The children for the total sample were predominantly male and white, with an average age of 11 years. They came from mostly middle income families with at least one parent having had more than a high school education. About half of the children lived with both biological parents. Compared to children without parent-report of prior exposure to traumatic events, children who had been exposed to traumatic events were more likely to be white, more likely to live in a family with a household income below $20,000, and less likely to live with both biological parents. There were no differences related to prior exposure to traumatic events on a variety of family characteristics related to military status, including deploy-ment of a primary caregiver and reassignments to other military posts. Of the 984 children included in this study, 37% of the children had been exposed to trauma or abuse prior to intake into the study according to parent report. Although the majority of children in the study received at least one major diagnosis or were diagnosed with an adjustment disorder, children exposed to traumatic events were more likely to have received a major diagnosis. Prior exposure to traumatic events was associated with the greater likelihood of comorbid internalizing and externalizing disorders, including depressive disorders, anxiety disorders, and conduct disorder. When specific diagnoses were examined separately, there were no differences in rates of oppositional-defiant disorder and attention deficit disorder. Compared to children with a variety of other emotional and behavioral disorders, children who had been previously exposed to traumatic events exhibited more overall symptomatology, resulting in poorer mental health outcomes and greater impairment in functioning. Although all children improved over time from intake into the study to six months later, these differences were still present after six months of involvement in mental health services.
Within the group of children with parent-reported exposure to traumatic events, there was a 27% rate of PTSD (10% of the total sample of children included in the study). Compared to children with prior exposure but no PTSD diagnosis, children with PTSD were more likely to have comorbid internalizing and externalizing disorders. However, when specific diagnoses were examined separately, PTSD was more likely to be comorbid with depressive and anxiety disorders, but there were no differences in externalizing disorders, such as conduct disorder, oppositional-defiant disorder, and attention deficit disorder. In addition, the presence of PTSD was associated with even greater levels of overall symptomatology at both intake and six months later, although there were no differences in level of functioning when compared to children exposed to traumatic events without PTSD.
These findings support the conceptualization that exposure to traumatic events can have prolonged and severe consequences on children's behavior. The PTSD diagnosis appears to be a useful clinical tool, differentiating the severity of emotional and behavior problems among those children exposed to prior traumatic events. However, because the association with greater impairment in functioning and poorer mental health outcomes was not as strong for the group of children with PTSD, this study raises the issue that PTSD may not be the "defining" construct for understanding mental health problems for clinic samples of children exposed to traumatic events.
It should be noted that this study was limited because of a selection bias. Namely, by examining the effects of exposure or non-exposure to traumatic events within a clinic sample without a non-referred comparison group, it was not possible to determine whether differences in children's mental health outcomes were due to the occurrence of traumatic events or some other unmeasured phenomenon. In addition, this study was limited by the use of parent-report information only regarding children's experience with traumatic events and subsequent PTSD symptomatology. Finally, because this was a broad overview of the effects of exposure to traumatic events on children's mental health outcomes, there was no distinction made between types of events (e.g., acute or chronic, trauma or abuse), the occurrence of multiple events, or the influence of child or family characteristics. Further research needs to be conducted to investigate the influence of event, child, and family factors on PTSD and other mental health outcomes.
- Susan M. Douglas, M.S., Vanderbilt University
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