In recent years, the mental health of children and adolescents has risen to the forefront of public health discourse, yet understanding the nuances of how caregivers perceive and report on these issues remains both critical and complex. A groundbreaking study published in BMC Psychology delves into this very topic, focusing on “I don’t know” responses encountered in the International Trauma Questionnaire caregiver-version (ITQ-CV). This research provides novel insights into caregivers’ knowledge gaps and diagnostic challenges surrounding children’s mental health, potentially signaling a paradigm shift in trauma assessment and intervention strategies.
The International Trauma Questionnaire is a widely respected tool for evaluating traumatic stress reactions, primarily designed to be used by adults reporting their own symptoms. To capture the mental health status of children indirectly, a caregiver version has been developed, wherein parents or guardians assess the traumatic stress symptoms of their wards. However, discrepancies and frequent “I don’t know” responses when caregivers complete this survey have prompted in-depth analysis by the authors, spearheaded by Lueger-Schuster and colleagues. Addressing these ambiguous responses is crucial for improving the accuracy and reliability of trauma diagnosis in youth populations.
From a methodological standpoint, the study involves a meticulously designed quantitative and qualitative approach analyzing the frequency and context of the “I don’t know” responses. These responses may reflect actual limitations in caregiver awareness, the subtlety of children’s symptom expression, or even social stigma surrounding mental health discussions. Unraveling the cognitive and emotional barriers that caregivers face when asked to evaluate potentially distressing symptoms in children could refine the clinical tools and training modules used to equip caregivers and professionals alike.
One of the study’s pivotal contributions is highlighting that “I don’t know” answers are not merely missing data but rather meaningful indicators of insufficient mental health literacy or communication gaps between children and their caregivers. The tendency to select such responses can skew trauma prevalence rates and undermine subsequent treatment plans if left unaddressed. This finding underscores the importance of interpreting questionnaire data with a nuanced understanding of family dynamics and cultural factors influencing disclosure.
The researchers present a series of analytical models to categorize the various causes behind these uncertain answers. For example, they show that caregivers with limited exposure to mental health information or specialized training are more prone to uncertainty about internalizing symptoms such as anxiety and depression, which may be less overt than behavioral problems. The differentiation between externalizing and internalizing symptom recognition shapes how caregivers report and engage with professional assessments.
Further, the study critically examines how the phrasing of questions within the ITQ-CV influences the likelihood of “I don’t know” responses. Complex, jargon-laden inquiries may intimidate or confuse respondents, whereas clearer, behaviorally anchored questions elicit more confident and accurate answers. This observation supports a broader movement within psychological assessment toward user-friendly, culturally sensitive instruments that truly capture lived experiences.
Importantly, the research extends beyond individual factors and explores systemic issues, including societal stigma around mental illness in children. Caregivers may consciously or unconsciously deny or evade reporting symptoms due to fear of labeling, social judgement, or concerns about consequences within school or healthcare settings. These sociocultural dimensions critically temper the interpretation of trauma-related data and call for community-based educational efforts to normalize mental health conversations.
Clinicians engaging with families must therefore navigate a complex interplay of psychological, communicative, and cultural variables to interpret ITQ-CV results. The study advocates for integrating psychoeducation directly into assessment protocols, whereby caregivers receive clear information about symptom identification and the importance of honesty in reporting, coupled with reassurance about confidentiality and support resources. Such strategies might reduce avoidance patterns that manifest as “I don’t know” responses.
Moreover, the findings have deep implications for the epidemiology of childhood trauma. Reliable identification of traumatic stress reactions depends on accurate reporting by proxies, particularly among young children unable to self-report effectively. Any distortion due to caregiver uncertainty can lead to underestimation of trauma exposure and hinder early intervention efforts, which are essential for mitigating long-term psychiatric morbidity.
In educational and social service contexts, these insights may inform training curricula for parents, teachers, and child welfare workers, equipping them with enhanced ability to recognize subtle symptomatology. Furthermore, the digital transformation of mental health assessments, including app-based screening tools, can incorporate adaptive questioning algorithms that minimize “I don’t know” responses by tailoring inquiries based on initial caregiver inputs.
From a research standpoint, the study pioneers a conceptual framework for examining the reliability of informant reports beyond mere item completion rates. By viewing ambiguous responses as diagnostic signals rather than data absences, psychological science gains a more refined lens through which to understand the complexities inherent in caregiver-child communication about trauma. Future studies could expand this line of investigation across diverse populations and trauma types.
The potential impact of this research reverberates through public health policy as well. Systems aiming to improve mental health outcomes must recognize the limitations caregivers face in symptom recognition and reporting. Policy-driven initiatives could integrate standardized caregiver training and support systems into pediatric healthcare, ensuring that objective trauma assessments are supplemented by strengthened caregiver capacity.
Given the rising prevalence of mental health conditions globally, and the particularly vulnerable developmental windows in childhood when trauma exerts lasting effects, enhancing caregiver knowledge is not merely an academic exercise but a societal imperative. This study not only quantifies the problem but also points the way toward practical solutions that could revolutionize trauma screening practices.
In conclusion, this comprehensive investigation by Lueger-Schuster and colleagues serves as a wake-up call to the mental health community. It reveals how the simple response “I don’t know,” often overlooked as a non-response, unravels complex layers of caregiver understanding, communication difficulties, and systemic cultural factors. By bringing clarity to these ambiguities, mental health professionals can develop more effective assessment tools, improve screening accuracy, and ultimately deliver better care for traumatized children.
This work exemplifies the intersection of clinical psychology, public health, and social science in addressing one of today’s most pressing concerns: how to recognize and heal childhood trauma before it manifests into lifelong dysfunction. As the authors demonstrate, addressing the unknowns in caregiver knowledge has the power to transform outcomes and break the silence surrounding child mental health challenges worldwide.
Subject of Research: Caregivers’ knowledge and awareness regarding children’s mental health symptoms as measured by the International Trauma Questionnaire caregiver-version, with a focus on “I don’t know” responses that reflect diagnostic uncertainty.
Article Title: I don’t know-responses in the international trauma questionnaire caregiver-version: caregivers’ knowledge about children’s mental health.
Article References:
Lueger-Schuster, B., Weindl-Wagner, D., Zagaria, A. et al. I don’t know-responses in the international trauma questionnaire caregiver-version: caregivers’ knowledge about children’s mental health. BMC Psychol 13, 876 (2025). https://doi.org/10.1186/s40359-025-03229-3
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