Sandra Kaplan

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES)

Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.

Identification of PTSD in Cancer Survivors

The authors measured the rate and determinants of posttraumatic stress disorder (PTSD) in a group of cancer survivors. Patients who had a history of cancer diagnosis with at least 3 years since diagnosis, receiving no active treatment, such as chemotherapy or radiation, were interviewed (N = 27). Patients, who were part of the DSM-IV PTSD field trial, were compared with a community-based control group matched for age and socioeconomic status. One member of the survivor group (4%) and no members of the control group met criteria for current PTSD (NS). Six of the survivors (22%) and no control subjects met lifetime criteria (P < 0.02). Cancer patients have a higher rate of PTSD than found in the community. Symptoms closely resemble those of individuals who have experienced other traumatic events.

Post-Traumatic Stress Disorder in Physically Abused Adolescents

OBJECTIVE In an investigation of the prevalence of post-traumatic stress disorder (PTSD), other Axis I psychiatric disorders, and social and behavioral difficulties, 27 physically abused adolescents were compared with 27 nonabused controls who were recruited through random-digit dialing procedures. METHOD The Structured Clinical Interview for Diagnosis (PTSD module), Kiddie-Schedule for Affective Disorders and Schizophrenia, and Youth Self-Report were administered to all subjects; mothers were interviewed regarding their adolescents behavior using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children and Child Behavior Checklist. RESULTS The three physically abused adolescents who received a diagnosis of PTSD on the PTSD module of the Structured Clinical Interview for Diagnosis reported their PTSD symptoms were in reaction to extrafamilial sexual assaults and not to physical abuse. In contrast, the abused adolescents showed significantly higher prevalence rates of depression, conduct disorder, internalizing and externalizing behavior problems, and social deficits. CONCLUSIONS Findings suggest that physically abused adolescents may be more at risk for behavioral and social difficulties than for PTSD.

Posttraumatic stress disorder and family functioning in adolescent cancer

Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD save their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.

Parent and teacher assessment of children's behavior in child maltreating families

This study is an assessment of the amount of intellectual and behavioral dysfunction found in children from families in which child maltreatment has occurred. It reports differences in the information obtained from parents and teachers. The clinical implications of the results suggest the incorporation of parent training in developmental issues in programs which treat maltreating families and the use of teachers for more accurately assessing all the children in these families.

Psychopathology of Parents of Abused and Neglected Children and Adolescents

Seventy-six parents of abused and neglected children who were referred for psychiatric treatment to a child abuse and neglect treatment program in a general medical hospital were compared to 38 control parents of nonmaltreated pediatric outpatients of the same hospital in terms of the presence of diagnosed psychopathology. The psychiatric assessment was made using a standard semistructured instrument, the SADS-L, and was based on Research Diagnostic Criteria. Abusive and neglectful parents were more frequently given psychiatric diagnoses than were control parents, and perpetrators of abuse were given diagnoses different from their nonabusing spouses.

Adolescent Physical Abuse and Risk for Suicidal Behaviors

The present study assessed the contribution of physical abuse to increased risk for suicidal behaviors in physically abused adolescents compared with nonabused adolescents. Suicidal thoughts and behaviors were assessed using the Suicide Probability Scale. Physically abused adolescents had higher mean scores on the Hopelessness, Negative Self-Evaluation, Hostility, and Suicide Ideation subscales. Significant predictors of subscale and overall scores included parent and adolescent psychopathology, poor academic performance, and decreased family cohesiveness. Physical abuse was a significant predictor of negative self-evaluation scores. It was concluded that physically abused adolescents experienced a combination of risk factors related to increased suicidal thoughts, attitudes, and behaviors. Furthermore, a model proposing an indirect relationship between physical abuse and suicide risk was described.

Interactional effects of marital status and physical abuse on adolescent psychopathology

OBJECTIVE The purpose of this study was to explore the interactional effects of parental marital disruption and physical abuse on risk for adolescent psychopathology in a nonclinical sample with a randomly selected control group. METHOD The sample was drawn from 99 community-based adolescents indicated as physically abused by Child Protective Services and 99 randomly selected controls. Nonabused adolescents whose parents were married, abused adolescents whose parents were married, nonabused adolescents with a parental marital disruption, and abused adolescents with a parental marital disruption were compared. Outcome was psychopathology as measured by psychiatric diagnosis based on a best-estimate procedure subsequent to semistructured diagnostic interviewing. RESULTS Interactional effects of marital disruption and abuse were found for risk for lifetime Attention Deficit Hyperactivity Disorder (ADHD), with parental marital disruption and having been physically abused combining to increase the risk 15 times for diagnosis of lifetime ADHD. Parental marital status alone was not a significant risk factor for adolescent psychopathology, but physical abuse was a significant risk factor for several diagnostic categories. CONCLUSIONS Future divorce research should include abuse history as a possible confounding variable. Possible reasons for the findings are reviewed and clinical implications are discussed.

The failure of a school-based child sexual abuse prevention program.

Structured interviews were administered to 22 children, ranging in age from 6 to 10 years old, who did not disclose long-term sexual abuse by an auxiliary school employee, despite having been exposed to a school-based child sexual abuse prevention program. The results are presented in the context of a review of existing literature on school-based child sexual abuse prevention programs. Results point to the ineffectiveness of brief, single presentation, prevention efforts not geared to specific developmental levels of the audience, the need to explore the impact of the variable of group versus individual victimization on disclosure, and the need for further study of sexually victimized children who received prevention programming with the addition of a control group sample.

An Examination of Bias in Volunteer Subject Selection: Findings from an In-Depth Child Abuse Study

Remarkably few reported studies tested the assumption that a research sample can be constructed which is representative of the population of interest. In order to investigate potential volunteer bias in abuse research, we utilized a database assembled for an NIMH funded study investigating the relationship among adolescent physical abuse, suicidal behavior, and psychopathology. Extensive information was available concerning the nonparticipant pool from which this sample was assembled, allowing for a comprehensive assessment of possible sample bias. The volunteer sample of 99 abused families who agreed to participate in our study was compared on a large number of variables with a random sample of 99 abused families who declined to participate. Comparisons of the two groups did not support the hypothesis that the non-participating families represented a more dysfunctional population. The two groups were far more similar to, than disparate from, each other.