Child maltreatment and the development of posttraumatic stress disorder
R. Famularo, T. Fenton and R. Kinscherff
Boston Juvenile Court Clinic, Massachusetts Department of Mental Health, Boston, MA 02108.
OBJECTIVE--The purpose of this study was to compare the relative effects of
various forms of maltreatment on the development of posttraumatic stress
disorder (PTSD) in children. DESIGN--Children were randomly selected from a
population of court-involved maltreated children. The children were then
assigned to a PTSD group and a non-PTSD group on the basis of their
responses to a structured interview. SETTING--A juvenile/family court in a
large urban area. PARTICIPANTS--This study examined 101 children who were
before a juvenile/family court because of severe child maltreatment. All
children had been removed from parental custody as a result of the
maltreatment. INTERVENTIONS--None. MEASUREMENTS AND RESULTS--Structured
clinical psychiatric interviews were administered to each child and each
parent, and all court records were reviewed. The major analyses assessed
the extent to which the presence and duration of the most common types of
severe maltreatment were associated with a diagnosis of PTSD. Thirty-nine
children met criteria for PTSD. Those who were sexually maltreated and
those who witnessed family violence had a much greater likelihood of
developing PTSD than did those whose histories of maltreatment did not
include these types of events. The duration of emotional abuse
(psychological terror) also proved to be a significant factor in
discriminating children diagnosed as having PTSD from other severely
maltreated children. CONCLUSIONS--These findings delineate factors
implicated in the cause of PTSD. Moreover, they provide information that
will enable the protective service community to screen more effectively for
PTSD among maltreated children.
