Susan V. McLeer

Post-Traumatic Stress Disorder in Sexually Abused Children

Abstract Thirty-one sexually abused children were studied using structured interviews and standardized instruments to determine the frequency of post-traumatic stress disorder (PTSD) and associated symptoms. Of these sexually abused children, 48.4% met DSM-III-R PTSD criteria; 75% of children abused by natural fathers, 67% abused by strangers, and 25% of those abused by trusted adults met criteria as opposed to none of the children abused by an older child. Many children not meeting full DSM-III-R criteria exhibited partial PTSD symptoms. No relationship was observed between the time lapsed since last abusive episode and the development of PTSD. Three standardized instruments (CDI, SEI, and STAIC), although useful in identifying non-PTSD related symptoms, were not useful in differentiating PTSD. The CBCL detected group differences, with PTSD children exhibiting significantly more symptoms of externalizing and internalizing behaviors.

Post-traumatic stress in sexually abused, physically abused, and nonabused children

This investigation compared the rates of post-traumatic stress disorder symptoms across sexually abused, physically abused, and nonabused psychiatrically hospitalized children matched for age, sex, and socioeconomic status. Among the sexually abused children, 20.7% met diagnostic criteria for post-traumatic stress disorder compared with 6.9% of the physically abused and 10.3% of the nonabused children. Although these overall rates were not significantly different across groups, they were significantly high to reinforce the need for further study of post-traumatic stress in childhood. Further, significant symptom rate differences across groups were found with respect to specific post-traumatic stress symptoms. Specifically, sexually abused children exhibited significantly higher rates of inappropriate sexual behaviors than either the physically abused or nonabused children. In addition, both the sexually abused and physically abused groups showed a tendency to exhibit more avoidant/dissociative symptoms as compared to the nonabused children. Results are discussed in terms of their clinical and research implications.

Education is not enough: A systems failure in protecting battered women

A retrospective study of female trauma patients presenting in an emergency department during 1976 and 1977 demonstrated that the introduction of a protocol designed to detect injuries caused by battering increased the identification of battered women from 5.6% of female trauma patients to 30%. An eight-year follow-up study in the same ED demonstrated that only 7.7% of female trauma patients were diagnosed as having injuries secondary to battering. This study suggests that without institutional policies and procedures for detecting and treating victims of domestic violence, many abused women will pass through EDs unidentified and, hence, untreated.

Psychiatric Disorders in Sexually Abused Children

OBJECTIVE This study was designed to compare the prevalence of psychiatric disorders in a clinical sample of sexually abused children referred for outpatient evaluation. Two a priori hypotheses were tested: (1) the sexually abused group would have more post-traumatic stress disorder than the non-sexually abused group and (2) non-sexually abused children referred for evaluation would have more diagnoses than the sexually abused group. METHODS Twenty-six sexually abused children and 23 non-sexually abused children referred for psychiatric outpatient evaluation at a medical school center were matched by age, sex, race, and socioeconomic status and compared to determine differences in prevalence of Axis I, DSM-III-R disorders. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version was used for systematic diagnosis. RESULTS Groups did not differ significantly in the number of diagnoses and, in both groups, attention-deficit hyperactivity disorder was the most frequent diagnosis. However, the prevalence of post-traumatic stress disorder among sexually abused children was significantly greater (p < .02), with 42.3% of sexually abused children and 8.7% of non-sexually abused children meeting full criteria. There were no significant differences between groups in other diagnostic categories. CONCLUSIONS This study, using structured interviews and comparison groups, confirmed earlier findings suggesting that sexually abused children are at heightened risk for the development of post-traumatic stress disorder.

Cognitive-behavioral treatment of conduct-disordered children

The present study compared the effects of a cognitive-behavioral therapy with those of a supportive/psychodynamic therapy in a psychiatric dayhospital for the treatment of conduct-disordered youth (mean age 10 years 8 months). Subjects were diagnosed conduct-disordered and randomly assigned to one of two orders of the two individual treatment conditions in a crossover design. Dependent measures included indices of psychopathology as well as measures of prosocial behavior and were gathered from multiple sources. The cognitive-behavioral treatment led to significant improvements on teachers blind ratings of classroom behavior (e.g., Self-Control Rating Scale) indicating a reduction in impulsivity, as well as on measures inidcating increases in appropriate behavior and adaptive functioning (e.g., Child Behavior Checklist). Both treatments produced some significant gains (teacher ratings of externalizing problems using the Child Behavior Checklist, and hyperactivity using the Conners Teacher Questionnaire), and some dependent measures did not evidence therapeutic change. Some of the cognitive-behavioral programs positive effects were more pronounced after its second administration. Normative comparisons, used to attempt to address clinical significance, were conducted and reported. The implications of the findings and the need for future research are discussed.

The role of the emergency physician in the prevention of domestic violence

In the United States, every 7.4 seconds a woman is battered by her husband. Of women who present to emergency departments with traumatic injuries, 16% to 30% report that their injuries were secondary to domestic violence. Not infrequently, battered womens medical and surgical problems are treated by ED staff and the women are released without any intervention directed toward the prevention of future battering and/or injury. Protocols are presented that require only minimal reorganization of staffing in EDs to provide essential services directed toward battered womens most serious health problem, chronic victimization.