Assessment of mental health problems in children following early maltreatment: What will the new diagnosis of complex PTSD add?

Abstract

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.