Child maltreatment and the development of posttraumatic stress disorder.

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.