Screening for Trauma and Adverse Experiences in Looked-After Children Using the TALE Tool

Screening for Trauma and Adverse Experiences in Looked-After Children Using the TALE Tool | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Screening for Trauma and Adverse Experiences in Looked-After Children Using the TALE Tool Saul Hillman, Katharine Anderson, Richard Cross This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9235006/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Children in care are disproportionately exposed to multiple, chronic, and relationally embedded adversities, which increased risk for poor emotional, behavioural, and developmental outcomes. The present study evaluates the Trauma and Adverse Life Events (TALE) screening tool, examining its reliability, factorial structure, and associations with psychosocial functioning to determine its suitability as a trauma-informed assessment for this population. This cross-sectional study used routine assessment data from 394 looked-after children in FRCC fostering and residential services to evaluate the TALE screening tool. Demographic, placement, and trauma-related information was collected via the TALE, alongside additional measures of emotional and behavioural difficulties, dissociation, attachment and global mental health risk were completed by social workers approximately six weeks post-placement, with other measures completed by carers or key workers. Data were anonymised and analysed in SPSS using descriptive statistics, exploratory factor analysis, and correlations to examine the TALE’s internal structure, reliability, and associations. Exploratory factor analysis supported a three-factor structure (Hurt, Neglect, Loss) with satisfactory reliability, and TALE scores were positively associated with behavioural and emotional difficulties, dissociation, and attachment problems. Higher TALE scores, particularly on the Neglect subscale, were also linked to unplanned placement endings, suggesting preliminary predictive validity. The TALE is a reliable, clinically useful tool for assessing cumulative adversity in children in care, supporting trauma-informed assessment, care planning, and targeted interventions in foster and residential settings. Adverse Childhood Experiences ACEs measure Looked-after Children Trauma 1. Introduction 1.1 Adverse Childhood Experiences and Outcomes Childhood trauma is widespread and can have profound, long-lasting impacts on development, health, and wellbeing (Felitti et al., 1998 ). Severe or chronic adversity—including abuse, neglect, household dysfunction, exposure to racism, or war/conflict—especially in the absence of supportive adults, can lead to toxic stress that disrupts biological, cognitive, and emotional development (Nelson et al., 2020 ; Tognin et al., 2023 ). Such stress increases the risk of psychiatric disorders, substance misuse, chronic illness, lower educational attainment, unemployment, and premature mortality (Anda et al., 2006 ; Hughes et al., 2017 ; Nelson et al., 2020 ). Neuroscientific research has clarified the mechanisms underlying these outcomes (Cross et al., 2017 ). Persistent stress during sensitive developmental periods can dysregulate the hypothalamic–pituitary–adrenal (HPA) axis, increase inflammatory processes, and alter connectivity between the amygdala and prefrontal cortex (Teicher et al., 2021; Perry, 2006 ). These changes contribute to overactive threat responses, underdeveloped executive functioning, and impaired emotion regulation, collectively reinforcing vulnerability to mental health conditions (Nelson et al., 2020 ). Additionally, research has shown that exposure to chronic adversity can affect the immune system, which reciprocally impacts upon brain development and long-term functioning (Danese and Lewis, 2016 ). Subsequently, exposure to chronic trauma during critical developmental periods may force children to focus on survival rather than growth (Ford, 2011 ; Gregorowski & Seedat, 2013 ). 1.2 Looked-After Children, Trauma, Adversity and Attachment Abuse and neglect are considered to be major adverse childhood events (ACE’s; NICE, 2021), with previous research suggesting that 90% of children living in care have experienced at least one form of trauma (Dorsey et al., 2012 ). In fact, is has been estimated that 60% of children in local authority placements in Scotland and 72% of children in local authority placements in England have experienced four or more ACE’s (Gibson, 2020 ). This pattern is consistent with studies indicating that emotional neglect and difficulties within caregiving relationships tend to be especially prevalent in looked-after young people (Cicchetti & Toth, 2016 ; Ford et al., 2007 ; Oswald et al., 2010 ; Tarren-Sweeney, 2008 ; Zeanah & Smyke, 2015 ). Research has widely publicised that adverse childhood experiences are associated with elevated risk for poor physical and psychological health outcomes as week as higher rates of mortality and morbidity (Valrie et al 2024 ; Shevlin et al 2025 ; Fuller-Thompson and Sawyer 2024; Leslie 2023). Bing-Canar et al. ( 2024 ) illustrate through paediatric literature that adverse childhood experience exposure has shown a clear association between the number of adverse childhood experiences and the risk of developmental, social and behavioural delays. For many children and young people, upon entering care a sense of earlier work instability can perpetuate, with many children and young people experiencing a frequent number of placement moves (NICE, 2021). Such experiences may mean that children in care are disproportionately affected by attachment disruptions. Research shows elevated rates of insecure and disorganised attachment among this population, largely due to early relational trauma and prolonged separation from primary caregivers (Fearon et al., 2010 ; Goemans et al., 2015; Minnis et al., 2006 ; Pace et al., 2020 ). Without stable, attuned caregiving, children’s internal working models of relationships may be impaired, leading to difficulties in trust, self-esteem, and emotion regulation (Bowlby, 1988 ; Schore, 2001 ; Sroufe, 2005 ). It could be said that attachment functions as both mediator and moderator, with insecure or disorganised attachments amplifying vulnerability (Masten and Cicchetti, 2016 ). Although disruptions in caregiving can amplify such risks, what is known is that relational context is crucial: secure attachment relationships can buffer the effects of trauma (Brandon et al., 2020 ; Nelson et al., 2020 ). Research has shown that even a single consistent, attuned caregiver can substantially mitigate risk, highlighting the need to assess protective and resilience factors alongside adversity (Rutter, 2012 ). Increasing caregiver understanding of trauma, especially in relation to the child(ren) in their care, may further support the likelihood of placement stability and recovery from adversity (Kerr-Davis et al., 2023 ). 1.3 Assessing Trauma: Key Challenges Accurate trauma assessment is critical but methodologically complex. Trauma is multidimensional: type, timing, duration, severity, frequency, relational context, and protective factors all influence outcomes (McLaughlin & Lambert, 2020 ). Traditional approaches—such as ACE checklists (Felitti et al., 1998 )—provide a population-level risk index but do not capture severity, chronicity, relational context, or functional impact. Poly-victimisation frameworks, which consider multiple forms of adversity, highlight that children exposed to several trauma types are at disproportionate risk of further hardship and adversity (Finkelhor et al., 2007 ). Symptom-based measures, including the Child PTSD Symptom Scale (CPSS; Foa et al., 2001 ), the Children’s Revised Impact of Event Scale (CRIES; Deeba et al., 2014 ), and the Paediatric Emotional Distress Scale (Spilsbury et al., 2005), capture post-traumatic sequelae but often focus narrowly on PTSD rather than developmental trauma. Broad behavioural tools such as the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997 ) are frequently used in child welfare settings but primarily detect secondary behavioural manifestations, providing limited insight into the trauma itself. Comprehensive assessment must therefore extend beyond symptom checklists to include relational, functional, and resilience dimensions. Trauma assessment tools can be broadly grouped into several categories, each with distinct strengths and limitations. Exposure-focused measures, such as ACE checklists, the Juvenile Victimisation Questionnaire (JVQ; Finkelhor et al., 2005 ), and trauma history interviews, provide a comprehensive overview of the types and frequency of adversities a child has experienced. However, these measures often rely on retrospective reporting and may underestimate the subjective impact of these events. Symptom-based measures, including the Child PTSD Symptom Scale (CPSS), the Children’s Revised Impact of Event Scale (CRIES; Deeba et al., 2014 ), and the Paediatric Emotional Distress Scale (Spilsbury et al., 2005), focus on post-traumatic sequelae and behavioural manifestations of trauma, but they offer a narrower perspective, often capturing only PTSD-related symptoms rather than the full spectrum of developmental trauma. Finally, relational and attachment-focused measures, including the Strange Situation Procedure (Ainsworth et al., 1978 ) and narrative or story-stem tasks (e.g. SSAP; Hodges & Hillman, 2007 ), assess internal working models and patterns of attachment. These approaches are particularly valuable for evaluating disorganised attachment, which is highly prevalent among maltreated and looked-after children (Fearon et al., 2010 ), and for understanding how trauma affects children’s relational and emotional development. Though narrative assessments can provide insight into internal representations of relationships and lived experiences, they are not a direct reflection of the reality and offer a more subjective interpretation of early attachment. 1.4 Screening Looked-After Children for Trauma and Adverse Life Events Given the prevalence of trauma in care, comprehensive screening is a priority. Standard diagnostic frameworks may fail to capture the chronic, relational, and developmental nature of adversity, which result might result in children’s needs not being identified and met. The conceptualisation of Developmental Trauma Disorder (DTD) addresses this gap by recognising the pervasive impact of chronic, relational, and cumulative trauma that occurs during critical developmental periods (van der Kolk, 2020; Ford et al., 2021 ). DTD emphasizes how repeated exposure to interpersonal stressors—such as neglect, abuse, and disrupted caregiving—can profoundly affect a child’s emotion regulation, attachment security, self-concept, and capacity to trust others. The Trauma and Adverse Life Events (TALE; Hillman, Cross and Anderson, 2018 ) tool was developed to assess both exposure and impact among looked-after children, integrating relational context and subjective experience to increase sensitivity (Hanson et al., 2021 ). Advances in digital health, including AI-assisted screening, may further improve early detection and intervention (Smith et al., 2025 ). Embedding trauma-informed screening across health, social care, and education pathways may reduce misdiagnosis, improve placement stability, and enhance mental health outcomes. 1.5 Rationale The complexity of trauma within care populations underscores the need for assessment frameworks that are multidimensional, psychometrically robust, and developmentally sensitive. Traditional trauma measures have tended to focus narrowly on either exposure or symptomatology, overlooking the relational, contextual, and functional dimensions that are especially salient for looked-after children. In this population, adversity often arises from chronic relational disruption and the absence of protective caregiving relationships, meaning that a comprehensive understanding of trauma must capture both the nature and impact of these experiences. The Trauma and Adverse Life Events (TALE; Hillman et al., 2018 ) tool was developed to address these limitations by integrating two key components: (1) an Exposure section, adapted from the original ACEs framework (Felitti et al., 1998 ), which records the presence of adverse experiences, and (2) an Impact section, which rates the degree to which each experience is thought to have affected the child’s emotional and behavioural wellbeing. This dual structure allows the TALE to go beyond simple event-count approaches and to provide richer, ecologically valid insights into the lived experiences of looked-after children. In line with contemporary models of trauma assessment, the TALE seeks to combine exposure, symptom, and relational dimensions; incorporate multiple informants; balance psychometric rigour with practical feasibility for frontline use; and demonstrate sensitivity to change over time. Preliminary evaluation using the TALE on a much smaller sample within Five Rivers Child Care (FRCC), a social enterprise who provide services for LAC, suggested that it offers a feasible, trauma-informed method for identifying both the breadth and perceived severity of adversity, supporting its potential as a screening tool within multi-informant assessment frameworks (Kerr-Davis et al., 2023 ). In line with contemporary models of trauma assessment, the TALE seeks to combine exposure, symptom, and relational dimensions; incorporate multiple informants; balance psychometric rigour with practical feasibility for frontline use; and demonstrate sensitivity to change over time. Against this background, the present study utilised routine assessment to evaluate the psychometric properties of the TALE in a large, naturalistic sample of looked-after children. Analyses were conducted to explore the internal structure of the tool, its associations with relevant background characteristics, and its relationships with other established measures of emotional, behavioural, and trauma-related functioning. Specifically, the study sought to: a) Assess the internal reliability of the TALE measure and explore its underlying factorial structure to determine whether it represents a coherent construct. b) Examine discriminant validity by investigating whether TALE scores differ systematically across demographic and background variables, including age at entry to care and gender. c) Examine convergent validity by investigating relationships between TALE scores and other measures of trauma and adversity, thereby determining whether the TALE captures overlapping but distinct dimensions of trauma-related experience. c) Evaluate criterion validity, exploring whether the TALE scores are associated with indicators of psychosocial functioning including emotional and behavioural difficulties and attachment. f) Explore predictive validity in relation to TALE scores being predictive of placement endings. Collectively, these analyses were designed to provide a comprehensive examination of the TALE’s psychometric properties and to inform its potential use as a brief, trauma-informed screening tool for looked-after children within multi-informant assessment frameworks. 2. Methodology 2.1 Design This quantitative cross-sectional study used routine assessment data collected by FRCC to examine the development, internal structure, and external psychometric properties of the TALE. The study formed part of a wider evaluation project exploring assessment and outcomes of children who are looked after within FRCC fostering and residential services. 2.2 Participants The study sample comprised 394 looked-after children for whom a completed TALE assessment was returned by local authority social workers. Inclusion criteria were broad, and all children placed within FRCC services were considered eligible with the exception of parent and child placements, and children placed under an ICO. Children were also excluded if their social worker did not consent to their participation (n = 0) or if the TALE was only partially completed (n = 7). The sample included 204 males (51.8%) and 190 females (48.2%). In terms of ethnicity, the majority were White British (77.2%), with smaller proportions of White Other (3.6%), Asian British (3.6%), Black British (1.3%), Black African (2.3%), Mixed heritage (5.8%), and Other ethnic backgrounds (2.1%). The mean age at entry into care was 9.56 years (SD = 3.60). Placement stability varied considerably. At the point of data collection, and where such data was available, 105 children (32.7%) had experienced no previous placements, 142 (44.2%) had experienced one or two, while 74 (23.1%) had experienced three or more. Placement moves ranged from 0 to 10, with an average of 1.54 moves (SD = 1.75). With regard to placement composition, just over half of the children were placed as singletons (n = 209, 53.2%) while nearly half were placed with siblings (n = 184, 46.8%). 2.3 Measures The Trauma and Adverse Life Events (TALE) screening tool (Hillman, Cross & Anderson, 2018 ) is a brief social worker-report measure designed to capture both the extent and impact of adversity and trauma in children in care. It comprises two sections: Indicators: 14 items adapted from the Adverse Childhood Experiences (ACE) tool (Felitti et al., 1998 ), covering neglect, abuse, and household dysfunction (e.g., parental mental illness, domestic violence, separation, substance misuse, incarceration). This strand of the TALE covers exposure. Responses include Not known , Possible , or Definite . Scores are calculated on a 3-point scale which allow for a sum score across the 14 items { Indicators} (range 0–42) Impact: Respondents rate the degree to which each adverse experience is thought to have affected the child ( Mild , Moderate , Severe ). Scores are summed to yield a composite score { Impact} (range 0–42). A composite score is calculated for the TALE which is scored by multiplying the items on Indicators that were present ( Possible, Definite) by the score on the second scale ( Impact). Additional measures included: Strengths and Difficulties Questionnaire (SDQ) The Strengths and Difficulties Questionnaire (SDQ; Goodman, 2001 ) is a 25-item carer-report instrument designed to screen for emotional and behavioural difficulties in children and adolescents aged 2–17 years. Items are rated on a three-point scale ( Not true , Somewhat true , Certainly true ) and grouped into five subscales: Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention, Peer Relationship Problems, and Prosocial Behaviour. The first four subscales can be summed to produce a Total Difficulties Score , with scores of 17 or above typically indicating clinically significant problems. The SDQ demonstrates good concurrent validity (Goodman & Scott, 1999 ; Muris, Meesters & van den Berg, 2003 ), discriminant validity (Lundh, Wangby-Lundh & Bjarehed, 2008), and moderate test–retest reliability (Yao et al., 2009). For younger children, Mieloo et al. (2012) recommend use of the total difficulties score due to lower subscale consistency (Cronbach’s α < .70). Child Dissociative Checklist (CDC) The Child Dissociative Checklist (CDC; Putnam, Helmers & Trickett, 1993 ) is a 20-item observer-report screening measure used to identify dissociative behaviours in children over the past 12 months. Items such as “goes into a trance-like state” or “refers to self in the third person” are rated on a three-point scale ( Not true , Sometimes true , True ), producing total scores between 0 and 60. Scores above 12 may indicate clinically significant dissociation. The CDC has strong internal consistency, excellent test–retest reliability (Putnam et al., 1993 ), and good convergent and discriminant validity (Peterson and Putnam, 1994 . Internal consistency in the current study was excellent (Cronbach’s α = .92). The Development and Well-Being Assessment (DAWBA) The DAWBA (Goodman et al., 2000 ) is a structured diagnostic instrument combining questionnaires, rating scales, and interviews to generate likely psychiatric diagnoses in children and adolescents. It integrates information from multiple informants (parents, teachers, and children) and produces computer-generated probability scores indicating the likelihood of specific disorders. For the purposes of the present study, only the overall prediction subscale—reflecting the total predicted likelihood of a difficulties associated with a particular condition—was used in subsequent analyses as a global indicator of mental health risk. At FRCC, the DAWBA is not used as a diagnostic measure, but instead is utilised to highlight risk in relation to a particular set of needs or difficulties. Relationship Problems Questionnaire (RPQ) The RPQ (Minnis, Rabe-Hesketh and Wolkind, 2002 ) is a 10-item observer-report measure developed to screen for symptoms of reactive attachment disorder amongst 12–17-year-olds. It assesses behaviours associated with inhibited and disinhibited attachment patterns, such as social withdrawal, indiscriminate friendliness, or hypervigilance. Items are rated on a Likert scale reflecting frequency or intensity, with higher scores suggesting greater attachment-related difficulties. The RPQ has demonstrated good to excellent internal consistency, satisfactory test–retest reliability, and good concurrent and discriminant validity (Minnis et al., 2002 ; Minnis et al., 2006 ; Vervoort et al., 2013). Attachment Screening Assessment (ASA) The ASA (Glaser et al., 2013 ) is a 45-item caregiver-report instrument designed to evaluate attachment classifications in children aged 4–11 years. Carers respond to 12 scenario-based questions (e.g., child distress, separation, or fear) rated on a five-point Likert scale from Never to Always . Subscales correspond to eight attachment categories: Secure, Anxious–Avoidant, Ambivalent–Resistant, Disorganised, Post-Disorganisation Controlling–Punitive, Post-Disorganisation Controlling–Caregiving, Inhibited (RAD), and Disinhibited (DSED). The ASA has shown satisfactory face and concurrent validity (Glaser et al., 2013 ), although lower internal consistency has been reported for the RAD and DSED subscales (Barge et al., 2026 ), indicating the need for further psychometric evaluation. Demographic and Background Variables Demographic information, including gender, age at placement , number of placements (prior to current placement) , and placement with/without siblings , was extracted from FRCC records. Two further risk factors were obtained from social worker-recorded specific maltreatment experiences ( neglect, physical abuse, domestic violence , sexual abuse, emotional abuse) , coded as dichotomous variables, and aggregates to create a Child Risk Variable. Similarly, a variable was created relating either to or from the birth family factors; these included substance use, alcohol use and mental health diagnosis, and was aggregated to create a Birth Parent Risk score. Finally, and specifically relating to the final hypothesis, a variable on the database was used to indicate whether the placements had planned or unplanned endings within the first 12 months of placement. 2.4 Procedure In line with FRCC’s routine assessment procedures, the TALE was distributed to local authority social workers approximately six weeks after a child’s placement began. The SDQ, CDC, RPQ or ASA were distributed separately to foster carers or residential key workers, who were asked to return completed measures by email within two weeks. Where measures were not returned, administrative staff at FRCC followed up with reminders after one month. Data were anonymised, encrypted, and entered into SPSS for analysis. Referral documentation was cross-referenced to extract background information, which was merged into the research dataset. 2.5 Ethical Considerations This study was conducted under ethical approval from University College London (UCL) as part of a larger programme of FRCC research. All data were collected through FRCC’s routine assessment process, with consent for use in research provided by local authority social workers. Foster carers completed the additional assessments with anonymised data shared securely with the research team. 2.6 Statistical Analysis SPSS version 28 was used for analysis. Initial descriptive statistics were produced for demographic and placement variables, followed by exploratory factor analysis of the TALE. As a Shapiro–Wilk test indicated normal distribution of Indicators scores (W = 2.44, p > 0.05), parametric tests (were used to examine relationships between the TALE and the different background and psychometric measures used in this study. Throughout the analyses below, the n will fluctuate considerably given that not all measures were completed on all the participants within this study. A series of Pearson’s r correlations and T tests were used throughout this report to examine the patterns within the TALE. 3. Results 3.1 Descriptives The 14 individual items of the TALE are displayed below in terms of responses on the frequency of experience across the population (n = 394). Table 1 TALE indicators (frequency) Has the child ever been in a serious accident where they have been physical hurt? Not known Possible Definite 301 (77.6%) 64 (16.5%) 23 (5.9%) Has the child ever suffered from a serious of life-threatening illness, which has had an impact on their life? 357 (92.5%) 15 (3.9%) 14 (3.6%) Has the child ever been physical punished or beaten by a parent/caregiver/other resulting in injuries? 164 (41.7%) 160 (40.7%) 69 (17.6% Has the child ever been pressurised into some form of unwanted sexual contact? 261 (66.9%) 84 (21.5%) 45 (11.5%) Has a close family member of the child been seriously hurt or killed? 297 (76%) 46 (11.8%) 48 (12.2%) Has the child ever witnessed someone close to him/her being seriously hurt or worse? 116 (29.7%) 180 (46%) 95 (24.3%) Has the child ever been unsupported, unloved and unprotected? 35 (8.9%) 97 (24.6%) 262 (66.5%) Has the child been exposed to a parent or other adult being verbally abusive to them? 47 (11.9%) 163 (41.4%) 184 (46.7%) Has the child been physically hurt in some way by a parent or adult? 135 (34.4%) 146 (37.2%) 112 (28.5%) Has the child been in a situation where they would have felt like no one in their family thought they were important or special? 65 (16.5%) 153 (38.8%) 176 (44.7%) Has the child ever been looked after by a parent that was mentally unwell?? 70 (17.8%) 116 (29.5%) 207 (32.7%) Has the child been looked after by someone who is/was under the influence of alcohol or drugs? 85 (21.6%) 80 (20.3%) 229 (58.1%) Has a close family member of the child been to prison? 234 (59.7%) 45 (11.5%) 113 (28.8%) Has child ‘lost’ a close family member through divorce, abandonment, or another reason? 94 (21.5%) 69 (17.6%) 229 (58.4%) As Table 1 above shows, across the 14 TALE indicator items, patterns indicated clear variation in the types of adversity most frequently reported. Those items most commonly rated as Definite were experiences of emotional neglect and family instability. The majority of children were described as unsupported or unprotected (66.5%), exposed to parental substance misuse (58.1%), and having lost a close family member through separation or abandonment (58.4%). High proportions also experienced verbal abuse (46.7%) and feeling unimportant within their family (44.7%). Items most often marked as Possible reflected ambiguous or less well-documented experiences, notably witnessing violence (46%), physical punishment or beating (40.7%), and physical harm by a parent or adult (37.2%). Items most frequently rated as Not known related to events outside the caregiving context, including serious accidents (77.6%), life-threatening illness (92.5%), and family members being seriously hurt or killed (76%). Overall, emotional neglect, family disruption, and exposure to substance misuse emerged as the most clearly identified adversities, whereas accidental or medical traumas were less often known or recorded. Table 2 TALE indicators (impact) Has the child ever been in a serious accident where they have been physical hurt? Minimal impact Moderate impact Severe impact 37 (42.6%) 31 (35.6%) 19 (21.8%) Has the child ever suffered from a serious of life-threatening illness, which has had an impact on their life? 9 (31%) 11 (37.8%) 9 (31%) Has the child ever been physical punished or beaten by a parent/caregiver/other resulting in injuries? 42 (18.4%) 107 (46.9%) 79 (34.5%) Has the child ever been pressurised into some form of unwanted sexual contact? 22 (17%) 41 (31.8%) 66 (51.2%) Has a close family member of the child been seriously hurt or killed? 33 (35.1%) 22 (23.4%) 39 (41.5%) Has the child ever witnessed someone close to him/her being seriously hurt or worse? 50 (18.2%) 110 (40%) 115 (41.8%) Has the child ever been unsupported, unloved and unprotected? 22 (6.1%) 123 (34.3%) 214 (59.6%) Has the child been exposed to a parent or other adult being verbally abusive to them? 44 (12.7%) 128 (36.9%) 175 (50.4%) Has the child been physically hurt in some way by a parent or adult? 37 (14.3%) 115 (44.6%) 106 (41.1%) Has the child been in a situation where they would have felt like no one in their family thought they were important or special? 17 (5.2%) 110 (33.4%) 202 (61.4%) Has the child ever been looked after by a parent that was mentally unwell?? 31 (9.6%) 136 (42.1%) 156 (48.3%) Has the child been looked after by someone who is/was under the influence of alcohol or drugs? 29 (9.4%) 112 (36.2%) 168 (54.4%) Has a close family member of the child been to prison? 57 (36.3%) 41 (26.1%) 59 (37.6%) Has child ‘lost’ a close family member through divorce, abandonment, or another reason? 40 (13.4%) 89 (29.9%) 169 (56.7%) As Table 2 above displays, ratings of perceived impact showed that many adversities were judged to have had a severe effect on children’s wellbeing. The highest severe impact scores were for experiences of feeling unsupported or unloved (59.6%), feeling unimportant within the family (61.4%), exposure to parental substance misuse (54.4%), and loss of a close family member through separation or abandonment (56.7%). Similarly high levels of severe impact were observed for verbal abuse (50.4%) and unwanted sexual contact (51.2%). Experiences involving witnessing violence (41.8%), being physically hurt by an adult (41.1%), and having a parent with mental illness (48.3%) were also frequently associated with moderate to severe perceived impact. In contrast, adversities such as serious accidents, life-threatening illness, or having a family member imprisoned were more evenly distributed across impact categories or more often rated as minimal , suggesting relatively lower or more variable perceived effects. Overall, emotional neglect, family disruption, and exposure to abuse or parental dysfunction were viewed as the most damaging experiences within this sample. 3.2 Exploratory Factor Analysis The Kaiser-Meyer-Olkin measure showed that the initial model reached criteria for sampling adequacy (overall MSA = 0.76) and the Bartlett’s test of sphericity demonstrated sufficient correlations between TALE items for EFA ( p < 0.01). An exploratory factor analysis was conducted using principal axis factoring (or principal components analysis ) . Inspection of the scree plot indicated an inflection point at three factors, which was also supported by the parallel analysis. A (varimax/oblimin) rotation was performed to aid interpretability. The rotated solution yielded a clear and interpretable factor structure, with simple structure evident. Items loaded strongly (> .40) on their respective factors, with minimal cross-loadings. Factor loadings are presented in Table 3 . The initial factor extraction using parallel analysis revealed four factors with eigenvalues greater than 1. However, a decision was made to retain three factors for further analysis after considering the result of the scree plot analysis and the interpretability of the factors (Tabachnik & Fidell, 2014). These three factors accounted for a cumulative variance of 49.5%. Table 3 Reliability coefficients of the TALE as shown by Cronbach’s alpha. Subscale Cronbach’s a 95% CI LL UL A Hurt ( four items ) .69 .63 .74 B Neglect ( four items ) .75 .70 .79 C Loss ( four items) .57 .54 .61 CI = confidence interval; LL = lower limit; UL = upper limit. Factor 1, labelled ‘Hurt’ consisted of four items related to being hurt, attacked or physically sick, and accounted for 19.3% of total variance. All 4 items loaded on this factor with relatively high loadings, indicating a good correspondence to the pre-defined subscale Factor 2, named ‘Neglect’, represented items measuring parental absence, unavailability, deprivation or mental ill health. All four items loaded on this factor with relatively high loadings, accounting for 17.5% of the total variance. Factor 3 is labelled as ‘Loss’ and comprised items measuring familial death, imprisonment or other losses. It accounted for 12.6% of total variance. All four items loaded on this factor with marginally high loadings including an adequate correspondence. As the three retained factors in the exploratory factor analysis aligned well with the pre-defined subscale structure of the TALE, it was decided that these three subscales provided a reasonably clear division for different aspects measured in relation to traumatic life events. Given that, the internal consistency was calculated for each subscale using Cronbach’s alpha and the results are shown in Table X. The internal consistency of the TALE was generally satisfactory (mean alpha = 0.67), indicating good reliability (DeVellis, 2003). It should, however, be noted that the third subscale was moderately low. Table 4 Correlation of TALE and Background Factors Variables 1 2 3 4 5 6 7 8 9 10 11 1. TALE (Total) 2. TALE (Neglect) .851** .851** .726** .476** .706** .426** .008 .007 − .012 -.057 − .042 .040 − .167** -.133* .198* .091 .001 .095 − .202** -.254** 3. TALE (Hurt) .726** 750** .318** .-,049 .109 .079 − .192* .266** .112* − .123* 4.TALE (Loss)) .706** .426** .318** .047 − .035 .030 .029 .088 − .005 − .116 5.Gender .008 007 − .049 .047 − .034 − .043 − .041 030 − .047 .018 6. Age into care − .012 − .057 .109 − .035 − .034 .184* .313** − .141** -057 .081 7. No placemen − .042 .040 .079 .030 .007 .184* − .243** .015 .184** − .167 8. Placed sibs − .167** − .133* − .192* − .029 − .041 .313** − .243** − .067 − .144** − .067 9. Risk factor (C) .198*. .091 .266 ** .088 .030 -141** .015 − .067 .795** .086 10. Risk factor (P) .001 ..095 .112* − .005 − .047 − .057 .184** -144** .795** .040 11Planned/unplanned − .202** − .254** .123 − .116 .018 .081 − .167 − .067 .086` .040 *p < .05, **p < .01, ***p < .001 Table 5 Correlation of TALE and Psychometric measures Variables 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. TALE (Total) 2. TALE (Neglect) .851** .851** .726** .476** .706** .426** .243* .219* .155* .188* .255** .270** − .118* .173** .160** -.127 − .101 .101 − .107* .121 .198** .114 .130** .110 .136 3. TALE (Hurt) .726** 750** .318** .236* .207** .216* .180** − .058 .085 .241** .223** .094 4.TALE (Loss)) .706** .426** .318** .036 − .048 − .048 .027 − .045 .060 .125* .053 .027 5. SDQ Total .243*. .219* .236 * .036 .795** .867** 695** .048 .058 .406** .487**. .311** 6. SDQ Int .155** .188** .207** − .048 .795** .457** .594** .115 .027 .344** .571** .144 7.SDQ Ext .255** .270** .216** − .048 .867** .457** .620** .016 .051 ..368** .296** .378** 8.RPQ total .-.118* .092 .187* − .003 .640** .504** .591** .594** .262** − .202 .086 .239 .186 9.CDC total) .183** .173** .180** .027 .695** .594** .620** .109 .002 .334** .551** .229** 10.ASA (Secure)) .-101 − .127 − .058 − .045 .048 .115 .016 .109 − .733 − .054 .036 .036 11. ASA (Avoidt) − .107 .101 .085 .060 .058 .027 .051 .002 − .733** − .206 .101 − .002 12. ASA (Resist) .198** .121 .241** .125* .406** .344** .368** .334** − .054 − .206* - .575** .082 13. ASA (Disorg) .130** .114 .223** .053 .487** .571** .296** .551** .102 .101 .575** .014 14. DAWBA .110 .136* .094 .027 .311** .144 .378** .229** .036 − .002 .082 .014 3.3 Relationship to background variables Table 4 indicates the correlations between the TALE measures and gender, age at placement, number of placements, placed alone/within siblings, risk factor (child), risk factor (parent) and placement ending (planned vs unplanned). As Table 6 below indicates, boys and girls had very similar mean TALE overall scores on the TALE composite and its three subscales ( Neglect, Hurt, Loss) . Bivariate analysis indicated in Table 4 that there was no significant correlation between age at placement and TALE composite and its three subscales. Explorations were also made to see whether the TALE scales were correlated with concurrent retrospective data available on the children’s adverse histories. Bivariate analyses in Table 4 indicated that TALE scales were not found to be significantly associated with number of placements (number prior to placement). For the variable placed alone/with siblings , on average, as indicated in Table 6 below, Children placed alone had higher scores on the TALE and its subscales compared to Children placed with siblings They had statistically significantly higher scores on the TALE total and both Neglect and Hurt subscales. Table 6 TALE and Background variables GENDER TALE subscales Male Female t, df, p TALE total 31.39 (15.56) 30.96 (14.28) .155, 392, p=.877 Neglect 28.52 (12.12) 28.36 (10.77) − .139, 392, p=.889 Hurt 10.46 (7.77) 11.25 (8.17) − .927, 356, p=.354 Loss 14.13 (8.53) 13.44 (7.90) − .798, 360, p=.242 PLACEMENT siblings TALE subscales Placed with siblings (n = 184) Placed as singleton (n = 209) t, df, p TALE total 28.36 (14.61) 33.33 (14.76) -3.341, 391, p<.001 Neglect 26.78 (11.32) 29.84 (11.41) -2.66, 391, p < 0.001 Hurt 9.31 (7.05) 12.27 (8.42) -3.69, 355, p < 0.001 Loss 13.53 (8.71) 14.00 (7.76) − .547, 359, p=.585, ns Bivariate correlations in Table 3 showed that more ‘child risk’ variables (e.g. physical abuse) had significantly higher scores on the TALE total and on the TALE subscale Hurt. This was not the case for the other two subscales. Those with more ‘birth parent risk’ variables (e.g. parental mental health) did not have significantly higher scores on the TALE overall though there was a weak positive correlation on the TALE subscale Hurt. 3.4 Relationship to psychosocial difficulties An SDQ was completed by the foster carers of 210 of the children in the present sample, 44.8% of whom ( n = 99) scored on or above the clinical cut-off of 17, indicating that clinically significant behavioural and emotional problems were present. As Table 5 indicates, a significant positive correlation was found between TALE overall and SDQ Total Difficulties, with a small effect size (r s =.207, p <.001). This was also evident for the Neglect subscale (r s =.219, p <.001) and the Hurt subscale (r s =.236, p <.001). There was no such correlation with the Loss subscale. As Table 7 below shows, those who score above the clinical range on the SDQ had significantly higher scores on the TALE total and two subscales (Neglect, Hurt) compared to those who scored below the cut-off. Both internalising and externalising subscales were also examined in relation to the four TALE scores. As Table 4 shows, this was stronger for externalizing in relation to TALE overall (r s =.270, p <.001), TALE Neglect (r s =.270, p <.001) and TALE Hurt (r s =.216, p <.001) Though weaker, internalising scores on the SDQ were still significantly correlated with TALE overall (r s =.145, p <.05), TALE Neglect (r s =.188, p <.001) and TALE Hurt (r s =.207, p <.001). As Table 5 indicates, on a smaller subsample, the DAWBA prediction score was not significantly correlated with TALE scores, suggesting no clear association between early adversity and predicted diagnostic risk on the DAWBA in this sample. Table 7 TALE and psychosocial difficulties SDQ Total cut off TALE subscales Above clinical cut off > 17 (n = 173) Below clinical cut off < 16 (n = 213) t, df, p TALE total 34.08 (14.24) 28.78 (15.09) 3.513, 384, p < 0.001 Neglect 30.98 (10.33) 26.40 (12.03) -3.954, 384, p < 0.001 Hurt 12.69 (8.14) 9.51 (7.65) 3.742, 349, p < 0.001 Loss 14.05 (8.46) 13.59 (8.08) .518, 353, p = 0.04, ns Two additional measures were examined in order to see how other dimensions of psychopathology might relate to the TALE. The DAWBA prediction score was significantly related with both TALE overall, albeit with a very small effect size (r s =.161, p <.001, and TALE Neglect (r s =.136, p <.05). The CDC was completed by foster carers for 205 of the children in the sample, of whom 136 (61.5%) scored above the clinical threshold indicative of dissociative difficulties (score of 12 or more). As Table 5 indicates, TALE overall score was significantly positively correlated with CDC score ( r s =.160, p < 0.01), whilst two subscales TALE Neglect ( r s =.173, p < 0.01) and TALE Hurt were also correlated with CDC ( r s =.180, p < 0.01). As Table 8 below shows, those who score above the clinical range on the CDC had significantly higher scores on the TALE total and two subscales (Neglect, Hurt) compared to those who scored below the cut-off. Table 8 TALE and dissociative experiences CDC Total cut off TALE subscales Above clinical cut off (n = 126) Below clinical cut off (n = 257) t, df, p TALE total 33.57 (14.67) 29.82 (14.88) 2.326, 381, p < 0.05 Neglect 30.52 (10.73) 27.35 (11.73) 2.561, 381, p < 0.05 Hurt 13.25 (8.32) 9.71 (7.52) 3.987, 347, p < 0.01 Loss 13.82 (8.23) 13.77 (8.23) 0.073, 350, p=.942 Two parent report measures of attachment were used, the ASA with parents of younger children, and the RPQ with parents of older children/adolescents. In Table 5 above, TALE overall score was significantly positively correlated with RPQ score ( r s =.133, p < 0.05), whilst the subscale TALE Hurt was also correlated ( r s =.187, p < 0.05). As Table 9 below shows, those who score above the clinical range on the CDC did not have significantly higher scores on the TALE total and subscales though there was a weak positive effect with the Hurt subscale. Table 9 TALE and RPQ RPQ Total cut off TALE subscales Above clinical cut off (n = 74) Below clinical cut off (n = 146) t, df, p TALE total 33.12 (15.55) 29.57 (15.04) 1.637, 218, p=.103 Neglect 29.07 (12.01) 26.75 (7.54) 1.367, 218, p=.177 Hurt 13.26 (7.54) 10.77 (7.94) 2.155, 199, p=.033 Loss .13.96 (8.89) 13.53 (8.10) .340, 199, p=.734, ns The four attachment subscales of the ASA had mixed findings. ASA Secure was significantly albeit weakly corelated with TALE overall (r s =-.130, p <.05) whilst ASA Avoidance was not significantly correlated with the TALE scores. ASA Resistance was significantly correlated with TALE overall (r s =.216, p <.001), TALE Hurt (r s =.241, p <.001) and TALE Loss (r s =.125, p <.005). TALE Disorganised was sig nificantly correlated with TALE overall (r s =.181, p <.05) and TALE Hurt (r s =.223, p <.001) 3.5 Predictive validity As Table 10 below shows, those with unplanned endings had higher scores on the TALE overall ( M = 4.79, SD = 2.74) compared to those with planned endings , and the difference was found to be statistically significant ( t =-2.864, 148, p = 0.05). This was also repeated across the three subscales for Neglect ( t =-3.197, 148, p=.002), Hurt ( t =-1.412, 130, p=.160) and Loss ( t =-1.350, 133, p=.179) Table 10 TALE and placement endings (planned vs unplanned) PLACEMENT endings TALE subscales Placement ending planned (n = 36) Placement ending unplanned (n = 114) t, df, p TALE total 25.97 (16.39) 33.18 (14.54) − .2.515, 148, p=.0013 Neglect 22.89 (13.73) 29.92 (10.72) − .3.197, 148, p = 0.002 Hurt 9.68 (7.71) 11.89 (7.61) -1.412, 130, p=.160 Loss 12.61 (9.96) 14.93 (7.88) -1.350, 133, p=.179 4. Discussion 4.1 Overview of Findings The present study examined the psychometric properties and concurrent validity of the Trauma and Adversity Life Events (TALE) measure in a large sample of looked-after children. Drawing on routine data from fostering and residential settings, the study explored the structure, internal reliability, and correlates of the TALE, as well as its associations with measures of psychosocial adjustment, dissociation, and attachment. Overall, the findings support the TALE as a psychometrically adequate and clinically meaningful tool for assessing the breadth and impact of early adversity in children in care. The emerging three-factor structure— Hurt, Neglect , and Loss —was conceptually coherent and aligned closely with the domains proposed by Kerr-Davis et al. ( 2023 ), who identified these as key dimensions capturing both direct maltreatment experiences and relational disruptions central to developmental trauma. 4.2 Patterns of Reported Adversity Descriptive analyses revealed that experiences of emotional neglect, family instability, and exposure to parental substance misuse were the most prevalent and most clearly defined adversities in the sample. These patterns echo prior evidence that emotional neglect and caregiver dysfunction are among the most pervasive forms of adversity in looked-after populations (Cicchetti & Toth, 2016 ). Conversely, accidental or medical traumas were less frequently known or reported, perhaps reflecting both reporting biases and the more chronic, relational nature of trauma within this group (Briere and Spinazzola, 2005 ). The perceived impact ratings similarly highlighted neglect, emotional unavailability, and relational loss as the adversities judged to have the most severe effects on wellbeing, aligning with relational models of complex trauma and attachment disorganisation (Dallos and Vetere, 2020). 4.3 Factor Structure and Internal Reliability The exploratory factor analysis produced a three-factor solution accounting for nearly 50% of the variance, with factors corresponding to Hurt , Neglect , and Loss . This structure demonstrates both empirical robustness and theoretical coherence, providing further support for the multidimensional model of trauma exposure within developmental contexts (Finkelhor et al., 2015 ). Internal consistency for the subscales was generally satisfactory, with Cronbach’s alpha values ranging from .57 to .75—comparable to those reported by Kerr et al. (2023) and consistent with early-stage development of multidomain screening tools (DeVellis, 2017 ). The relatively lower alpha for the Loss factor likely reflects the heterogeneity of loss experiences (e.g., bereavement vs. imprisonment), a challenge also noted in broader trauma measurement literature (Ford et al., 2013 ). 4.4 Associations with Background and Demographic Variables Consistent with prior research (Oswald et al., 2010 ; McCrory & Viding, 2015), gender and age at entry to care were not significant predictors of adversity exposure, suggesting that trauma experiences cut across demographic boundaries in care populations. However, children placed alone, rather than with siblings, showed significantly higher scores on the TALE total and Neglect and Hurt subscales. It has been shown in wider research that being placed alongside a sibling could be considered a protective factor against foster care placement breakdown (Konijn et al., 2019 ). This may indicate both the protective role of sibling co-placement and the possibility that greater adversity histories contribute to placement decisions for single children (Herrick and Piccus, 2005 ). Associations between higher TALE scores and higher numbers of “child risk” factors preplacement (e.g. physical abuse) further support the discriminant validity of the tool in differentiating levels of cumulative adversity. This correlation did not hold when only factoring in the risk variables directly related to birth parents. 4.5 Associations with Psychosocial Adjustment and Mental Health The TALE showed consistent and theoretically meaningful correlations with carer-reported psychosocial difficulties on the SDQ, particularly for Neglect and Hurt subscales. These relationships, albeit modest, support the convergent validity of the TALE in relation to emotional and behavioural symptoms, echoing findings that cumulative maltreatment predicts both internalising and externalising difficulties (Cecil et al., 2017 ; Ford et al., 2007 ). Associations with the DAWBA prediction score further suggest criterion validity, indicating that higher adversity histories were modestly associated with increased likelihood of psychiatric diagnoses. Similarly, the TALE correlated with dissociative difficulties (CDC scores), particularly for Neglect and Hurt , consistent with theoretical links between chronic relational trauma and dissociative responses (Liotti, 2004 ; Putnam, 2016 ). This pattern reinforces the value of the TALE in identifying trauma profiles that may underlie complex symptom presentations in care-experienced youth. 4.6 Associations with Attachment Patterns Correlations between the TALE and attachment measures provided preliminary support for construct validity in relation to relational functioning. Higher TALE scores were associated with insecure and disorganised attachment styles, particularly resistant and disorganised subtypes on the ASA, aligning with attachment theory’s predictions that early maltreatment disrupts the formation of coherent attachment strategies (Fearon et al., 2010 ; Lyons-Ruth & Jacobvitz, 2016). The association between Hurt subscale scores and insecure attachment representations further underscores the TALE’s sensitivity to the relational dimensions of trauma. 4.7 Predictive Validity: Placement Stability Children with unplanned placement endings had significantly higher total TALE scores, particularly on the Neglect subscale, supporting the predictive validity of the measure. This finding is consistent with evidence linking early adversity to placement instability and relational breakdowns in care (Leve et al., 2012 ; Tarren-Sweeney, 2017 ). Furthermore, research has shown that it is difficult to disrupt the cycle of placement breakdowns due to a complex array of risk factors which may be related to the child, foster carers, or social work team (Montserrat et al., 2020 ). The association between neglect histories and placement disruption highlights the importance of identifying relational trauma early to inform therapeutic care planning. 4.8 Strengths and Limitations This study benefits from a large, well-characterised sample of looked-after children, reflecting real-world diversity in age, placement type, and adversity history. Using routinely collected data enhances ecological validity and demonstrates the feasibility of implementing the TALE in frontline care settings. The study also examined multiple psychometric properties, including internal consistency, factorial structure, convergent validity with psychosocial and attachment measures, and predictive validity in relation to placement outcomes. The inclusion of multiple subscales capturing distinct dimensions of adversity ( Hurt, Neglect, Loss ) provides a multidimensional perspective that aligns with contemporary conceptualisations of complex trauma (Cloitre et al., 2013 ). Despite these strengths, several limitations warrant consideration. First, the study relied on social worker and caregiver reports, which may introduce informant bias and limit the child’s direct voice in reporting experiences. Second, while the TALE subscales generally demonstrated good internal reliability, the Loss subscale was moderately low, reflecting heterogeneity of experiences and potentially limiting sensitivity. It is possible that though loss through bereavement or separation might likely have psychological impact, it could be more context-dependent than the other two subscales that are more suggestive of a chronic relational threat. Third, correlations with psychosocial and attachment measures, though significant, were small to moderate, indicating that multiple factors beyond recorded adversity likely contribute to outcomes. The lack of direct child measures that capture their perspectives and internal representations is also evident. Finally, the cross-sectional design precludes causal inferences regarding the direction of associations between adversity and psychosocial outcomes. Currently, the TALE currently does not have an indicative clinical cut-off score. As most previous ACEs scales have shown a dose-response effect (e.g., Felitti et al., 1998 ), it may not be possible to detect one point of the Exposure scale at which clinical difficulties are particularly likely. Conventionally, an ACE score of five or more has been taken to indicate likely negative impacts on future health (Bellis et al., 2017 ), but this threshold requires statistical confirmation. It is also possible that the TALE does not capture all of the possible adverse or traumatic experiences which a child in care may have experienced. For example, the TALE does not include a question around asylum seeking which as a shortcoming, as we know the number of children seeking asylum is on the rise. Lastly, the limitations of all ACEs tools equally apply to the TALE: cumulative measures of adversity and trauma are limited in their ability to calculate actual risk of mental and physical health difficulties on a case-by-case basis (Danese, 2019). However, the purpose of the TALE is to pragmatically capture an impression of the known information about the child’s past to contribute to clinical formulation and the planning of psychological interventions. In this purpose, the TALE has been demonstrated to be a practical and valid tool. 4.9 Implications The findings indicate that the TALE is a practical and multidimensional tool for assessing trauma in looked-after children. By capturing both the range and relational context of adversity, it can inform clinical formulation, guide trauma-informed interventions, and support monitoring of change over time (Bath, 2017 ; Bunting et al., 2021 ). Practitioners can use the TALE to identify high-risk children, tailor support strategies, and prioritize interventions in both foster and residential settings. If utilised in initial planning and formulation, the TALE may be a useful and informative tool to highlight experience and risk, and therefore buffer against further placement breakdowns (Eltink et al., 2025 ). Further work is needed to examine the TALE’s longitudinal stability, sensitivity to change, and predictive validity for outcomes such as mental health, educational attainment, and placement stability. Confirmatory factor analyses could refine the subscale structure, ensuring each factor achieves acceptable internal consistency. Comparing scores to a normative sample would allow identification of children experiencing exceptionally high levels of adversity. Additionally, exploring clinician perspectives on integrating the TALE into broader assessment processes and examining how recorded experiences relate to children’s emotional wellbeing during placements would deepen understanding of its utility. The relationships observed between specific types of adversity and psychosocial outcomes also provide a foundation for more targeted longitudinal studies. Routine use of a validated tool like the TALE could inform evidence-based resource allocation, ensuring children with higher adversity receive priority access to therapeutic services and specialist placements. The prevalence and impact of emotional neglect and family disruption highlighted by this study support the adoption of trauma-informed care policies and targeted workforce training in child welfare settings. Standardizing the use of the TALE across agencies could also improve consistency in documenting adversity and facilitate data-driven evaluation of child protection strategies. 5. Conclusion The findings support the TALE as a psychometrically sound and clinically relevant tool for assessing cumulative adversity in children in care. Its alignment with theoretical frameworks of complex developmental trauma, attachment disruption, and cumulative risk underscores its potential as both a research and clinical instrument. Continued validation and refinement will enhance its capacity to support trauma-informed assessment and care planning. The findings suggest that the TALE can be readily integrated into routine assessments in foster and residential care settings. Its brief and structured format allows for timely identification of high-risk children, particularly those experiencing neglect, emotional abuse, or relational disruption. Practitioners can use TALE data to guide trauma-informed care planning, targeted interventions, and decisions around placement support, sibling co-placement, or therapeutic prioritisation (Bath, 2015; Bunting et al., 2021 ), and therefore, the TALE may be a useful tool for local authority social work teams. Furthermore, the TALE’s multidimensional structure may help staff distinguish between different types of trauma exposure, informing tailored intervention strategies. Declarations Author contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XX and XX. The first draft of the manuscript was written by XX and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Compliance with Ethical Standards: This study forms part of a wider study commissioned by Five Rivers which was granted ethical approval by University College London (UCL). All the data included in this study was collected as part of Five Rivers’ routine assessment process, which monitors outcomes and facilitates interventions for children in Five Rivers’ care. Competing interests: The authors declare that there are no known competing interests. Conflict of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Consent for Publication Consent for the use of assessment data for research purposes was obtained at the beginning of the young person’s placement, and is therefore implicit in the publication of this research. Funding: The authors did not receive support from any organisation for the submitted work. The authors have no relevant financial or non-financial interests to disclose. Informed Consent: Consent for the use of assessment data for research purposes was obtained at the beginning of the young person’s placement. 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Implications of intergenerational trauma: Associations between caregiver ACEs and child internalizing symptoms in an urban African American sample. Psychological trauma: theory, research, practice, and policy , 15 (5), 877. 10.1037/tra0001334 . Epub 2022 Jul 28. Leve, L. D., Harold, G. T., Chamberlain, P., Landsverk, J. A., Fisher, P. A., & Vostanis, P. (2012). Practitioner review: Children in foster care–vulnerabilities and evidence-based interventions that promote resilience processes. Journal of Child Psychology and Psychiatry , 53 (12), 1197–1211. 10.1111/j.1469-7610.2012.02594.x Liotti, G. (2004). Trauma, dissociation, and disorganized attachment: Three strands of a single braid. Psychotherapy: Theory Research Practice Training , 41 (4), 472–486. 10.1037/0033-3204.41.4.472 Lundh, L. G., Wångby-Lundh, M., & Bjärehed, J. (2008). Self-reported emotional and behavioural problems in Swedish 14 to 15-year-old adolescents: a study with the self-report version of the Strengths and Difficulties Questionnaire. Scandinavian Journal of Psychology , 49 (6), 523–532. 10.1111/j.1467-9450.2008.00668.x Lyons-Ruth, K., & Jacobvitz, D. (2008). Attachment Disorganisation: Genetic factors, parenting contexts and developmental transformations from infancy to adulthood. In J. Cassidy, & P. Shaver (Eds.), Handbook of Attachment: Theory, Research and Clinical Applications (Vol. 2). Guildford. Masten, A. S., & Cicchetti, D. (2016). Resilience in development: Progress and transformation. In D. Cicchetti (Ed.), Developmental psychopathology: Risk, resilience, and intervention (3rd ed., pp. 271–333). John Wiley & Sons, Inc. 10.1002/9781119125556.devpsy406 McLaughlin, K. A., & Lambert, H. K. (2020). Mechanisms linking childhood trauma exposure and psychopathology: a transdiagnostic model of risk and resilience. BMC Medicine , 18 , 96. 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A., Scott, R. D., Bhutta, Z. A., Harris, N. B., Danese, A., & Samara, M. (2020). Adversity in childhood is linked to mental and physical health throughout life. British Medical Journal , 28 (371). 10.1136/bmj.m3048 National Institute for Health and Care Excellence (2021). Evidence reviews – October 2021: Looked-after children and young people. NICE. Available at: https://www.nice.org.uk/guidance/ng205/evidence/evidence-reviews-october-2021-333471052696?tab=evidence (accessed 16/02/2026). Oswald, S. H., Heil, K., & Goldbeck, L. (2010). History of maltreatment and mental health problems in foster children: a review of the literature. Journal of Paediatric Psychology , 35 (5), 462–472. 10.1093/jpepsy/jsp114 Pace, C. S., Guerriero, V., & Zavattini, G. C. (2020). Children’s attachment representations: A pilot study comparing family drawing with narrative and behavioural assessments in adopted and community children. The Arts in Psychotherapy , 67 . 10.1016/j.aip.2019.101612 Perry, B. D. (2006). Applying Principles of Neurodevelopment to Clinical Work with Maltreated and Traumatized Children: The Neurosequential Model of Therapeutics. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27–52). The Guilford Press. Peterson, G., & Putnam, F. W. (1994). Preliminary results of the field trial of proposed criteria for dissociative disorder of childhood. Dissociation: Progress in the Dissociative Disorders , 7 (4), 212–220. Putnam, F. W., Helmers, K., & Trickett, P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect , 17 (6), 731–741. 10.1016/S0145-2134(08)80004-X Putnam, F. W. (2016). The way we are: How states of mind influence our identities, personality and potential for change . International Psychoanalytic Books: New York, USA. Rutter, M. (2012). Resilience as a dynamic concept. Developmental Psychopathology , 24 (2), 335–344. 10.1017/S0954579412000028 Schore, A. N. (2001). Effects of early relational trauma on right brain development. Infant Mental Health Journal , 22 (1–2), 201–269. Shevlin, M., Hyland, P., Brewin, C. R., Cloitre, M., Karatzias, T., & Redican, E. (2025). Testing the use of ‘clinical checks’ with the International Trauma Questionnaire to measure PTSD and complex PTSD. Acta Psychiatrica Scandinavica , 152 (1), 49–59. 10.1111/acps.13799 Smith, J. D., Fu, E., & Carroll, A. J. (2025). Implementation science to translate evidence-based interventions in health psychology. In N. Schneiderman, M. H. Antoni, F. J. Penedo, T. W. Smith, N. B. Anderson, T. A. Revenson, & A. F. Abraído-Lanza (Eds.), APA handbook of health psychology, Vol. 2. Clinical interventions and disease management in health psychology (pp. 269–290). American Psychological Association. 10.1037/0000395-012 Sroufe, L. A. (2005). Attachment and development: A prospective, longitudinal study. Attachment & Human Development , 7(4), 349–367. Longitudinal evidence linking early caregiving quality to later self-esteem, social competence, and emotional functioning. Spilsbury, K., Hewitt, C., Stirk, L., & Bowman, C. (2011). The relationship between nurse staffing and quality of care in nursing homes: a systematic review. International Journal of Nursing Studies , 48 (6), 732–750. 10.1016/j.ijnurstu.2011.02.014 Tarren-Sweeney, M. (2008). The mental health of children in out-of-home care. Current Opinion in Psychiatry , 21 (4), 345–349. Tarren-Sweeney, M. (2017). Rates of meaningful change in the mental health of children in long-term out-of-home care: A seven- to nine-year prospective study. Child Abuse and Neglect , 72 , 1–9. 10.1016/j.chiabu.2017.07.002 Teicher, M. H., Gordon, J. B., & Nemeroff, C. B. (2022). Recognising the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education. Molecular Psychiatry , 27 (3), 1331–1338. 10.1038/s41380-021-01367-9 Tognin, S., Catalan, A., Kempton, M. J., Nelson, B., McGorry, P., Riecher-Rössler, A., Bressan, R., Barrantes-Vidal, N., Krebs, M. O., Nordentoft, M., Ruhrmann, S., Sachs, G., Rutten, B. P. F., van Os, J., de Haan, L., van der Gaag, M., McGuire, P., & Valmaggia, L. R. (2023). Impact of adverse childhood experiences on educational achievements in young people at clinical high risk of developing psychosis. European Journal of Psychiatry , 18 (1). 10.1192/j.eurpsy.2022.2351 Valrie, C. R., Kliewer, W., Gary, K., Cyrus, J., Hood, K., Derlan Williams, C., Lytle, L., & Shipman-Lacewell, J. (2024). Psychological Trauma: Theory, Research, Practice and Policy. Trauma Psychology American Psychological Association , 56 , 1–24. 10.1037/tra0001676 Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma . New York City, USA. Yao, S., Zhang, C., Zhu, X., Jing, X., McWhinnie, C. M., & Abela, J. R. (2008). Measuring adolescent psychopathology: psychometric properties of the self-report strengths and difficulties questionnaire in a sample of Chinese adolescents. Journal of Adolescent Health , 45 (1), 55–62. 10.1016/j.jadohealth.2008.11.006 Zeanah, C. H., & Smyke, A. T. (2015). Attachment disorders in early childhood. Journal of Clinical Child & Adolescent Psychology , 44 (3), 329–344. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9235006","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":624522659,"identity":"d6313a8e-b969-4af6-9c77-5b85320fc756","order_by":0,"name":"Saul Hillman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYHACxgOMDRIyfCDmBxDBfABIsOHXA9LCA1LDOAPEZUsgSgsDWAszDzFa5NvPGBxg3GHBwyZ2+Nljm5o7efxtvA8f85QxyJn3L8CqxeBMDlDLGaDDpNPMjXOOPSuWOMZubMxzjsFY5sYD7FoYQFraQFoSzKRz2A4nNtxvY5PmbWNInCFxALvD+t/AtKR/k7b4dzhx/jE29t/4tDDcgNuSYybN2HY4ccMxNjZmsBb+BuwOu/Gs4EAiREuZZG/f4cSNx9iYJeeckzCWkMARYv3JGx98bKuT45dO3ybx49vhxHnH2Bg/vCmzkZPgx+EwEEjAIga0QgKbOH6Az5ZRMApGwSgYSQAAEPNX0c2AKakAAAAASUVORK5CYII=","orcid":"","institution":"Anna Freud Centre","correspondingAuthor":true,"prefix":"","firstName":"Saul","middleName":"","lastName":"Hillman","suffix":""},{"id":624522660,"identity":"03fefad5-5977-4f4e-a701-5dae7308558b","order_by":1,"name":"Katharine Anderson","email":"","orcid":"","institution":"Midhurst Clinical Therapeutic Services","correspondingAuthor":false,"prefix":"","firstName":"Katharine","middleName":"","lastName":"Anderson","suffix":""},{"id":624522661,"identity":"bbfefba4-9cfc-4360-84ff-caf95fed2cc2","order_by":2,"name":"Richard Cross","email":"","orcid":"","institution":"Five Rivers Child Care Limited","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Cross","suffix":""}],"badges":[],"createdAt":"2026-03-26 13:53:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9235006/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9235006/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107707728,"identity":"a26cefdb-e73e-400b-a287-b6e8951a2c2c","added_by":"auto","created_at":"2026-04-24 09:21:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":862894,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9235006/v1/e38ead9b-e7a5-4706-ace2-2ca38fc67881.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Screening for Trauma and Adverse Experiences in Looked-After Children Using the TALE Tool","fulltext":[{"header":"1. Introduction","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n \u003ch2\u003e1.1 Adverse Childhood Experiences and Outcomes\u003c/h2\u003e\n \u003cp\u003eChildhood trauma is widespread and can have profound, long-lasting impacts on development, health, and wellbeing (Felitti et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). Severe or chronic adversity\u0026mdash;including abuse, neglect, household dysfunction, exposure to racism, or war/conflict\u0026mdash;especially in the absence of supportive adults, can lead to toxic stress that disrupts biological, cognitive, and emotional development (Nelson et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tognin et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Such stress increases the risk of psychiatric disorders, substance misuse, chronic illness, lower educational attainment, unemployment, and premature mortality (Anda et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Hughes et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Nelson et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eNeuroscientific research has clarified the mechanisms underlying these outcomes (Cross et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Persistent stress during sensitive developmental periods can dysregulate the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal (HPA) axis, increase inflammatory processes, and alter connectivity between the amygdala and prefrontal cortex (Teicher et al., 2021; Perry, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). These changes contribute to overactive threat responses, underdeveloped executive functioning, and impaired emotion regulation, collectively reinforcing vulnerability to mental health conditions (Nelson et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Additionally, research has shown that exposure to chronic adversity can affect the immune system, which reciprocally impacts upon brain development and long-term functioning (Danese and Lewis, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Subsequently, exposure to chronic trauma during critical developmental periods may force children to focus on survival rather than growth (Ford, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Gregorowski \u0026amp; Seedat, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e1.2 Looked-After Children, Trauma, Adversity and Attachment\u003c/h2\u003e\n \u003cp\u003eAbuse and neglect are considered to be major adverse childhood events (ACE\u0026rsquo;s; NICE, 2021), with previous research suggesting that 90% of children living in care have experienced at least one form of trauma (Dorsey et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In fact, is has been estimated that 60% of children in local authority placements in Scotland and 72% of children in local authority placements in England have experienced four or more ACE\u0026rsquo;s (Gibson, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This pattern is consistent with studies indicating that emotional neglect and difficulties within caregiving relationships tend to be especially prevalent in looked-after young people (Cicchetti \u0026amp; Toth, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Ford et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Oswald et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Tarren-Sweeney, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Zeanah \u0026amp; Smyke, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eResearch has widely publicised that adverse childhood experiences are associated with elevated risk for poor physical and psychological health outcomes as week as higher rates of mortality and morbidity (Valrie et al \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Shevlin et al \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Fuller-Thompson and Sawyer 2024; Leslie 2023). Bing-Canar et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) illustrate through paediatric literature that adverse childhood experience exposure has shown a clear association between the number of adverse childhood experiences and the risk of developmental, social and behavioural delays.\u003c/p\u003e\n \u003cp\u003eFor many children and young people, upon entering care a sense of earlier work instability can perpetuate, with many children and young people experiencing a frequent number of placement moves (NICE, 2021). Such experiences may mean that children in care are disproportionately affected by attachment disruptions. Research shows elevated rates of insecure and disorganised attachment among this population, largely due to early relational trauma and prolonged separation from primary caregivers (Fearon et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Goemans et al., 2015; Minnis et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Pace et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Without stable, attuned caregiving, children\u0026rsquo;s internal working models of relationships may be impaired, leading to difficulties in trust, self-esteem, and emotion regulation (Bowlby, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1988\u003c/span\u003e; Schore, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Sroufe, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). It could be said that attachment functions as both mediator and moderator, with insecure or disorganised attachments amplifying vulnerability (Masten and Cicchetti, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eAlthough disruptions in caregiving can amplify such risks, what is known is that relational context is crucial: secure attachment relationships can buffer the effects of trauma (Brandon et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Nelson et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Research has shown that even a single consistent, attuned caregiver can substantially mitigate risk, highlighting the need to assess protective and resilience factors alongside adversity (Rutter, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Increasing caregiver understanding of trauma, especially in relation to the child(ren) in their care, may further support the likelihood of placement stability and recovery from adversity (Kerr-Davis et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e1.3 Assessing Trauma: Key Challenges\u003c/h2\u003e\n \u003cp\u003eAccurate trauma assessment is critical but methodologically complex. Trauma is multidimensional: type, timing, duration, severity, frequency, relational context, and protective factors all influence outcomes (McLaughlin \u0026amp; Lambert, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Traditional approaches\u0026mdash;such as ACE checklists (Felitti et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1998\u003c/span\u003e)\u0026mdash;provide a population-level risk index but do not capture severity, chronicity, relational context, or functional impact. Poly-victimisation frameworks, which consider multiple forms of adversity, highlight that children exposed to several trauma types are at disproportionate risk of further hardship and adversity (Finkelhor et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eSymptom-based measures, including the Child PTSD Symptom Scale (CPSS; Foa et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), the Children\u0026rsquo;s Revised Impact of Event Scale (CRIES; Deeba et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), and the Paediatric Emotional Distress Scale (Spilsbury et al., 2005), capture post-traumatic sequelae but often focus narrowly on PTSD rather than developmental trauma. Broad behavioural tools such as the Strengths and Difficulties Questionnaire (SDQ; Goodman, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) are frequently used in child welfare settings but primarily detect secondary behavioural manifestations, providing limited insight into the trauma itself. Comprehensive assessment must therefore extend beyond symptom checklists to include relational, functional, and resilience dimensions.\u003c/p\u003e\n \u003cp\u003eTrauma assessment tools can be broadly grouped into several categories, each with distinct strengths and limitations. Exposure-focused measures, such as ACE checklists, the Juvenile Victimisation Questionnaire (JVQ; Finkelhor et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2005\u003c/span\u003e), and trauma history interviews, provide a comprehensive overview of the types and frequency of adversities a child has experienced. However, these measures often rely on retrospective reporting and may underestimate the subjective impact of these events. Symptom-based measures, including the Child PTSD Symptom Scale (CPSS), the Children\u0026rsquo;s Revised Impact of Event Scale (CRIES; Deeba et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), and the Paediatric Emotional Distress Scale (Spilsbury et al., 2005), focus on post-traumatic sequelae and behavioural manifestations of trauma, but they offer a narrower perspective, often capturing only PTSD-related symptoms rather than the full spectrum of developmental trauma. Finally, relational and attachment-focused measures, including the Strange Situation Procedure (Ainsworth et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1978\u003c/span\u003e) and narrative or story-stem tasks (e.g. SSAP; Hodges \u0026amp; Hillman, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), assess internal working models and patterns of attachment. These approaches are particularly valuable for evaluating disorganised attachment, which is highly prevalent among maltreated and looked-after children (Fearon et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), and for understanding how trauma affects children\u0026rsquo;s relational and emotional development. Though narrative assessments can provide insight into internal representations of relationships and lived experiences, they are not a direct reflection of the reality and offer a more subjective interpretation of early attachment.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e1.4 Screening Looked-After Children for Trauma and Adverse Life Events\u003c/h2\u003e\n \u003cp\u003eGiven the prevalence of trauma in care, comprehensive screening is a priority. Standard diagnostic frameworks may fail to capture the chronic, relational, and developmental nature of adversity, which result might result in children\u0026rsquo;s needs not being identified and met. The conceptualisation of Developmental Trauma Disorder (DTD) addresses this gap by recognising the pervasive impact of chronic, relational, and cumulative trauma that occurs during critical developmental periods (van der Kolk, 2020; Ford et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). DTD emphasizes how repeated exposure to interpersonal stressors\u0026mdash;such as neglect, abuse, and disrupted caregiving\u0026mdash;can profoundly affect a child\u0026rsquo;s emotion regulation, attachment security, self-concept, and capacity to trust others.\u003c/p\u003e\n \u003cp\u003eThe Trauma and Adverse Life Events (TALE; Hillman, Cross and Anderson, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) tool was developed to assess both exposure and impact among looked-after children, integrating relational context and subjective experience to increase sensitivity (Hanson et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Advances in digital health, including AI-assisted screening, may further improve early detection and intervention (Smith et al., \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Embedding trauma-informed screening across health, social care, and education pathways may reduce misdiagnosis, improve placement stability, and enhance mental health outcomes.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e1.5 Rationale\u003c/h2\u003e\n \u003cp\u003eThe complexity of trauma within care populations underscores the need for assessment frameworks that are multidimensional, psychometrically robust, and developmentally sensitive. Traditional trauma measures have tended to focus narrowly on either exposure or symptomatology, overlooking the relational, contextual, and functional dimensions that are especially salient for looked-after children. In this population, adversity often arises from chronic relational disruption and the absence of protective caregiving relationships, meaning that a comprehensive understanding of trauma must capture both the nature and impact of these experiences.\u003c/p\u003e\n \u003cp\u003eThe Trauma and Adverse Life Events (TALE; Hillman et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) tool was developed to address these limitations by integrating two key components: (1) an Exposure section, adapted from the original ACEs framework (Felitti et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), which records the presence of adverse experiences, and (2) an Impact section, which rates the degree to which each experience is thought to have affected the child\u0026rsquo;s emotional and behavioural wellbeing. This dual structure allows the TALE to go beyond simple event-count approaches and to provide richer, ecologically valid insights into the lived experiences of looked-after children. In line with contemporary models of trauma assessment, the TALE seeks to combine exposure, symptom, and relational dimensions; incorporate multiple informants; balance psychometric rigour with practical feasibility for frontline use; and demonstrate sensitivity to change over time. Preliminary evaluation using the TALE on a much smaller sample within Five Rivers Child Care (FRCC), a social enterprise who provide services for LAC, suggested that it offers a feasible, trauma-informed method for identifying both the breadth and perceived severity of adversity, supporting its potential as a screening tool within multi-informant assessment frameworks (Kerr-Davis et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In line with contemporary models of trauma assessment, the TALE seeks to combine exposure, symptom, and relational dimensions; incorporate multiple informants; balance psychometric rigour with practical feasibility for frontline use; and demonstrate sensitivity to change over time.\u003c/p\u003e\n \u003cp\u003eAgainst this background, the present study utilised routine assessment to evaluate the psychometric properties of the TALE in a large, naturalistic sample of looked-after children. Analyses were conducted to explore the internal structure of the tool, its associations with relevant background characteristics, and its relationships with other established measures of emotional, behavioural, and trauma-related functioning.\u003c/p\u003e\n \u003cp\u003eSpecifically, the study sought to:\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ea) Assess the internal reliability of the TALE measure and explore its underlying factorial structure to determine whether it represents a coherent construct.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eb) Examine discriminant validity by investigating whether TALE scores differ systematically across demographic and background variables, including age at entry to care and gender.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ec) Examine convergent validity by investigating relationships between TALE scores and other measures of trauma and adversity, thereby determining whether the TALE captures overlapping but distinct dimensions of trauma-related experience.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ec) Evaluate criterion validity, exploring whether the TALE scores are associated with indicators of psychosocial functioning including emotional and behavioural difficulties and attachment.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ef) Explore predictive validity in relation to TALE scores being predictive of placement endings.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eCollectively, these analyses were designed to provide a comprehensive examination of the TALE\u0026rsquo;s psychometric properties and to inform its potential use as a brief, trauma-informed screening tool for looked-after children within multi-informant assessment frameworks.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design\u003c/h2\u003e \u003cp\u003eThis quantitative cross-sectional study used routine assessment data collected by FRCC to examine the development, internal structure, and external psychometric properties of the TALE. The study formed part of a wider evaluation project exploring assessment and outcomes of children who are looked after within FRCC fostering and residential services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eThe study sample comprised 394 looked-after children for whom a completed TALE assessment was returned by local authority social workers. Inclusion criteria were broad, and all children placed within FRCC services were considered eligible with the exception of parent and child placements, and children placed under an ICO. Children were also excluded if their social worker did not consent to their participation (n\u0026thinsp;=\u0026thinsp;0) or if the TALE was only partially completed (n\u0026thinsp;=\u0026thinsp;7).\u003c/p\u003e \u003cp\u003eThe sample included 204 males (51.8%) and 190 females (48.2%). In terms of ethnicity, the majority were White British (77.2%), with smaller proportions of White Other (3.6%), Asian British (3.6%), Black British (1.3%), Black African (2.3%), Mixed heritage (5.8%), and Other ethnic backgrounds (2.1%). The mean age at entry into care was 9.56 years (SD\u0026thinsp;=\u0026thinsp;3.60).\u003c/p\u003e \u003cp\u003ePlacement stability varied considerably. At the point of data collection, and where such data was available, 105 children (32.7%) had experienced no previous placements, 142 (44.2%) had experienced one or two, while 74 (23.1%) had experienced three or more. Placement moves ranged from 0 to 10, with an average of 1.54 moves (SD\u0026thinsp;=\u0026thinsp;1.75). With regard to placement composition, just over half of the children were placed as singletons (n\u0026thinsp;=\u0026thinsp;209, 53.2%) while nearly half were placed with siblings (n\u0026thinsp;=\u0026thinsp;184, 46.8%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Measures\u003c/h2\u003e \u003cp\u003eThe Trauma and Adverse Life Events (TALE) screening tool (Hillman, Cross \u0026amp; Anderson, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) is a brief social worker-report measure designed to capture both the extent and impact of adversity and trauma in children in care. It comprises two sections:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eIndicators: 14 items adapted from the Adverse Childhood Experiences (ACE) tool (Felitti et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), covering neglect, abuse, and household dysfunction (e.g., parental mental illness, domestic violence, separation, substance misuse, incarceration). This strand of the TALE covers exposure. Responses include \u003cem\u003eNot known\u003c/em\u003e, \u003cem\u003ePossible\u003c/em\u003e, or \u003cem\u003eDefinite\u003c/em\u003e. Scores are calculated on a 3-point scale which allow for a sum score across the 14 items {\u003cem\u003eIndicators} (range 0\u0026ndash;42)\u003c/em\u003e\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImpact: Respondents rate the degree to which each adverse experience is thought to have affected the child (\u003cem\u003eMild\u003c/em\u003e, \u003cem\u003eModerate\u003c/em\u003e, \u003cem\u003eSevere\u003c/em\u003e). Scores are summed to yield a composite score {\u003cem\u003eImpact}\u003c/em\u003e (range 0\u0026ndash;42).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eA composite score is calculated for the TALE which is scored by multiplying the items on \u003cem\u003eIndicators\u003c/em\u003e that were present (\u003cem\u003ePossible, Definite)\u003c/em\u003e by the score on the second scale (\u003cem\u003eImpact).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAdditional measures included:\u003c/p\u003e \u003cp\u003e \u003cem\u003eStrengths and Difficulties Questionnaire (SDQ)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe \u003cem\u003eStrengths and Difficulties Questionnaire\u003c/em\u003e (SDQ; Goodman, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) is a 25-item carer-report instrument designed to screen for emotional and behavioural difficulties in children and adolescents aged 2\u0026ndash;17 years. Items are rated on a three-point scale (\u003cem\u003eNot true\u003c/em\u003e, \u003cem\u003eSomewhat true\u003c/em\u003e, \u003cem\u003eCertainly true\u003c/em\u003e) and grouped into five subscales: Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention, Peer Relationship Problems, and Prosocial Behaviour. The first four subscales can be summed to produce a \u003cem\u003eTotal Difficulties Score\u003c/em\u003e, with scores of 17 or above typically indicating clinically significant problems. The SDQ demonstrates good concurrent validity (Goodman \u0026amp; Scott, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Muris, Meesters \u0026amp; van den Berg, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), discriminant validity (Lundh, Wangby-Lundh \u0026amp; Bjarehed, 2008), and moderate test\u0026ndash;retest reliability (Yao et al., 2009). For younger children, Mieloo et al. (2012) recommend use of the total difficulties score due to lower subscale consistency (Cronbach\u0026rsquo;s α\u0026thinsp;\u0026lt;\u0026thinsp;.70).\u003c/p\u003e \u003cp\u003e \u003cem\u003eChild Dissociative Checklist (CDC)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe \u003cem\u003eChild Dissociative Checklist\u003c/em\u003e (CDC; Putnam, Helmers \u0026amp; Trickett, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e1993\u003c/span\u003e) is a 20-item observer-report screening measure used to identify dissociative behaviours in children over the past 12 months. Items such as \u0026ldquo;goes into a trance-like state\u0026rdquo; or \u0026ldquo;refers to self in the third person\u0026rdquo; are rated on a three-point scale (\u003cem\u003eNot true\u003c/em\u003e, \u003cem\u003eSometimes true\u003c/em\u003e, \u003cem\u003eTrue\u003c/em\u003e), producing total scores between 0 and 60. Scores above 12 may indicate clinically significant dissociation. The CDC has strong internal consistency, excellent test\u0026ndash;retest reliability (Putnam et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e1993\u003c/span\u003e), and good convergent and discriminant validity (Peterson and Putnam, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e1994\u003c/span\u003e. Internal consistency in the current study was excellent (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;.92).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe Development and Well-Being Assessment (DAWBA)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe DAWBA (Goodman et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) is a structured diagnostic instrument combining questionnaires, rating scales, and interviews to generate likely psychiatric diagnoses in children and adolescents. It integrates information from multiple informants (parents, teachers, and children) and produces computer-generated probability scores indicating the likelihood of specific disorders. For the purposes of the present study, only the overall prediction subscale\u0026mdash;reflecting the total predicted likelihood of a difficulties associated with a particular condition\u0026mdash;was used in subsequent analyses as a global indicator of mental health risk. At FRCC, the DAWBA is not used as a diagnostic measure, but instead is utilised to highlight risk in relation to a particular set of needs or difficulties.\u003c/p\u003e \u003cp\u003e \u003cem\u003eRelationship Problems Questionnaire (RPQ)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe RPQ (Minnis, Rabe-Hesketh and Wolkind, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) is a 10-item observer-report measure developed to screen for symptoms of reactive attachment disorder amongst 12\u0026ndash;17-year-olds. It assesses behaviours associated with \u003cem\u003einhibited\u003c/em\u003e and \u003cem\u003edisinhibited\u003c/em\u003e attachment patterns, such as social withdrawal, indiscriminate friendliness, or hypervigilance. Items are rated on a Likert scale reflecting frequency or intensity, with higher scores suggesting greater attachment-related difficulties. The RPQ has demonstrated good to excellent internal consistency, satisfactory test\u0026ndash;retest reliability, and good concurrent and discriminant validity (Minnis et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Minnis et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Vervoort et al., 2013).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAttachment Screening Assessment (ASA)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe ASA (Glaser et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) is a 45-item caregiver-report instrument designed to evaluate attachment classifications in children aged 4\u0026ndash;11 years. Carers respond to 12 scenario-based questions (e.g., child distress, separation, or fear) rated on a five-point Likert scale from \u003cem\u003eNever\u003c/em\u003e to \u003cem\u003eAlways\u003c/em\u003e. Subscales correspond to eight attachment categories: Secure, Anxious\u0026ndash;Avoidant, Ambivalent\u0026ndash;Resistant, Disorganised, Post-Disorganisation Controlling\u0026ndash;Punitive, Post-Disorganisation Controlling\u0026ndash;Caregiving, Inhibited (RAD), and Disinhibited (DSED). The ASA has shown satisfactory face and concurrent validity (Glaser et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), although lower internal consistency has been reported for the RAD and DSED subscales (Barge et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2026\u003c/span\u003e), indicating the need for further psychometric evaluation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDemographic and Background Variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDemographic information, including \u003cem\u003egender, age at placement\u003c/em\u003e, \u003cem\u003enumber of placements (prior to current placement)\u003c/em\u003e, and \u003cem\u003eplacement with/without siblings\u003c/em\u003e, was extracted from FRCC records. Two further risk factors were obtained from social worker-recorded specific maltreatment experiences (\u003cem\u003eneglect, physical abuse, domestic violence\u003c/em\u003e, \u003cem\u003esexual abuse, emotional abuse)\u003c/em\u003e, coded as dichotomous variables, and aggregates to create a \u003cem\u003eChild Risk Variable.\u003c/em\u003e Similarly, a variable was created relating either to or from the birth family factors; these included substance use, alcohol use and mental health diagnosis, and was aggregated to create a Birth Parent Risk score.\u003c/p\u003e \u003cp\u003eFinally, and specifically relating to the final hypothesis, a variable on the database was used to indicate whether the placements had planned or unplanned endings within the first 12 months of placement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Procedure\u003c/h2\u003e \u003cp\u003eIn line with FRCC\u0026rsquo;s routine assessment procedures, the TALE was distributed to local authority social workers approximately six weeks after a child\u0026rsquo;s placement began. The SDQ, CDC, RPQ or ASA were distributed separately to foster carers or residential key workers, who were asked to return completed measures by email within two weeks. Where measures were not returned, administrative staff at FRCC followed up with reminders after one month.\u003c/p\u003e \u003cp\u003eData were anonymised, encrypted, and entered into SPSS for analysis. Referral documentation was cross-referenced to extract background information, which was merged into the research dataset.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical Considerations\u003c/h2\u003e \u003cp\u003eThis study was conducted under ethical approval from University College London (UCL) as part of a larger programme of FRCC research. All data were collected through FRCC\u0026rsquo;s routine assessment process, with consent for use in research provided by local authority social workers. Foster carers completed the additional assessments with anonymised data shared securely with the research team.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Statistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS version 28 was used for analysis. Initial descriptive statistics were produced for demographic and placement variables, followed by exploratory factor analysis of the TALE. As a Shapiro\u0026ndash;Wilk test indicated normal distribution of Indicators scores (W\u0026thinsp;=\u0026thinsp;2.44, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), parametric tests (were used to examine relationships between the TALE and the different background and psychometric measures used in this study. Throughout the analyses below, the \u003cem\u003en\u003c/em\u003e will fluctuate considerably given that not all measures were completed on all the participants within this study. A series of Pearson\u0026rsquo;s r correlations and T tests were used throughout this report to examine the patterns within the TALE.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Descriptives\u003c/h2\u003e \u003cp\u003eThe 14 individual items of the TALE are displayed below in terms of responses on the frequency of experience across the population (n\u0026thinsp;=\u0026thinsp;394).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE indicators (frequency)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHas the child ever been in a serious accident where they have been physical hurt?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot known\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePossible\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDefinite\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e301 (77.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (16.5%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (5.9%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever suffered from a serious of life-threatening illness, which has had an impact on their life?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e357 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been physical punished or beaten by a parent/caregiver/other resulting in injuries?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (17.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been pressurised into some form of unwanted sexual contact?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261 (66.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas a close family member of the child been seriously hurt or killed?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e297 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever witnessed someone close to him/her being seriously hurt or worse?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been unsupported, unloved and unprotected?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e262 (66.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been exposed to a parent or other adult being verbally abusive to them?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e184 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been physically hurt in some way by a parent or adult?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e112 (28.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been in a situation where they would have felt like no one in their family thought they were important or special?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e176 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been looked after by a parent that was mentally unwell??\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e207 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been looked after by someone who is/was under the influence of alcohol or drugs?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e229 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas a close family member of the child been to prison?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e234 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e113 (28.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas child \u0026lsquo;lost\u0026rsquo; a close family member through divorce, abandonment, or another reason?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (21.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e229 (58.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above shows, across the 14 TALE indicator items, patterns indicated clear variation in the types of adversity most frequently reported.\u003c/p\u003e \u003cp\u003eThose items most commonly rated as Definite were experiences of emotional neglect and family instability. The majority of children were described as unsupported or unprotected (66.5%), exposed to parental substance misuse (58.1%), and having lost a close family member through separation or abandonment (58.4%). High proportions also experienced verbal abuse (46.7%) and feeling unimportant within their family (44.7%).\u003c/p\u003e \u003cp\u003eItems most often marked as Possible reflected ambiguous or less well-documented experiences, notably witnessing violence (46%), physical punishment or beating (40.7%), and physical harm by a parent or adult (37.2%).\u003c/p\u003e \u003cp\u003eItems most frequently rated as Not known related to events outside the caregiving context, including serious accidents (77.6%), life-threatening illness (92.5%), and family members being seriously hurt or killed (76%).\u003c/p\u003e \u003cp\u003eOverall, emotional neglect, family disruption, and exposure to substance misuse emerged as the most clearly identified adversities, whereas accidental or medical traumas were less often known or recorded.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE indicators (impact)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHas the child ever been in a serious accident where they have been physical hurt?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimal impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSevere impact\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (42.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (35.6%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (21.8%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever suffered from a serious of life-threatening illness, which has had an impact on their life?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (31%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been physical punished or beaten by a parent/caregiver/other resulting in injuries?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been pressurised into some form of unwanted sexual contact?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (31.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas a close family member of the child been seriously hurt or killed?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever witnessed someone close to him/her being seriously hurt or worse?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115 (41.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been unsupported, unloved and unprotected?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e214 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been exposed to a parent or other adult being verbally abusive to them?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e175 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been physically hurt in some way by a parent or adult?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (41.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been in a situation where they would have felt like no one in their family thought they were important or special?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (33.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e202 (61.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child ever been looked after by a parent that was mentally unwell??\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas the child been looked after by someone who is/was under the influence of alcohol or drugs?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e168 (54.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas a close family member of the child been to prison?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (36.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas child \u0026lsquo;lost\u0026rsquo; a close family member through divorce, abandonment, or another reason?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 (29.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above displays, ratings of perceived impact showed that many adversities were judged to have had a \u003cem\u003esevere effect\u003c/em\u003e on children\u0026rsquo;s wellbeing. The highest severe impact scores were for experiences of feeling unsupported or unloved (59.6%), feeling unimportant within the family (61.4%), exposure to parental substance misuse (54.4%), and loss of a close family member through separation or abandonment (56.7%). Similarly high levels of severe impact were observed for verbal abuse (50.4%) and unwanted sexual contact (51.2%).\u003c/p\u003e \u003cp\u003eExperiences involving witnessing violence (41.8%), being physically hurt by an adult (41.1%), and having a parent with mental illness (48.3%) were also frequently associated with \u003cem\u003emoderate\u003c/em\u003e to severe perceived impact.\u003c/p\u003e \u003cp\u003eIn contrast, adversities such as serious accidents, life-threatening illness, or having a family member imprisoned were more evenly distributed across impact categories or more often rated as \u003cem\u003eminimal\u003c/em\u003e, suggesting relatively lower or more variable perceived effects.\u003c/p\u003e \u003cp\u003eOverall, emotional neglect, family disruption, and exposure to abuse or parental dysfunction were viewed as the most damaging experiences within this sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Exploratory Factor Analysis\u003c/h2\u003e \u003cp\u003eThe Kaiser-Meyer-Olkin measure showed that the initial model reached criteria for sampling adequacy (overall MSA\u0026thinsp;=\u0026thinsp;0.76) and the Bartlett\u0026rsquo;s test of sphericity demonstrated sufficient correlations between TALE items for EFA (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). An exploratory factor analysis was conducted using principal axis factoring (or principal components analysis\u003cb\u003e)\u003c/b\u003e. Inspection of the scree plot indicated an inflection point at three factors, which was also supported by the parallel analysis. A (varimax/oblimin) rotation was performed to aid interpretability. The rotated solution yielded a clear and interpretable factor structure, with simple structure evident. Items loaded strongly (\u0026gt;\u0026thinsp;.40) on their respective factors, with minimal cross-loadings. Factor loadings are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe initial factor extraction using parallel analysis revealed four factors with eigenvalues greater than 1. However, a decision was made to retain three factors for further analysis after considering the result of the scree plot analysis and the interpretability of the factors (Tabachnik \u0026amp; Fidell, 2014). These three factors accounted for a cumulative variance of 49.5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eReliability coefficients of the TALE as shown by Cronbach\u0026rsquo;s alpha.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubscale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCronbach\u0026rsquo;s \u003cem\u003ea\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eLL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eUL\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA Hurt (\u003cem\u003efour items\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB Neglect (\u003cem\u003efour items\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC Loss (\u003cem\u003efour items)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; \u003cem\u003eLL\u003c/em\u003e\u0026thinsp;=\u0026thinsp;lower limit; \u003cem\u003eUL\u003c/em\u003e\u0026thinsp;=\u0026thinsp;upper limit.\u003c/p\u003e \u003cp\u003eFactor 1, labelled \u0026lsquo;Hurt\u0026rsquo; consisted of four items related to being hurt, attacked or physically sick, and accounted for 19.3% of total variance. All 4 items loaded on this factor with relatively high loadings, indicating a good correspondence to the pre-defined subscale\u003c/p\u003e \u003cp\u003eFactor 2, named \u0026lsquo;Neglect\u0026rsquo;, represented items measuring parental absence, unavailability, deprivation or mental ill health. All four items loaded on this factor with relatively high loadings, accounting for 17.5% of the total variance.\u003c/p\u003e \u003cp\u003eFactor 3 is labelled as \u0026lsquo;Loss\u0026rsquo; and comprised items measuring familial death, imprisonment or other losses. It accounted for 12.6% of total variance. All four items loaded on this factor with marginally high loadings including an adequate correspondence.\u003c/p\u003e \u003cp\u003eAs the three retained factors in the exploratory factor analysis aligned well with the pre-defined subscale structure of the TALE, it was decided that these three subscales provided a reasonably clear division for different aspects measured in relation to traumatic life events. Given that, the internal consistency was calculated for each subscale using Cronbach\u0026rsquo;s alpha and the results are shown in Table X. The internal consistency of the TALE was generally satisfactory (mean \u003cem\u003ealpha\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.67), indicating good reliability (DeVellis, 2003). It should, however, be noted that the third subscale was moderately low.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCorrelation of TALE and Background Factors\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. TALE (Total)\u003c/p\u003e \u003cp\u003e2. TALE (Neglect)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.851**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.851**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.726**\u003c/p\u003e \u003cp\u003e.476**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.706**\u003c/p\u003e \u003cp\u003e.426**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.008\u003c/p\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e \u003cp\u003e-.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.042\u003c/p\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.167**\u003c/p\u003e \u003cp\u003e-.133*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.198*\u003c/p\u003e \u003cp\u003e.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.202**\u003c/p\u003e \u003cp\u003e-.254**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. TALE (Hurt)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.726**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e750**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.318**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.-,049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.192*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.266**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.112*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.123*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.TALE (Loss))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.706**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.426**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.318**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.Gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Age into care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.184*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.313**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.141**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. No placemen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.184*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.243**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.184**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Placed sibs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.167**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.133*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.192*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.313**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.243**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.144**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Risk factor (C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.198*.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.266 **\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-141**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Risk factor (P)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e..095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.112*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e.184**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-144**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11Planned/unplanned\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.202**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.254**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.086`\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e*p \u0026lt; .05, **p \u0026lt; .01, ***p \u0026lt; .001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u0026nbsp;\u003c/strong\u003e\u003cem\u003eCorrelation of TALE and Psychometric measures\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"15\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. TALE (Total)\u003c/p\u003e \u003cp\u003e2. TALE (Neglect)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.851**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.851**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.726**\u003c/p\u003e \u003cp\u003e.476**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.706**\u003c/p\u003e \u003cp\u003e.426**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.243*\u003c/p\u003e \u003cp\u003e.219*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.155*\u003c/p\u003e \u003cp\u003e.188*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.255**\u003c/p\u003e \u003cp\u003e.270**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.118*\u003c/p\u003e \u003cp\u003e.173**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.160**\u003c/p\u003e \u003cp\u003e-.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.101\u003c/p\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.107*\u003c/p\u003e \u003cp\u003e.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.198**\u003c/p\u003e \u003cp\u003e.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.130**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.110\u003c/p\u003e \u003cp\u003e.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. TALE (Hurt)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.726**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e750**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.318**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.236*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.207**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.216*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.180**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.241**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.223**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.TALE (Loss))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.706**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.426**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.318**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.125*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. SDQ Total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.243*.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.219*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.236 *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.867**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e695**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.406**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.487**.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.311**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. SDQ Int\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.155**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.188**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.207**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.795**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.457**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.594**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.344**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.571**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.SDQ Ext\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.255**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.270**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.216**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.867**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.457**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.620**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e..368**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.296**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.378**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.RPQ total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.-.118*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.187*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.640**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.504**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.591**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.594**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.262**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.CDC total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.183**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.173**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.180**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.695**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.594**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.620**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.334**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.551**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.229**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.ASA (Secure))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.-101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. ASA (Avoidt)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.733**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12. ASA (Resist)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.198**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.241**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.125*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.406**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.344**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.368**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.334**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.206*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.575**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13. ASA (Disorg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.130**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.223**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.487**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.571**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.296**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.551**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.575**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14. DAWBA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.136*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.311**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.378**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.229**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Relationship to background variables\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicates the correlations between the TALE measures and \u003cem\u003egender, age at placement, number of placements, placed alone/within siblings, risk factor (child), risk factor (parent)\u003c/em\u003e and \u003cem\u003eplacement ending (planned vs unplanned).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e below indicates, boys and girls had very similar mean TALE overall scores on the TALE composite and its three subscales (\u003cem\u003eNeglect, Hurt, Loss)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eBivariate analysis indicated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e that there was no significant correlation between \u003cem\u003eage at placement\u003c/em\u003e and TALE composite and its three subscales.\u003c/p\u003e \u003cp\u003eExplorations were also made to see whether the TALE scales were correlated with concurrent retrospective data available on the children\u0026rsquo;s adverse histories. Bivariate analyses in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e indicated that TALE scales were not found to be significantly associated with \u003cem\u003enumber of placements\u003c/em\u003e (number prior to placement).\u003c/p\u003e \u003cp\u003eFor the variable \u003cem\u003eplaced alone/with siblings\u003c/em\u003e, on average, as indicated in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e below, \u003cem\u003eChildren placed alone\u003c/em\u003e had higher scores on the TALE and its subscales compared to \u003cem\u003eChildren placed with siblings\u003c/em\u003e They had statistically significantly higher scores on the TALE total and both \u003cem\u003eNeglect\u003c/em\u003e and \u003cem\u003eHurt\u003c/em\u003e subscales.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE and Background variables\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGENDER \u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTALE total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.39 (15.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.96 (14.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.155, 392, p=.877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.52 (12.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.36 (10.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.139, 392, p=.889\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.46 (7.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.25 (8.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.927, 356, p=.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.13 (8.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.44 (7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.798, 360, p=.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLACEMENT siblings\u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePlaced with siblings (n\u0026thinsp;=\u0026thinsp;184)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePlaced as singleton (n\u0026thinsp;=\u0026thinsp;209)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTALE total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.36 (14.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.33 (14.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.341, 391, p\u0026lt;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.78 (11.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.84 (11.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.66, 391, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.31 (7.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.27 (8.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.69, 355, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.53 (8.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.00 (7.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.547, 359, p=.585, ns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBivariate correlations in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed that more \u0026lsquo;child risk\u0026rsquo; variables (e.g. physical abuse) had significantly higher scores on the TALE total and on the TALE subscale \u003cem\u003eHurt.\u003c/em\u003e This was not the case for the other two subscales.\u003c/p\u003e \u003cp\u003eThose with more \u0026lsquo;birth parent risk\u0026rsquo; variables (e.g. parental mental health) did not have significantly higher scores on the TALE overall though there was a weak positive correlation on the TALE subscale \u003cem\u003eHurt.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Relationship to psychosocial difficulties\u003c/h2\u003e \u003cp\u003eAn SDQ was completed by the foster carers of 210 of the children in the present sample, 44.8% of whom (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;99) scored on or above the clinical cut-off of 17, indicating that clinically significant behavioural and emotional problems were present.\u003c/p\u003e \u003cp\u003eAs Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e indicates, a significant positive correlation was found between TALE overall and SDQ Total Difficulties, with a small effect size \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.207, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001). This was also evident for the \u003cem\u003eNeglect\u003c/em\u003e subscale \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.219, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) and the \u003cem\u003eHurt subscale (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.236, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001). There was no such correlation with the \u003cem\u003eLoss\u003c/em\u003e subscale. As Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e below shows, those who score above the clinical range on the SDQ had significantly higher scores on the TALE total and two subscales (Neglect, Hurt) compared to those who scored below the cut-off.\u003c/p\u003e \u003cp\u003eBoth internalising and externalising subscales were also examined in relation to the four TALE scores. As Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows, this was stronger for \u003cem\u003eexternalizing\u003c/em\u003e in relation to TALE overall \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.270, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001), TALE \u003cem\u003eNeglect (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.270, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) and TALE \u003cem\u003eHurt (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.216, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) Though weaker, internalising scores on the SDQ were still significantly correlated with TALE overall \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.145, \u003cem\u003ep\u003c/em\u003e\u0026lt;.05), TALE \u003cem\u003eNeglect (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.188, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) and TALE \u003cem\u003eHurt (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.207, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001). As Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e indicates, on a smaller subsample, the DAWBA prediction score was not significantly correlated with TALE scores, suggesting no clear association between early adversity and predicted diagnostic risk on the DAWBA in this sample.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE and psychosocial difficulties\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSDQ Total cut off\u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAbove clinical cut off \u0026gt;\u0026thinsp;17 (n\u0026thinsp;=\u0026thinsp;173)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eBelow clinical cut off \u0026lt;\u0026thinsp;16 (n\u0026thinsp;=\u0026thinsp;213)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTALE total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.08 (14.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.78 (15.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.513, 384, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.98 (10.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.40 (12.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.954, 384, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.69 (8.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.51 (7.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.742, 349, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.05 (8.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.59 (8.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.518, 353, p\u0026thinsp;=\u0026thinsp;0.04, ns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTwo additional measures were examined in order to see how other dimensions of psychopathology might relate to the TALE. The DAWBA prediction score was significantly related with both TALE overall, albeit with a very small effect size \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.161, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001, and TALE \u003cem\u003eNeglect (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.136, \u003cem\u003ep\u003c/em\u003e\u0026lt;.05).\u003c/p\u003e \u003cp\u003eThe CDC was completed by foster carers for 205 of the children in the sample, of whom 136 (61.5%) scored above the clinical threshold indicative of dissociative difficulties (score of 12 or more). As Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e indicates, TALE overall score was significantly positively correlated with CDC score (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.160, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), whilst two subscales TALE \u003cem\u003eNeglect\u003c/em\u003e (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.173, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and TALE \u003cem\u003eHurt\u003c/em\u003e were also correlated with CDC (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.180, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). As Table \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e below shows, those who score above the clinical range on the CDC had significantly higher scores on the TALE total and two subscales (Neglect, Hurt) compared to those who scored below the cut-off.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE and dissociative experiences\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCDC Total cut off\u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAbove clinical cut off (n\u0026thinsp;=\u0026thinsp;126)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eBelow clinical cut off (n\u0026thinsp;=\u0026thinsp;257)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTALE total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.57 (14.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.82 (14.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.326, 381, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.52 (10.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.35 (11.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.561, 381, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.25 (8.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.71 (7.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.987, 347, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.82 (8.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.77 (8.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.073, 350, p=.942\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTwo parent report measures of attachment were used, the ASA with parents of younger children, and the RPQ with parents of older children/adolescents.\u003c/p\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e above, TALE overall score was significantly positively correlated with RPQ score (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.133, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whilst the subscale TALE \u003cem\u003eHurt\u003c/em\u003e was also correlated (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.187, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). As Table \u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e below shows, those who score above the clinical range on the CDC did not have significantly higher scores on the TALE total and subscales though there was a weak positive effect with the Hurt subscale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE and RPQ\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRPQ Total cut off\u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAbove clinical cut off (n\u0026thinsp;=\u0026thinsp;74)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eBelow clinical cut off (n\u0026thinsp;=\u0026thinsp;146)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTALE total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.12 (15.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.57 (15.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.637, 218, p=.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.07 (12.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.75 (7.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.367, 218, p=.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHurt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.26 (7.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.77 (7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.155, 199, p=.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.13.96 (8.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.53 (8.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.340, 199, p=.734, ns\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe four attachment subscales of the ASA had mixed findings. ASA \u003cem\u003eSecure\u003c/em\u003e was significantly albeit weakly corelated with TALE \u003cem\u003eoverall (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=-.130, \u003cem\u003ep\u003c/em\u003e\u0026lt;.05) whilst ASA \u003cem\u003eAvoidance\u003c/em\u003e was not significantly correlated with the TALE scores. ASA \u003cem\u003eResistance\u003c/em\u003e was significantly correlated with TALE overall \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.216, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001), TALE \u003cem\u003eHurt (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.241, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001) and TALE \u003cem\u003eLoss (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.125, \u003cem\u003ep\u003c/em\u003e\u0026lt;.005). TALE \u003cem\u003eDisorganised was sig\u003c/em\u003enificantly correlated with TALE overall \u003cem\u003e(r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.181, \u003cem\u003ep\u003c/em\u003e\u0026lt;.05) and TALE \u003cem\u003eHurt (r\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e=.223, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Predictive validity\u003c/h2\u003e \u003cp\u003eAs Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e below shows, those with \u003cem\u003eunplanned\u003c/em\u003e endings had higher scores on the TALE overall (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.79, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.74) compared to those with \u003cem\u003eplanned endings\u003c/em\u003e, and the difference was found to be statistically significant (\u003cem\u003et\u003c/em\u003e=-2.864, 148, p\u0026thinsp;=\u0026thinsp;0.05). This was also repeated across the three subscales for Neglect (\u003cem\u003et\u003c/em\u003e=-3.197, 148, p=.002), Hurt (\u003cem\u003et\u003c/em\u003e=-1.412, 130, p=.160) and Loss (\u003cem\u003et\u003c/em\u003e=-1.350, 133, p=.179)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eTALE and placement endings (planned vs unplanned)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLACEMENT endings\u003c/p\u003e \u003cp\u003eTALE subscales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePlacement ending planned (n\u0026thinsp;=\u0026thinsp;36)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePlacement ending unplanned (n\u0026thinsp;=\u0026thinsp;114)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et, df, p\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTALE total\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.97 (16.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.18 (14.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.2.515, 148, p=.0013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNeglect\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.89 (13.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.92 (10.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.3.197, 148, p\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHurt\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.68 (7.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.89 (7.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.412, 130, p=.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLoss\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.61 (9.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.93 (7.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.350, 133, p=.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Overview of Findings\u003c/h2\u003e \u003cp\u003eThe present study examined the psychometric properties and concurrent validity of the Trauma and Adversity Life Events (TALE) measure in a large sample of looked-after children. Drawing on routine data from fostering and residential settings, the study explored the structure, internal reliability, and correlates of the TALE, as well as its associations with measures of psychosocial adjustment, dissociation, and attachment. Overall, the findings support the TALE as a psychometrically adequate and clinically meaningful tool for assessing the breadth and impact of early adversity in children in care. The emerging three-factor structure\u0026mdash;\u003cem\u003eHurt, Neglect\u003c/em\u003e, and \u003cem\u003eLoss\u003c/em\u003e\u0026mdash;was conceptually coherent and aligned closely with the domains proposed by Kerr-Davis et al. (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who identified these as key dimensions capturing both direct maltreatment experiences and relational disruptions central to developmental trauma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Patterns of Reported Adversity\u003c/h2\u003e \u003cp\u003eDescriptive analyses revealed that experiences of emotional neglect, family instability, and exposure to parental substance misuse were the most prevalent and most clearly defined adversities in the sample. These patterns echo prior evidence that emotional neglect and caregiver dysfunction are among the most pervasive forms of adversity in looked-after populations (Cicchetti \u0026amp; Toth, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Conversely, accidental or medical traumas were less frequently known or reported, perhaps reflecting both reporting biases and the more chronic, relational nature of trauma within this group (Briere and Spinazzola, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The perceived impact ratings similarly highlighted neglect, emotional unavailability, and relational loss as the adversities judged to have the most severe effects on wellbeing, aligning with relational models of complex trauma and attachment disorganisation (Dallos and Vetere, 2020).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Factor Structure and Internal Reliability\u003c/h2\u003e \u003cp\u003eThe exploratory factor analysis produced a three-factor solution accounting for nearly 50% of the variance, with factors corresponding to \u003cem\u003eHurt\u003c/em\u003e, \u003cem\u003eNeglect\u003c/em\u003e, and \u003cem\u003eLoss\u003c/em\u003e. This structure demonstrates both empirical robustness and theoretical coherence, providing further support for the multidimensional model of trauma exposure within developmental contexts (Finkelhor et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Internal consistency for the subscales was generally satisfactory, with Cronbach\u0026rsquo;s alpha values ranging from .57 to .75\u0026mdash;comparable to those reported by Kerr et al. (2023) and consistent with early-stage development of multidomain screening tools (DeVellis, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The relatively lower alpha for the \u003cem\u003eLoss\u003c/em\u003e factor likely reflects the heterogeneity of loss experiences (e.g., bereavement vs. imprisonment), a challenge also noted in broader trauma measurement literature (Ford et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Associations with Background and Demographic Variables\u003c/h2\u003e \u003cp\u003eConsistent with prior research (Oswald et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; McCrory \u0026amp; Viding, 2015), gender and age at entry to care were not significant predictors of adversity exposure, suggesting that trauma experiences cut across demographic boundaries in care populations. However, children placed alone, rather than with siblings, showed significantly higher scores on the TALE total and \u003cem\u003eNeglect\u003c/em\u003e and \u003cem\u003eHurt\u003c/em\u003e subscales. It has been shown in wider research that being placed alongside a sibling could be considered a protective factor against foster care placement breakdown (Konijn et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This may indicate both the protective role of sibling co-placement and the possibility that greater adversity histories contribute to placement decisions for single children (Herrick and Piccus, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAssociations between higher TALE scores and higher numbers of \u0026ldquo;child risk\u0026rdquo; factors preplacement (e.g. physical abuse) further support the discriminant validity of the tool in differentiating levels of cumulative adversity. This correlation did not hold when only factoring in the risk variables directly related to birth parents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Associations with Psychosocial Adjustment and Mental Health\u003c/h2\u003e \u003cp\u003eThe TALE showed consistent and theoretically meaningful correlations with carer-reported psychosocial difficulties on the SDQ, particularly for \u003cem\u003eNeglect\u003c/em\u003e and \u003cem\u003eHurt\u003c/em\u003e subscales. These relationships, albeit modest, support the convergent validity of the TALE in relation to emotional and behavioural symptoms, echoing findings that cumulative maltreatment predicts both internalising and externalising difficulties (Cecil et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ford et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Associations with the DAWBA prediction score further suggest criterion validity, indicating that higher adversity histories were modestly associated with increased likelihood of psychiatric diagnoses.\u003c/p\u003e \u003cp\u003eSimilarly, the TALE correlated with dissociative difficulties (CDC scores), particularly for \u003cem\u003eNeglect\u003c/em\u003e and \u003cem\u003eHurt\u003c/em\u003e, consistent with theoretical links between chronic relational trauma and dissociative responses (Liotti, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Putnam, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). This pattern reinforces the value of the TALE in identifying trauma profiles that may underlie complex symptom presentations in care-experienced youth.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Associations with Attachment Patterns\u003c/h2\u003e \u003cp\u003eCorrelations between the TALE and attachment measures provided preliminary support for construct validity in relation to relational functioning. Higher TALE scores were associated with insecure and disorganised attachment styles, particularly \u003cem\u003eresistant\u003c/em\u003e and \u003cem\u003edisorganised\u003c/em\u003e subtypes on the ASA, aligning with attachment theory\u0026rsquo;s predictions that early maltreatment disrupts the formation of coherent attachment strategies (Fearon et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Lyons-Ruth \u0026amp; Jacobvitz, 2016). The association between \u003cem\u003eHurt\u003c/em\u003e subscale scores and insecure attachment representations further underscores the TALE\u0026rsquo;s sensitivity to the relational dimensions of trauma.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Predictive Validity: Placement Stability\u003c/h2\u003e \u003cp\u003eChildren with unplanned placement endings had significantly higher total TALE scores, particularly on the \u003cem\u003eNeglect\u003c/em\u003e subscale, supporting the predictive validity of the measure. This finding is consistent with evidence linking early adversity to placement instability and relational breakdowns in care (Leve et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Tarren-Sweeney, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Furthermore, research has shown that it is difficult to disrupt the cycle of placement breakdowns due to a complex array of risk factors which may be related to the child, foster carers, or social work team (Montserrat et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The association between neglect histories and placement disruption highlights the importance of identifying relational trauma early to inform therapeutic care planning.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.8 Strengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study benefits from a large, well-characterised sample of looked-after children, reflecting real-world diversity in age, placement type, and adversity history. Using routinely collected data enhances ecological validity and demonstrates the feasibility of implementing the TALE in frontline care settings. The study also examined multiple psychometric properties, including internal consistency, factorial structure, convergent validity with psychosocial and attachment measures, and predictive validity in relation to placement outcomes. The inclusion of multiple subscales capturing distinct dimensions of adversity (\u003cem\u003eHurt, Neglect, Loss\u003c/em\u003e) provides a multidimensional perspective that aligns with contemporary conceptualisations of complex trauma (Cloitre et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these strengths, several limitations warrant consideration. First, the study relied on social worker and caregiver reports, which may introduce informant bias and limit the child\u0026rsquo;s direct voice in reporting experiences. Second, while the TALE subscales generally demonstrated good internal reliability, the \u003cem\u003eLoss\u003c/em\u003e subscale was moderately low, reflecting heterogeneity of experiences and potentially limiting sensitivity. It is possible that though loss through bereavement or separation might likely have psychological impact, it could be more context-dependent than the other two subscales that are more suggestive of a chronic relational threat.\u003c/p\u003e \u003cp\u003eThird, correlations with psychosocial and attachment measures, though significant, were small to moderate, indicating that multiple factors beyond recorded adversity likely contribute to outcomes. The lack of direct child measures that capture their perspectives and internal representations is also evident. Finally, the cross-sectional design precludes causal inferences regarding the direction of associations between adversity and psychosocial outcomes.\u003c/p\u003e \u003cp\u003eCurrently, the TALE currently does not have an indicative clinical cut-off score. As most previous ACEs scales have shown a dose-response effect (e.g., Felitti et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1998\u003c/span\u003e), it may not be possible to detect one point of the Exposure scale at which clinical difficulties are particularly likely. Conventionally, an ACE score of five or more has been taken to indicate likely negative impacts on future health (Bellis et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), but this threshold requires statistical confirmation. It is also possible that the TALE does not capture all of the possible adverse or traumatic experiences which a child in care \u003cem\u003emay\u003c/em\u003e have experienced. For example, the TALE does not include a question around asylum seeking which as a shortcoming, as we know the number of children seeking asylum is on the rise.\u003c/p\u003e \u003cp\u003eLastly, the limitations of all ACEs tools equally apply to the TALE: cumulative measures of adversity and trauma are limited in their ability to calculate actual risk of mental and physical health difficulties on a case-by-case basis (Danese, 2019). However, the purpose of the TALE is to pragmatically capture an impression of the known information about the child\u0026rsquo;s past to contribute to clinical formulation and the planning of psychological interventions. In this purpose, the TALE has been demonstrated to be a practical and valid tool.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.9 Implications\u003c/h2\u003e \u003cp\u003eThe findings indicate that the TALE is a practical and multidimensional tool for assessing trauma in looked-after children. By capturing both the range and relational context of adversity, it can inform clinical formulation, guide trauma-informed interventions, and support monitoring of change over time (Bath, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Bunting et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Practitioners can use the TALE to identify high-risk children, tailor support strategies, and prioritize interventions in both foster and residential settings. If utilised in initial planning and formulation, the TALE may be a useful and informative tool to highlight experience and risk, and therefore buffer against further placement breakdowns (Eltink et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurther work is needed to examine the TALE\u0026rsquo;s longitudinal stability, sensitivity to change, and predictive validity for outcomes such as mental health, educational attainment, and placement stability. Confirmatory factor analyses could refine the subscale structure, ensuring each factor achieves acceptable internal consistency. Comparing scores to a normative sample would allow identification of children experiencing exceptionally high levels of adversity. Additionally, exploring clinician perspectives on integrating the TALE into broader assessment processes and examining how recorded experiences relate to children\u0026rsquo;s emotional wellbeing during placements would deepen understanding of its utility. The relationships observed between specific types of adversity and psychosocial outcomes also provide a foundation for more targeted longitudinal studies.\u003c/p\u003e \u003cp\u003eRoutine use of a validated tool like the TALE could inform evidence-based resource allocation, ensuring children with higher adversity receive priority access to therapeutic services and specialist placements. The prevalence and impact of emotional neglect and family disruption highlighted by this study support the adoption of trauma-informed care policies and targeted workforce training in child welfare settings. Standardizing the use of the TALE across agencies could also improve consistency in documenting adversity and facilitate data-driven evaluation of child protection strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe findings support the TALE as a psychometrically sound and clinically relevant tool for assessing cumulative adversity in children in care. Its alignment with theoretical frameworks of complex developmental trauma, attachment disruption, and cumulative risk underscores its potential as both a research and clinical instrument. Continued validation and refinement will enhance its capacity to support trauma-informed assessment and care planning.\u003c/p\u003e \u003cp\u003eThe findings suggest that the TALE can be readily integrated into routine assessments in foster and residential care settings. Its brief and structured format allows for timely identification of high-risk children, particularly those experiencing neglect, emotional abuse, or relational disruption. Practitioners can use TALE data to guide trauma-informed care planning, targeted interventions, and decisions around placement support, sibling co-placement, or therapeutic prioritisation (Bath, 2015; Bunting et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and therefore, the TALE may be a useful tool for local authority social work teams. Furthermore, the TALE\u0026rsquo;s multidimensional structure may help staff distinguish between different types of trauma exposure, informing tailored intervention strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XX and XX. The first draft of the manuscript was written by XX and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eCompliance with Ethical Standards:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study forms part of a wider study commissioned by Five Rivers which was granted ethical approval by University College London (UCL). All the data included in this study was collected as part of Five Rivers\u0026rsquo; routine assessment process, which monitors outcomes and facilitates interventions for children in Five Rivers\u0026rsquo; care.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no known competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of Interests:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for the use of assessment data for research purposes was obtained at the beginning of the young person\u0026rsquo;s placement, and is therefore implicit in the publication of this research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organisation for the submitted work. The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003eInformed Consent:\u003c/p\u003e\n\u003cp\u003eConsent for the use of assessment data for research purposes was obtained at the beginning of the young person\u0026rsquo;s placement.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAinsworth, M. D. S., Blehar, M. C., Waters, E., \u0026amp; Wall, S. (1978). \u003cem\u003ePatterns of attachment: A psychological study of the strange situation\u003c/em\u003e. Lawrence Erlbaum.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., \u0026amp; Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. 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Attachment disorders in early childhood. \u003cem\u003eJournal of Clinical Child \u0026amp; Adolescent Psychology\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(3), 329\u0026ndash;344.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adverse Childhood Experiences, ACEs measure, Looked-after Children, Trauma","lastPublishedDoi":"10.21203/rs.3.rs-9235006/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9235006/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChildren in care are disproportionately exposed to multiple, chronic, and relationally embedded adversities, which increased risk for poor emotional, behavioural, and developmental outcomes. The present study evaluates the Trauma and Adverse Life Events (TALE) screening tool, examining its reliability, factorial structure, and associations with psychosocial functioning to determine its suitability as a trauma-informed assessment for this population.\u003c/p\u003e \u003cp\u003eThis cross-sectional study used routine assessment data from 394 looked-after children in FRCC fostering and residential services to evaluate the TALE screening tool. Demographic, placement, and trauma-related information was collected via the TALE, alongside additional measures of emotional and behavioural difficulties, dissociation, attachment and global mental health risk were completed by social workers approximately six weeks post-placement, with other measures completed by carers or key workers. Data were anonymised and analysed in SPSS using descriptive statistics, exploratory factor analysis, and correlations to examine the TALE\u0026rsquo;s internal structure, reliability, and associations.\u003c/p\u003e \u003cp\u003eExploratory factor analysis supported a three-factor structure (Hurt, Neglect, Loss) with satisfactory reliability, and TALE scores were positively associated with behavioural and emotional difficulties, dissociation, and attachment problems. Higher TALE scores, particularly on the Neglect subscale, were also linked to unplanned placement endings, suggesting preliminary predictive validity.\u003c/p\u003e \u003cp\u003eThe TALE is a reliable, clinically useful tool for assessing cumulative adversity in children in care, supporting trauma-informed assessment, care planning, and targeted interventions in foster and residential settings.\u003c/p\u003e","manuscriptTitle":"Screening for Trauma and Adverse Experiences in Looked-After Children Using the TALE Tool","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-24 06:27:16","doi":"10.21203/rs.3.rs-9235006/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92a29854-2f18-44c9-a456-98bcbf8f36d3","owner":[],"postedDate":"April 24th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"88419451934849358959582009948704046546","date":"2026-05-15T20:28:48+00:00","index":24,"fulltext":""},{"type":"reviewerAgreed","content":"92203506710404331854075296398005584517","date":"2026-05-11T15:29:48+00:00","index":21,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T06:27:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-24 06:27:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9235006","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9235006","identity":"rs-9235006","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}