The Trauma Content Index Revised: Validation and Improvement of a Rorschach Index of Trauma in Children

The Rorschach Trauma Content Index (TCI) is a valid indicator of trauma in adult victims but has not yet been validated in children. This study aimed to evaluate the validity of the Rorschach Performance Assessment System (R-PAS) CritCont% as a TCI in children and to examine the utility of adding the aggression content score (AGC) to the CritCont% index, thus forming a revised TCI (TCI-R). We compared the Rorschach of children with complex trauma and children with single trauma against R-PAS norms and nontraumatized patients, in a sample of 104 children (age 8-12 years), who were divided into three clinical groups: complex trauma, single trauma, and nontraumatized patients. Both CritCont% and TCI-R were found to be related to complex trauma but not to single trauma. The TCI-R had a larger effect size than the CritCont% in its ability to differentiate between patients with complex trauma and nontraumatized patients. The findings contribute to the ecological validity of the CritCont% as a trauma index in children and suggest that the AGC should be further studied as part of the CritCont% index in trauma. Clinical implications regarding the understanding and assessment of complex trauma are discussed, with a focus on the importance of aggression in the inner world of traumatized children.