Margaret T. McHugh

An analysis of the internalizing and externalizing behaviors of traumatized urban youth with and without PTSD

To test the differential validity of the posttraumatic stress disorder (PTSD) classification, 3 groups of youths (PTSD, traumatized PTSD negatives, and controls) were examined. Youth with major comorbid disorders were excluded. On the basis of an analysis of parent-derived Child Behavior Checklist (CBCL) ratings, significant variations in CBCL scores were associated with PTSD but not with exposure to exceptional stress in the absence of PTSD. The results also indicated that traumatic exposure without the development of PTSD was not associated with higher estimates of psychopathology.

The Validity of the Children's PTSD Inventory

The Childrens PTSD Inventory (CPTSDI) was administered to 76 traumatized and 28 nontraumatized youths. CPTSDI diagnoses were compared to DICA-R and SCID PTSD diagnoses. Moderate to high sensitivity, specificity, positive and negative predictive power, and diagnostic efficiency were evidenced across criterion measures. Convergent validity was evidenced by significant correlations with the Revised Childrens Manifest Anxiety Scale, Childrens Depression Inventory, Child Behavior Checklist (CBCL) Internalizing scale, and the Junior Eysenck Personality Inventory (JEPI) Neuroticism scale. Discriminant validity was observed through nonsignificant correlations with the CBCL Externalizing and the JEPI Extraversion scales.

Interdisciplinary training in the evaluation of child sexual abuse

To increase their knowledge of the medical evaluation and reporting of child sexual abuse, medical students, pediatric resident physicians, fellows and attendings participated in an interdisciplinary team-based training program consisting of didactic lectures, case discussions, videotapes and direct participation in patient evaluation. Content focused on the medical knowledge and skills needed for an assessment of the childs interview, anogenital examination and the indications for case reporting to child protection authorities. We evaluated the results of this training in our outpatient child abuse clinic located in a university-affiliated, municipal hospital using a survey which assesses knowledge of female genital anatomy, sexually-acquired diseases and case reporting in a nonrandomized control trial. Fifteen medical students and pediatric physicians participated and were compared to a reference group of 127 participants who did not receive this training and 15 others who randomly repeated the survey instrument during the study period. The results showed that resident physicians demonstrated increased mean total scores in the survey instrument. We conclude that an interdisciplinary team using patient care exposure increases physician knowledge in the evaluation of child sexual abuse.

Child Abuse and Neglect

Results.—A total of 5468 children were included. High-quality family centeredness was associated with a 27% (95% confidence interval [95% CI] 11%–40%) lower nonurgent ED visit rate, but no lowering of the urgent visit rate. High-quality timeliness was associated with 18% (95% CI, 3%–31%) lower nonurgent and 18% (95% CI, 1%–33%) lower urgent visit rates. High-quality realized access was associated with a 27% (95% CI, 8%–43%) lower nonurgent visit rate and a 33% (95% CI, 14%–48%) lower urgent visit rate. Conclusions.—Parent-reported high-quality timeliness, family centeredness, and realized access for a publicly insured child are associated with lower nonurgent ED, with high-quality timeliness and realized access associated with lower urgent ED utilization.