Sexually Abused Children At High Risk of Developing Post Traumatic Stress Disorder

BUFFALO, N.Y. -- Children who have been sexually abused are at high risk of developing post traumatic stress disorder (PTSD) and should be screened routinely for the disorder, even when they show no outward signs of psychological trauma, a University at Buffalo child and adolescent psychiatrist has shown.

Susan V. McLeer, M.D., professor and chair of the UB Department of Psychiatry, found that more than one-third of a group of 80 sexually-abused children who weren't referred for psychiatric evaluation by the investigating agency were suffering with the disorder.

Results of the study appear in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"These kids suffer in silence," McLeer said. "They don't get referred for treatment after experiencing sexual abuse because they aren't viewed as having a need. Their behavior isn't out of control and they aren't suicidal.

"This study shows, however, that they are at very high risk for PTSD. We believe there should be a system for screening all sexually abused children for PTSD and that those diagnosed should receive treatment specifically targeted to the disorder."

PTSD is a specific form of anxiety that comes on after a stressful or frightening event. Some of the children in the McLeer study diagnosed with PTSD also had separation anxiety and major depression. In addition, a majority of the full group was experiencing various symptoms of PTSD, although the symptoms didn't meet the criteria of the full-fledged disorder.

PTSD is especially harmful for children, McLeer said, because it may cause them to miss growth-promoting experiences that are crucial for transition into healthy adulthood.

Avoidance, one of the three major categories of PTSD symptoms, is particularly problematic, she noted.

"Children with PTSD may shrink from people and things that aren't dangerous and are often critical for their social and cognitive development. These youngsters experience a triple whammy: the initial sexual abuse, the direct effects of the PTSD symptoms themselves, and then the avoidance behavior that may result in lost experiences important for success throughout life."

To arrive at their results, McLeer, along with colleagues at the Medical College of Pennsylvania, compared psychological profiles of 80 sexually abused children between the ages of 6 and 16 with 77 non-abused children being seen in psychiatric outpatient clinics for other symptoms, and 73 school children with no history of sexual abuse or psychiatric problems.

Theirs is one of the first studies to investigate the effects of sexual abuse on children who weren't preselected based on the need for clinical services, McLeer said. The sexually abused children were referred to the researchers by the Philadelphia Department of Health, based on three criteria: the abuse was substantiated by authorities; it had ended within the past 30-60 days and the perpetrator was at least five years older than the child.

All children in the study completed several standardized tests to identify PTSD symptoms. Results showed that 29 of the sexually abused children were diagnosed with the disorder, and within this subgroup, several also exhibited separation anxiety and/or major depression.

Only one child in the psychiatric group was diagnosed with PTSD, while none of the school children met the full criteria, although some showed subthreshold symptoms of the disorder.

A breakout of individual PTSD symptoms showed that in the full group of sexually abused children, 65 percent reported re-experiencing the trauma, 44 percent had three or more episodes of avoiding non-threatening situations they associated with the abuse and 57 percent suffered hyperarousal of the nervous system, including easy startling, hypervigilance and trouble sleeping.

These results were markedly different from those found in either of the two comparison groups, McLeer noted. In the psychiatric referral group, 2.6 percent reported re-experiencing trauma, 9.1 percent reported avoidance behavior and 13 percent had symptoms of hyperarousal. In the school group, 1 percent reported re-experiencing earlier trauma, while 8 percent reported avoidance behavior and the same percentage reported hyperarousal symptoms.

While sexually abused children are at very high risk of developing PTSD, standard psychiatric approaches used with children, primarily talk therapy and play therapy, are not effective with PTSD, McLeer said.

"These children need to be identified early and they need very special targeted treatment, such as cognitive behavior therapy," she stated. "Very few studies have been undertaken on the effectiveness of cognitive treatment with children, but the results with adults are very positive. We need to do these treatment studies with children with PTSD."

Additional researchers on the study were J. Faye Dixon, Ph.D., of Allegheny University of the Health Sciences; Delmina Henry, Ph.D., of the Devereux Foundation; Karen Escovitz, Teresa Niedda and Rita Scholle, research assistants at the Medical College of Pennsylvania, and Kenneth Ruggiero, a graduate student at West Virginia University.

The study was funded by the National Center for Child Abuse and Neglect.