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Current Findings on PTSD for children under 8: Domestic Violence as a Case Example

Difficulties in Assessment. Parental report requiredDifficulty in awareness of internalizing symptomsDefensive responding if parent involved in traumatic eventParent may also suffer from PTSD and may view child through this lens. Different Symptoms. Young children may exhibit different PTSD symptoms than older children and adults (Graham-Bermann et al., in press; Scheeringa, et al., 1995; 2003)Development of new fearsPost-traumatic playConstriction of playSeparation anxietyAggression.

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Current Findings on PTSD for children under 8: Domestic Violence as a Case Example

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    1. Current Findings on PTSD for children under 8: Domestic Violence as a Case Example Alytia A. Levendosky G. Anne Bogat Michigan State University

    2. Difficulties in Assessment Parental report required Difficulty in awareness of internalizing symptoms Defensive responding if parent involved in traumatic event Parent may also suffer from PTSD and may view child through this lens

    3. Different Symptoms Young children may exhibit different PTSD symptoms than older children and adults (Graham-Bermann et al., in press; Scheeringa, et al., 1995; 2003) Development of new fears Post-traumatic play Constriction of play Separation anxiety Aggression

    4. Differences in Neurobiological Response

    5. Domestic Violence as a Case Example: The Mother-Infant Study Longitudinal, prospective study 206 women first interviewed in their last trimester of pregnancy Women and children assessed yearly starting at the child’s 1st birthday through 7th birthday Purpose: To understand the risk and protective factors for women and children exposed to DV To examine the mechanisms involved in the intergenerational transmission of violence Other PIs: Alexander von Eye, and William Davidson Grant Support: National Institute of Justice (#8-7958-MI-IJ) Centers for Disease Control (R01/CCR518519-03-1)

    6. Research Goal related to PTSD To understand the effects of domestic violence on the mental health of the mother and child, specifically related to PTSD symptoms

    7. Demographic Characteristics of Participants Characteristic N=206 Racial/Ethnic Background Caucasian/White 132 (64.1%) African American/Black 52 (25.2%) Latina/Hispanic/Chicana 10 (4.9%) Multi-racial 8 (3.9%) Native American 2 (1.0%) Asian American/Pacific Islander 2 (1.0%) Marital Status Single, Never Married 103 (50.0%) Married 82 (39.8%) Separated/Divorced/Widowed 21 (10.2%)

    8. Demographic Characteristics of Participants Characteristic N=206 Age Mean Age in Years 25.4 (SD=5.0) Educational Level High School Graduate or Less 93 (45.1%) Some College/Associates Degree 86 (41.8%) Bachelor’s Degree/Graduate Degree 27 (13.1%) Family Income Median Monthly Income $1500 (SD=$1510) Gender of child 50% Boys

    9. Characteristics of the Violence During the first 9 years of our study, only 25% of the women report no experiences of domestic violence (DV) P 1 2 3 4 5 6 7 No DV% 41 60 55 69 63 67 63 72 DV% 59 40 45 31 37 33 37 28

    10. Measures of DV and PTSD Domestic Violence Severity of Violence Against Women Scales (Marshall, 1992) Maternal PTSD PTSD Scale for Battered Women (Saunders, 1994) Child PTSD Infant Trauma Symptom Questionnaire – ages 1 (Bogat & Levendosky, 1999) Child Trauma Symptom Questionnaire – ages 2-4 (Bogat & Levendosky, 2001) Child PTSD – ages 5 & 7 (Pynoos et al., 1998)

    11. Infant and Child Trauma Symptom Questionnaire Questions from the DC:0-3 (19XX) Sample Items: After the event happened, did your child have trouble going to sleep? After the event happened, did your child get startled or spooked easily? After the event happened, did your child play in a way that acted out something about the event? After the event happened, did your child ask lots of questions about what happened?

    12. Child PTSD From DSM-IV PTSD symptom criteria Did this problem happen at least one month after the event? When something reminds my child of what happened he/she gets very upset, scared or sad. My child has trouble concentrating or paying attention. My child has trouble feeling happiness or love.

    13. Descriptive Findings Percent of Children Exposed to DV who had any PTSD symptoms from ages 1 to 7 Age 1 2 3 4 5 7 DV 77 83 55 64 51 47 PTSD sx 19 24 22 33 13 19 Percent 25% 29% 40% 52% 25% 40%

    14. Developmental Changes in Symptoms: Ages 1 to 4 Age 1 2 3 4 Symptoms Quiet H L L L Sleep H L H L Aggressive H H H H Concentrate L L L L PT play N/A L L H Ask questions N/A L L H Talk about N/A L H H

    15. Developmental Changes in Symptoms: Ages 5 and 7 Age 5 7 Symptoms Watch danger H H Reminders upset H H Sleep H H Concentrate H H PT play L L Afraid happen H H Not talk about L H Flashbacks L L

    16. Developmental Changes in 3 Types of PTSD Symptoms from 1 to 7 Age 1 2 3 4 5 7 %Re-exp N/A 16 24 52 24 23 %Avoid 12 10 10 22 18 23 %Arousal 18 23 25 30 27 34

    17. Relationship between DV and Child PTSD symptoms Correlation between DV and Child PTSD total symptoms across ages Age 1 2 3 4 5 7 Pearson r .45* .16 .60* .54* .42* .27 For age 7, Arousal symptoms are correlated with DV.

    18. Relationship between Maternal and Child PTSD Symptoms Correlation between maternal and child PTSD total symptoms across ages Age 1 2 3 4 5 7 Pearson r .52* .24* .53* .50* .55* .11

    19. Conclusions Developmental changes Re-experiencing symptoms generally increase with child age Arousal symptoms are generally the most highly endorsed symptoms Avoidance symptoms increase at age 4 Assessment Issues Use of developmentally appropriate questions influences how frequently they are endorsed Current DC:0-3R revises DSM-IV criteria and number of symptoms required to meet diagnosis

    20. Conclusions Domestic Violence Children are affected by witnessing mother’s abuse and may increase with age across early childhood Relational PTSD (Scheeringa & Zeanah, 2001) appears relevant for young children, perhaps due to close physical proximity of mother and child during these years

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