Suchergebnisse

Complex post-traumatic stress disorder (CPTSD) is a new diagnosis which has been developed for the forthcoming International Classification of Diseases 11th Revision criteria. This is in recognition of the impact of repeated, interpersonal trauma and an emerging evidence base supporting a distinction between PTSD and CPTSD, with its disturbances in self-organization in addition to the core features of reexperiencing, avoidance, and hypervigilance. The new diagnosis is discussed in the context of assessing children who have experienced maltreatment, many of whom will have affect dysregulation, interpersonal difficulties, and negative thoughts about themselves. However, not all maltreated children will have the core features of PTSD, and they may be affected in various other ways, which are discussed in the experience of a specialist clinic taking referrals for children who have been abused or neglected. The assessments recognize that maltreated children are typically exposed to multiple genetic and environmental risk factors. Traumatic symptoms are seen an adaptation to chronic threat, and close attention is also paid to systemic factors such as family relationships. Young children with PTSD will require developmentally sensitive assessment. Maltreated children are at high risk of mental health and neurodevelopmental problems but may present with symptoms in various domains which cumulatively are very impairing without always meeting diagnostic thresholds. Children may frequently be referred with possible autistic traits or symptoms of attention-deficit hyperactivity disorder, which need to be assessed in the light of their traumatic backgrounds. Assessing the role attachment in the development of children who have been abused or neglected is also considered.

Childhood adversity can include traumatic experiences and exposure to other risk factors; consistently predicting poorer psychosocial outcomes in adulthood. Relatively little research has investigated the impact of cumulative risk exposure in childhood. Using data collected in a specialist clinical setting, we investigated the associations between risk exposure, psychopathology and psychosocial functioning. Participants were children attending the Attachment and Trauma service at Great Ormond Street Hospital in London ( N = 132, M = 10.25, SD = 3.35). Data was collected via routine clinical practice during multi-disciplinary assessments. Data was collected on developmental and trauma history, psychopathology, and functioning (CGAS), using standardised measures, clinical interviews, and observations. All children had experienced at least one risk factor, with 78% reporting multiple exposures, including witnessing interpersonal violence (52%), neglect (48%), and physical abuse (42%). Other risk exposures included exposure to alcohol (17%) and substances (24%) in-utero, as well as social risk factors such as multiple foster placements in some cases. In this sample, 65% of children met criteria for at least one psychiatric diagnosis (Anxiety = 31%, PTSD = 28%, Depression = 8%). High levels of functional impairment were found, with 52% of children falling into the highest categories of 'obvious' or 'severe' problems. Multiple risk exposure significantly predicted PTSD (OR 9.64 (1.1, 83.7)), but did not predict anxiety, depression, or functional impairment. This study highlights the rates of cumulative risk exposure in this clinical sample. The findings demonstrate the importance of detailed and accurate clinical assessments in ascertaining trauma histories in children with known histories of adversity and maltreatment. There are implications for assessment and treatment, such as the importance of clear guidelines on treating PTSD in children with complex trauma histories.