Richard Famularo

Psychiatric Diagnoses of Maltreated Children: Preliminary Findings

The study sample consists of 96 children (61 maltreated, 35 controls) between 5 and 10 years of age. The two groups of subjects were compared on diagnoses as determined by the administration of the Diagnostic Interview for Children and Adolescents, Revised 6th Version (DICA-6-R) as well as clinical DSM-III-R diagnoses. Children who had suffered maltreatment exhibited significantly greater incidences of attention deficit hyperactivity disorder, oppositional disorder and post-traumatic stress disorder diagnoses than did controls, on both child and parent DICA interviews. The childrens interviews revealed that maltreated children present with a significant incidence of psychotic symptomatology as well as personality and adjustment disorders. Conversely, conduct and mood disorders emerged as significant factors in the parent interviews, with the maltreated group showing significantly greater incidence of these diagnoses.

Psychiatric Comorbidity in Childhood Post Traumatic Stress Disorder.

OBJECTIVE The purpose of this study was to examine the psychiatric comorbidity between children presenting with Post Traumatic Stress Disorder (PTSD) and traumatized children not developing this disorder. DESIGN One-hundred and seventeen severely maltreated children were examined for evidence of PTSD. Analyses probed for diagnostic relationship, between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised Version (DICA-CR). PARTICIPANTS All children presented before a juvenile/family court due to severe child maltreatment and psychological trauma. These children had been ordered removed from parental custody due to the trauma suffered by the child. For the purposes of analyses, this entire group of maltreated and traumatized children were dichotomized into a PTSD group and a non-PTSD group. Thirty-five percent (41 of 117) of the children met strict DICA criteria for PTSD. MEASUREMENTS The children were examined by means of a structured clinical interview. The Diagnostic Interview for Children and Adolescents, revised version (DICA-Child-R), along with a more general psychiatric interview. The DICA-Child-R responses provided the only determination of whether the children met formal PTSD criteria. Data gathering on the sample also included a comprehensive review of risk factors for the development of PTSD, including demographics, and type(s) of trauma suffered. RESULTS Findings revealed that the PTSD diagnosis was significantly correlated with: 1. Attention Deficit Hyperactivity Disorder (ADHD) 2. Other anxiety disorders 3. Brief Psychotic Disorder or Psychotic Disorder NOS 4. The presence of suicidal ideation 5. A trend toward mood disorders. There were no differences between the two samples on measures of age, race, and family income. CONCLUSIONS Pediatric PTSD is a severe psychiatric disorder. In this study, PTSD was statistically related to other formal psychiatric diagnoses. The investigators attended to the issues relating to true comorbidity versus inaccurate diagnosis secondary to symptom overlap between different conditions. Applying strict criteria, the results suggest that the presence of PTSD in children confers a substantial likelihood of other formal diagnosis. Moreover, the symptom of suicidal ideation was overrepresented among PTSD subjects. Given these additional conditions, more extensive evaluation and specialized, multi-modal treatment should be considered in children presenting with PTSD.

Maternal and child posttraumatic stress disorder in cases of child maltreatment

The purpose of this study was to examine the rates of posttraumatic stress disorder (PTSD) among a sample of severely maltreated children and their mothers, and to investigate the age of onset of documented maltreatment in these children. The sample consisted of 109 pairs of women and their children who were before a juvenile/family court due to maltreatment of sufficient severity to warrant removal of the child from parental custody. Children were examined using the PTSD Section of the Diagnostic Interview for Children and Adolescents, Revised 6th Version (DICA-6-R). The PTSD Module of the Structured Clinical Interview for DSM-III-R (SCID) was administered to all mothers. Clinical psychiatric interviews were also administered to all children and mothers. From the sample of 109 cases, 15.6% of the mothers met SCID criteria for a current presentation of PTSD, while 36.7% had a past history of PTSD. Of the 109 evaluated children, 35.8% met current DICA criteria for PTSD. Posttraumatic stress disorder is significantly overrepresented in the children of mothers diagnosed with PTSD (p = .001). The average age of maltreatment onset was 46.4 months among the children diagnosed as PTSD, and was 61.3 months in the group of seriously maltreated children who did not develop PTSD (p = .038). The onset of maltreatment is significantly earlier among children whose mothers meet PTSD criteria than among other maltreated children (p = .025). Intergenerational transmission of violence and developmental effects of traumatic experiences upon the young child are discussed.

Psychiatric diagnoses of abusive mothers. A preliminary report

The Structured Clinical Interview for DSM-III-R diagnoses of 54 mothers who had maltreated their children were compared with those of 37 controls. The maltreatment group showed a significantly greater incidence of both current and past diagnoses. Maltreating mothers exhibited a significantly greater incidence of current mood disorder, alcohol abuse, and personality disorder than did controls. The results indicate that past abuse of cocaine, alcohol, other substances and past mood disorders were significantly more prevalent among the maltreatment sample than among controls. Mothers who had maltreated their children were significantly more likely to have histories of posttraumatic stress disorder than were controls.

Posttraumatic stress disorder among children clinically diagnosed as borderline personality disorder.

Using the Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R), the authors evaluated 19 children ages 7 to 14 who had recently been clinically diagnosed as borderline personality disorder by DSM-III-R criteria. The results reveal that 78.9% of these children reported significant traumatic experiences, with 36.8% fitting DICA-C-R criteria for posttraumatic stress disorder. These findings raise the possibility that a diagnosis of borderline personality in childhood can often represent posttraumatic stress disorder.