Childhood physical and sexual abuse has long been recognized as detrimental to the development of those subjected to it. This paper will outline some of the damaging effects of maltreatment on learning and cognitive processing, the difficulties of assessing risk in children who have been maltreated, and summarize the theoretical basis for the present study. A great deal of research has focused on re-victimization, the likelihood of victims to become abusers and the long-term negative psychological and physical effects that abuse has on people (Sunday, Kline, Labruna, Pelcovitz, Salzinger, & Kaplan, 2011; Easton, Coohey, O’Leary, Zhang, & Hua, 2010; Garrido, Culhane, Petrenko, & Taussig, 2011; Loeb, Gaines, Wyatt, Zhang, & Liu, 2010). Child abuse may lead to internalizing behaviors and externalizing behaviors (Buckner, Bearslee and Bassuk, 2004; Feiring, Simon & Cleland, 2007; Moylan, Herrenkohl, Sousa, Tajima, Herrenkohl, & Russo, 2010). Internalizing behaviors include emotional issues such as posttraumatic stress disorder, anxiety and depression. Externalizing behaviors include actions such as aggression and delinquent behaviors. All of these internal and external conflicts can severely damage a child’s ability to navigate a variety of social contexts which may in turn decrease their likelihood of thriving within an academic environment. Previous research has found that children who are maltreated tend to have overall lower levels of intelligence, higher instances of learning disabilities, and academic difficulties and it has also been suggested that children who are abused struggle more with working memory, problem solving and creativity (Pandey, 2013). In contrast to the damaging effects of maltreatment, it is a primary goal within trauma psychology to identify not only risks, but also potential contributors of resilience within this population. Resilience can be defined as the ability to cope and find meaning in such stressful life events in which people must respond with healthy intelligent reasoning and supportive social functioning (Reich, 2010). Personal intelligence is a form of intelligence that umbrellas such forms of intelligence such as emotional and social intelligence. Sometimes termed as the “hot” intelligences, personal intelligence involves analytical thinking and abstract reasoning in contrast to verbal intelligence which perceptual and organizational. Personal intelligence is suggested to be a key component in resilience as it enables an individual to understand personal emotions and experiences in addition to other models of the self and others (Reich, 2010). Research in Japan found that children who had been maltreated had higher scores on a picture completion task which was thought to be related to hyperarousal symptoms resulting from PTSD. Picture completion tasks are commonly linked to higher order problem solving capacity (Ogata, 2011). In secondary analysis, the above research found that group differences existed in picture completion tasks with children who were sexually abused scoring significantly higher than children who were physically abused or not maltreated (Ogata, 2012). Additionally, in a study of typically developing school aged boys, it was found that positive coping mediated the relationship between emotional intelligence and academic achievement (MacCann, Fogarty, Zeidner & Roberts, 2006). This link suggests that as problem solving has been tied to greater emotional intelligence, children exposed to maltreatment with higher abstract processing may be able to develop more effective coping strategies thus increasing the likelihood of resilient outcomes.
While research has identified individual differences within children who have been maltreated, the field still struggles within every domain of assessing risk in this population. Psychological assessment can be described as “a process of testing that uses a combination of techniques to help arrive at some hypothesis about a person and their behavior, personality and capabilities (Framingham, 2011).” Thus the goal of psychological assessment is to create a comprehensive picture of the individual being assessed. Unfortunately in the case of children who have been exposed to varying degrees of trauma this task is not as clear cut and defined. Children have limited verbal capabilities and have little insight into their thoughts and feelings that can be communicated to clinicians (Arata ,Langhinrichsen-Rholing, Bowers & O’Brien, 2007). As a result of these challenges, the DSM-V has made an effort to develop an empirically based algorithm to better represent the manifestations of underlying criterion within younger age groups (Scheeringa, Zeanah & Cohen, 2010). In a study looking at children who had been exposed to severe trauma and have experienced consecutive clinical admissions, the frequency of PTSD diagnosis only ranged from 13-20% in comparison to adults at the same clinic that showed significantly higher frequencies of 32-59% (Scheeringa et al., 2010). In a community sample they found that older children had a PTSD frequency of 0-12.7% but children in the 2-5 year old range had a prevalence of only .1% (Scheeringa et al., 2010). These findings suggest that the diagnostic criterion for the DSM-IV-TR may be sufficient to identify trauma symptomology in older children but may not be sensitive enough to identify PTSD in young children. There is the potential explanation that young children still have protective factors such as cognitive and perceptual immaturity, however, the likelier reason is that the measures themselves are not developmentally acute enough for adequate detection.
According to a report by the Agency for Healthcare Research and Quality (AHRQ), children with PTSD may experience a number of symptoms outside of the symptom cluster criteria set by the DSM-IV or may have different manifestations of the symptoms described. For example children with PTSD may show signs of frequent memories or reliving the event through reenacting the event during play. Children are also more apt to have upsetting and frightening dreams or develop repeated physical and emotional symptoms when reminded of the event. Symptoms may include loss of interest in activities previously enjoyed, headaches, stomachaches, excessive worry, sleep or concentration problems, as well as other physical manifestations (Effective Healthcare Program, 2012).
Another challenge associated with the specificity of pediatric PTSD diagnosis is the overlap between the criterion for PTSD and other childhood internalizing disorders. Four symptoms of PTSD including decreased interest in activities, sleep disturbances, restricted range of affect and decreased concentration all overlap with the criteria for major depressive disorder (MDD) (Cohen & Scheeringa, 2009). In addition the symptoms of decreased concentration, irritability and sleep disturbances overlap with the symptoms of generalized anxiety disorder (GAD) (Cohen & Scheeringa, 2009). In total there are only 8 of the total 17 symptoms listed for PTSD that are unique to PTSD and as a result it is virtually impossible to be diagnosed with PTSD without the specific to traumatic incident re-experiencing symptoms under criteria B of the DSM-IV-TR. Unfortunately Criteria B of the DSM-IV-TR does not have child specific suggestions for potential behaviors that could be representative of re-experiencing a traumatic event (e.g., reenacting through play, pervasive memories that cannot be communicated as a result of limited vocabulary, etc.).
PTSD in children generally takes on a number of characteristics that are not necessarily seen in adults. One particular trait is “omen formation.” Omen formation is the belief that warning signs were there and the children come to believe that if they are observant and alert enough, they will be able to recognize these warning signs in the future and prevent future events from occurring (National Center for PTSD, 2012). This time of thought process is what can lead to life-long patterns of hypervigilence. School-aged children tend to exhibit post-traumatic play in which they reenact the event verbally, socially or in writing. Adolescents on the other hand experience PTSD similarly to adults and have a tendency to engage in reenactment by incorporating it into their daily life. An example would be carrying a weapon with them in reaction to witnessing a school shooting (National Center for PTSD, 2012).