Potentially traumatic events in foster youth, and association with DSM-5 trauma- and stressor related symptoms

Stine Lehmann,Kyrre Breivik,Sebastien Monette,Helen Minnis

doi:10.1016/j.chiabu.2020.104374

Abstract

BackgroundIn DSM 5, three disorders are related to trauma and/or maltreatment: Post-traumatic Stress Disorder (PTSD), Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) but how these disorders relate to each other and to traumatic events is unknown. ObjectiveWe examined 1. Prevalence of Potentially Traumatic Events (PTEs) and poly-victimization for youths in foster care. 2. Associations between single/multiple PTEs and PTSD, DSED, and the two symptom-clusters that constitute RAD: Failure to seek/accept comfort (RAD A), and Low social-emotional responsiveness/ emotion dysregulation (RAD B). Participants, setting and methodsFoster youth 11–17 years (N = 303) in Norway completed The Child and Adolescent Trauma Screen. Foster parents completed the RAD and DSED Assessment interview. ResultsFoster youth reported experiencing, on average, 3.44 PTEs each (range 0–15, SD 3.33), and 52.9 % reported PTSD symptoms at or above clinical cut off. The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD cluster B symptoms (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD cluster A symptoms (Failure to seek/accept comfort). ConclusionsThese findings raise new questions about the nature, mechanisms and timing of development of RAD and DSED. Maltreatment assessment needs to encompass a wide range of PTEs, and consider poly-victimization.

Highlights

Across countries, exposure to childhood adversities is reported by nearly a third of adults (Kessler et al, 2010) and the world-wide prevalence of childhood emotional abuse is estimated to be 36 % (Stoltenborgh, Bakermans-Kranenburg, Alink, & van Ijzendoorn, 2012)
In this study, we examine the following questions: 1) What is the prevalence of Potentially Traumatic Events (PTEs) and what is the extent of poly-victimization in a sample of young people in foster care in Norway? 2) Are there differential associations between PTEs that are related to parental abuse and neglect on the one hand, and those unrelated to parenting on the other, with symptoms of PTSED and Reactive Attachment Disorder (RAD)/Disinhibited Social Engagement Disorder (DSED) respectively? 3) Is there a dose-response relation between increased numbers of PTEs and symptom load of Posttraumatic Stress Disorder (PTSD), DSED and RAD?
The PTE sum score was associated with the latent factors PTSD (r = .66, p < 0.001), RAD B (Low social-emotional responsiveness / emotion dysregulation, r = .28, p < 0.001) and DSED (r = .11, p = 0.046), but not with RAD: Failure to seek/accept comfort (RAD A) (Failure to seek/accept comfort)

Summary

Introduction

Exposure to childhood adversities is reported by nearly a third of adults (Kessler et al, 2010) and the world-wide prevalence of childhood emotional abuse is estimated to be 36 % (Stoltenborgh, Bakermans-Kranenburg, Alink, & van Ijzendoorn, 2012). Child maltreatment may be divided into four main categories: physical abuse, sexual abuse, neglect and emotional abuse (Cicchetti & Toth, 2005), and constitutes a substantial risk factor for mental health problems across lifespan (Kessler et al, 2010). Exposure to childhood adversity, including abuse and neglect, has been estimated to account for 45% of mental disorders in childhood, is thought to be the single greatest predictor of mental health problems in children (Green et al, 2010). Children and young people placed in foster care are a vulnerable group who have usually experienced abuse and neglect and have a high prevalence of mental disorders (Ford, Vostanis, Meltzer, & Goodman, 2007; Garland et al, 2001; Lehmann, Havik, Havik, & Heiervang, 2013).

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Conclusion