A Trial of Neurofeedback as an Adjunctive Treatment for Youth in Outpatient Mental Health Settings

Children's trauma symptoms will be measured by the Trauma Symptom Checklist for Young Children (TSCYC) at baseline and post-intervention intervals. This caregiver-report measure is developed for children between the ages of 4-12. It consists of 90-items that encompass two reporter validity scales, eight symptom-specific clinical subscales. Answers to individual items are based on a 4-point scale with response options ranging from 1 ("Not at All") to 4 ("Very Often"), and is administered and scored in accordance with manualized instructions. This study will assess trauma symptoms via subscale scores for levels of overall post-traumatic stress, dissociation, post-traumatic intrusion, arousal, and avoidance, and trauma-related aggression. Scale ranges from 90-360 with higher scores indicating worse outcomes.

The child-report version of the Short Mood and Feelings Questionnaire (SMFQ)contains 13 items measuring depressive symptom severity over a 2-week period. Each item has 3 response categories: "True" (=2, the item applies to them most of the time), "Sometimes" (=1, the item applies to them sometimes), or "Not True" (=0, the item is not true about them). Scale ranges from 0-26 with higher scores indicating worse outcome.

The child-report version of the Patient Reported Outcomes Measurement Information System Pediatric Item Bank v2.0 - Anxiety - Short Form 8a (PROMIS)measures anxiety symptoms experienced by youth over the past seven days (PROMIS, 2019). The PROMIS (2019) contains 7 items, each with a 5-point Likert scale (1-5) by which youth indicate the frequency that each item applies to them (1=Never, 2=Almost Never, 3=Sometimes, 4=Often, 5=Almost Always). Scales ranges from 1-35 with higher scores indicating worse outcome.

Caregivers will be asked to respond yes or no to the same questions asked on the Center for Youth and Wellness Adverse Childhood Experiences (CYW ACE-Q) this time with respect to their own childhoods.

This is a 17-item, yes/no, child-specific (ages 0-12) version of a measure that includes 10 items on abuse, neglect, and household dysfunction. These items comprise section 1 of the measure. Seven additional items comprise section 2 of the measure and include foster care placement, bullying, death of a primary caregiver, separation from primary caregiver due to deportation or immigration, serious medical procedure/illness, witnessing neighborhood violence, and experiencing discrimination. If any items are reported, the caregiver will be categorized as having reported trauma.

A weekly check in survey will be used to collect the number of sessions per week and the duration of each session.

A weekly check in survey will be used for caregivers to rate their satisfaction with the intervention on a 5-point scale (1 = very dissatisfied; 5 = Very Satisfied). The scale ranges from 1-5 with 5 indicating higher satisfaction.

A weekly check in survey will be used to collect from caregivers the number of sessions per week and the duration of each session.

Beck Depression Inventory II (BDI-II) that assesses symptoms of depression over the prior two-week period in accordance with DSM-IV diagnostic criteria for major depressive disorder. The BDI-II is acceptable for use with clinical and non-clinical populations. It contains 21 items, each with a four-point response scale ranging in severity from no symptoms (1) to severe symptoms (3). A cut-off score of 20 is used to indicate depression among non-clinical populations, while scores ranges of 0-13 (minimal depression), 14-19 (mild depression), 20-28 (moderate depression), and 29-63 are used to assess levels of depression among clinically diagnosed patients. The scale ranges from 0-63 with higher scores indicating worse outcomes.

The post traumatic stress disorder (PTSD) Checklist for DSM-5 (PCL-5) is a validated screening instrument that measures past-month post traumatic stress disorder symptoms. The PCL-5 contains 20 items scored on a 5-point Likert scale, in which respondents indicate their agreement with each item, ranging from 0 ("Not at All") to 4 ("Extremely"). The scale ranges from 0-80 with higher scores indicating worse outcome.

The Parental Stress Scale (PSS) is an 18-item measure that assesses parenting-related stress among caregivers. Each item contains 5 numbered response options, ranging from 1 ("Disagree Strongly") to 5 (Strongly Agree), along with an additional "Not Sure" option. The scale ranges from 18-90 with higher scores indicating worse outcomes.