].Google Scholar
  19. Kerns, C. M., Newschaffer, C. J., Berkowitz, S., & Lee, B. K. (2017). Brief report: Examining the association of autism and adverse childhood experiences in the national survey of children’s health: The important role of income and co-occurring mental health conditions. Journal of Autism and Developmental Disorders, 47(7), 2275–2281. Scholar
  20. Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(11), 3475–3486. Scholar
  21. Kerns, C. M., Renno, P., Kendall, P. C., Wood, J. J., & Storch, E. A. (2017). Anxiety disorders interview schedule-autism addendum: Reliability and validity in children with autism spectrum disorder. Journal of Clinical Child and Adolescent Psychology, 46(1), 88–100. Scholar
  22. Kobak, K. A., Stone, W. L., Wallace, E., Warren, Z., Swanson, A., & Robson, K. (2011). A web-based tutorial for parents of young children with autism: Results from a pilot study. Telemedicine and e-Health, 17(10), 804–808. Scholar
  23. Kuhn, E., Kanuri, N., Hoffman, J. E., Garvert, D. W., Ruzek, J. I., & Taylor, C. B. (2017). A randomized controlled trial of a smartphone app for posttraumatic stress disorder symptoms. Journal of Consulting and Clinical Psychology, 85(3), 267–273. Scholar
  24. Kupersmidt, J. B., Stelter, R., & Dodge, K. A. (2011). Development and validation of the social information processing application: A web-based measure of social information processing patterns in elementary school-age boys. Psychological Assessment, 23(4), 834–847. Scholar
  25. Lanktree, C. B., Gilbert, A. M., Briere, J., Taylor, N., Chen, K., Maida, C. A., & Saltzman, W. R. (2008). Multi-informant assessment of maltreated children: Convergent and discriminant validity of the TSCC and TSCYC. Child Abuse & Neglect, 32(6), 621–625. Scholar
  26. Layne, C. M., Greeson, J. K. P., Ostrowski, S. A., Kim, S., Reading, S., Vivrette, R. L., … Pynoos, R. S. (2014). Cumulative trauma exposure and high risk behavior in adolescence: Findings from the national child traumatic stress network core data set. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S40–S49. Scholar
  27. Maclean, M. J., Sims, S., Bower, C., Leonard, H., Stanley, F. J., & O’Donnell, M. (2017). Maltreatment risk among children with disabilities. Pediatrics, 139(4), e20161817. Scholar
  28. Mahan, S., & Matson, J. L. (2011). Children and adolescents with autism spectrum disorders compared to typically developing controls on the behavioral assessment system for children, (BASC-2). Research in Autism Spectrum Disorders, 5(1), 119–125.Google Scholar
  29. Maïano, C., Normand, C. L., Salvas, M., Moullec, G., & Aimé, A. (2016). Prevalence of school bullying among youth with autism spectrum disorders: A systematic review and meta-analysis. Autism Research, 9(6), 601–615. Scholar
  30. Mannion, A., & Leader, G. (2013). Comorbidity in autism spectrum disorder: A literature review. Research in Autism Spectrum Disorders, 7(12), 1595–1616. Scholar
  31. Matson, J. L., & Cervantes, P. E. (2014). Commonly studied comorbid psychopathologies among persons with autism spectrum disorder. Research in Developmental Disabilities, 35(5), 952–962. Scholar
  32. Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., & Syed, E. (2013). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 7(1), 109–119. Scholar
  33. Mazefsky, C. A., Kao, J., & Oswald, D. P. (2011). Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 164–174. [doi].Google Scholar
  34. McKown, C., Russo-Ponsaran, N., Johnson, J. K., Russo, J., & Allen, A. (2016). Web-based assessment of children’s social-emotional comprehension. Journal of Psychoeducational Assessment, 34(4), 322–338. Scholar
  35. McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 52(8), 815–830. Scholar
  36. Mehtar, M., & Mukaddes, N. M. (2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 539–546.Google Scholar
  37. Neely, L., Rispoli, M., Camargo, S., Davis, H., & Boles, M. (2013). The effect of instructional use of an iPad® on challenging behavior and academic engagement for two students with autism. Research in Autism Spectrum Disorders, 7(4), 509–516. Scholar
  38. Neumann, M. M. (2018). Using tablets and apps to enhance emergent literacy skills in young children. Early Childhood Research Quarterly, 42, 239–246. Scholar
  39. Praver, F., DiGiuseppe, R., Pelcovitz, D., Mandel, F. S., & Gaines, R. (2000). A preliminary study of a cartoon measure for children’s reactions to chronic trauma. Child Maltreatment, 5(3), 273–285. Scholar
  40. Pynoos, R., & Steinberg, A. (2013). UCLA PTSD reaction index for DSM-5. Los Angeles: University of California Los Angeles.Google Scholar
  41. Renk, K., & Phares, V. (2004). Cross-informant ratings of social competence in children and adolescents. Clinical Psychology Review, 24(2), 239–254. Scholar
  42. Schriber, R. A., Robins, R. W., & Solomon, M. (2014). Personality and self-insight in individuals with autism spectrum disorder. Journal of Personality and Social Psychology, 106(1), 112–130. Scholar
  43. Schutte, J. L., McCue, M. P., Parmanto, B., McGonigle, J., Handen, B., Lewis, A., … Saptono, A. (2015). Usability and reliability of a remotely administered adult autism assessment, the autism diagnostic observation schedule (ADOS) module 4. Telemedicine and e-Health, 21(3), 176–184. Scholar
  44. Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ippen, C. G., Ostrowski, S. A., … Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD reaction index: Part I. Journal of Traumatic Stress, 26(1), 1–9. Scholar
  45. Storch, E. A., Larson, M. J., Ehrenreich-May, J., Arnold, E. B., Jones, A. M., Renno, P., … Wood, J. J. (2012). Peer victimization in youth with autism spectrum disorders and co-occurring anxiety: Relations with psychopathology and loneliness. Journal of Developmental and Physical Disabilities, 24(6), 575–590. Scholar
  46. Valenti, M., Ciprietti, T., Di Egidio, C., Gabrielli, M., Masedu, F., Tomassini, A. R., & Sorge, G. (2012). Adaptive response of children and adolescents with autism to the 2009 earthquake in L’Aquila, italy. Journal of Autism and Developmental Disorders, 42(6), 954–960.Google Scholar
  47. Van der Meer, M., Bakker, A., Schrieken, B. A. L., Hoofwijk, M. C., & Olff, M. (2017). Screening for trauma-related symptoms via a smartphone app: The validity of smart assessment on your mobile in referred police officers. International Journal of Methods in Psychiatric Research. Scholar
  48. Zablotsky, B., Bradshaw, C. P., Anderson, C., & Law, P. A. (2013). The association between bullying and the psychological functioning of children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 34(1), 1–8. Scholar
  49. Zeedyk, S. M., Rodriguez, G., Tipton, L. A., Baker, B. L., & Blacher, J. (2014). Bullying of youth with autism spectrum disorder, intellectual disability, or typical development: Victim and parent perspectives. Research in Autism Spectrum Disorders, 8(9), 1173–1183. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Child and Family Traumatic StressKennedy Krieger Institute; Johns Hopkins School of MedicineBaltimoreUSA
  2. 2.Gallaudet University, Counseling and Psychological ServicesWashingtonUSA

Personalised recommendations