Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma

Breslau, Peterson, and Shultz (2008) reported that prior trauma alone, in the absence of PTSD, did not predict an increased PTSD risk, relative to no prior trauma. Only prior trauma that resulted in PTSD predicted an increased PTSD risk following a subsequent trauma. Recently, Cougle, Resnick, and Kilpatrick (2009) proposed that the effect of prior trauma might vary by type of prior trauma, a possibility not considered in Breslau et al. They report that childhood sexual or physical assault, in the absence of PTSD, increased the PTSD risk following a subsequent trauma. This report examines the PTSD effects of prior assaultive violence, using data from Breslau et al. (1998). The study assessed PTSD in relation to up to three events. Analysis was performed on the subset with PTSD assessment for two distinct events, the earliest trauma and a subsequent trauma (n = 967), using as reference persons with no prior trauma (n = 972). Neither prior assaultive violence nor other prior traumas, in the absence of PTSD, influenced the subsequent risk of PTSD. In contrast, prior PTSD increased considerably the PTSD risk of a subsequent trauma. The limitations in Cougle et al. (2009) and in this study and future research directions are discussed.     

Psychiatric sequelae of low birth weight at 6 years of age

The study examined the association between low birth weight (LBW) (2,500 g) and attention deficit hyperactivity disorder (ADHD) in two socioeconomically disparate populations. LBW and normal birth weight (NBW) children from the 1983 to 1985 newborn lists of an urban and a suburban hospital in Southeast Michigan were randomly selected. A total of 823 children, 473 LBW and 350 NBW, participated. Data were gathered in 1990 to 1992, when the children were 6 to 7 years of age. The National Institute of Mental Health Diagnostic Interview Schedule for children—Parent version (DISC-P) was used to elicit information on DSM-III-R diagnoses of simple phobia, overanxious, separation anxiety, oppositional defiant, and ADHD. Teachers' ratings of behavior problems were obtained. LBW was associated with ADHD but not with childhood anxiety disorders or oppositional defiant disorder. The association was stronger in the urban than in the suburban population. Data from teachers' ratings revealed an association between LBW and attention problems. The prognostic significance of the observed psychopathology at 6 years of age requires follow-up assessment as the children mature.This research was supported by NIMH research grant MH-44586 and NIMH Research Scientist Development Award MH-00380 to Dr. Breslau.     

Sex Differences in the Pathway from Low Birth Weight to Inattention/hyperactivity

Inattention/hyperactivity is a childhood outcome of low birth weight. However, the mechanisms by which low birth weight leads to inattention/hyperactivity are unclear. This study examined arousal, activation, motor speed, and motor coordination as possible mechanisms, attending to sex differences. 823 children (400 males) from Detroit and surrounding suburbs were assessed with the Child Behavior Checklist and the Teacher Report Form and completed experimental tasks to assess vigilance and activation (Continuous Performance Test signal detection parameters) and motor output speed and control (Grooved Pegboard) at 6 years of age. The relationship between birth weight and inattention/hyperactivity was slightly, but not significantly, stronger for boys than for girls. Arousal, motor speed, and motor coordination significantly partially mediated the relationship between birth weight and inattention/hyperactivity for boys and girls. Moderated mediation was found for the pathway between motor coordination and inattention/hyperactivity such that this relationship was stronger for boys than for girls. Sex differences in the associated features of attention symptoms may reflect partially distinct etiological pathways.     

Gender differences in the sensitivity to posttraumatic stress disorder: An epidemiological study of urban young adults

The authors examine the relationship between 2 separate but interrelated findings in the epidemiology of posttraumatic stress disorder (PTSD): women's greater PTSD risk following traumatic events and the sensitizing effects of a prior trauma on the PTSD response to a subsequent trauma. Data come from a representative sample of 1,698 young adults from a large U.S. city. Analysis was conducted on the subset exposed to traumatic events. Women's risk for PTSD following assaultive violence was higher than men's. When assaultive violence preceded a later nonassaultive trauma in women, there was an increased risk (relative risk = 4.9) for PTSD, which was not observed in men. The relative risk estimate in women was significantly higher than in men. These findings suggest that assaultive violence elicits women's PTSD response directly and by sensitizing them to the effects of subsequent traumatic events of lesser magnitude.     

Stressors: Continuous and Discontinuous

DSM-III defined PTSD as a syndrome that follows exposure to a special class of stressors, that is, events that are outside the range of usual human experience. The definition of the PTSD stressor in DSM-III is ambiguous: It is unclear if it depends on a quantitative or qualitative difference. Furthermore, although a body of literature had described psychologic reactions to war and civilian catastrophes, there was at the time little empirical support for a strong and unique association between the PTSD symptom cluster and a special class of stressors. The revised definition of PTSD in DSM-III-R has not clarified the PTSD stressor criterion. However, changes were made in the criterial symptoms. Symptoms of avoidance were moved from the "Miscellaneous" to the "Numbing" category. The change was not based on empirical evidence; it was based instead on an untested psychologic paradigm about traumatic neurosis. Suggestions are made for future research to test the assumptions embedded in the PTSD definition.     

Psychological disturbance in children with physical disabilities: Continuity and change in a 5-year follow-up

This study measures continuity in behavioral disturbance over a 5-year period among 255 children with physical disabilities who were 6 to 18 years old at first assessment. The pattern of the results differed from that reported previously for a sample of the general population of children. Disabled children showed little stability in aggression, an area in which stability over time had been consistently reported for the general child population. Furthermore, important differences were observed between children with cystic fibrosis and children with cerebral palsy, myelodysplasia, or multiple physical handicaps, all conditions involving brain abnormality. Children with cystic fibrosis followed the trend toward better adjustment seen among the general population of children. In contrast, among children with conditions involving the brain, the majority of those who had been classified as psychologically severely impaired remained at this level of impairment 5 years later. In two behavioral domains, Mentation Problems and Isolation, children with conditions involving the brain maintained, on the average, the same markedly high score they had initially. Among children with physical conditions involving the brain, Mentation Problems and Isolation signify persistent problems that do not subside as the children mature.This study was supported by NIH grant No. HD-16821, by Research Scientist Development Award No. MH-00380 from NIMH, and by grants from the Cleveland Foundation and the Charles S. Mott Foundation.     

The psychological study of chronically ill and disabled children: Are healthy siblings appropriate controls?

This study examined the appropriateness of siblings as controls in the psychological assessment of children with chronic illness or disability. Findings from 304 cases and 360 randomly selected controls were compared to findings from a subset of 206 case-sibling pairs. Cases were children 6 to 18 years of age with cystic fibrosis, cerebral palsy, myelodysplasia, and multiple handicaps, selected from specialty clinics in two teaching hospitals in the Cleveland area. Results from both data sets were in agreement on major findings indicating that children with cystic fibrosis are not at increased risk for psychopathology, whereas children in the remaining three diagnostic groups show a substantial excess in Mentation Problems and Isolation. The comparisons with matched siblings underestimated pathology in the disabled children in Regressive-Anxiety and aggressive behavior.     

Siblings of disabled children: Birth order and age-spacing effects

Whereas older siblings of children with congenital disability have lived their earliest years in a normal family environment, younger siblings, especially those in a close age-spacing relationship, were born into families marked by the presence of a disabled child. In this paper, 237 siblings of disabled children are compared to 248 siblings from a random sample of families to examine whether the early family environment of siblings of disabled children, as indexed by relative birth order and age-spacing, has a unique influence on psychological functioning. The findings partially confirmed the expected relationships: Younger male siblings, specifically those in close age-spacing relationship to the disabled child, scored higher on psychological impairment than older male siblings. Among female siblings, a similar influence was not in evidence: Younger female siblings were psychologically better off than older female siblings and their age-spacing was not significantly related to psychological functioning. However, the results suggest that siblings' later response to early life experience may be sex-contingent, with males demonstrating interpersonal aggression and females experiencing depressive-anxious feelings.This study was supported by grants from the Cleveland Foundation and the C. S. Mott Foundation. The helpful comments of Joanne C. Gersten are gratefully acknowledged.     

Academic achievement of low birthweight children at age 11: the role of cognitive abilities at school entry

We examine the extent to which deficits in academic achievement in low birthweight (LBW) children at age 11 are explained by deficits in cognitive abilities at school entry. Data come from a longitudinal study of a stratified sample of LBW and normal birthweight (NBW) children from an innercity and middle class suburbs in the Detroit area. Woodcock-Johnson Psychoeducational Battery-Revised was used to measure reading and math at age 11. WISC-R and specific neuropsychologic tests were administered at age 6. On reading, the LBW-NBW difference was -3.6 points (SE = 1.2). The difference was explained almost entirely by IQ at age 6. On math, the LBW-NBW difference was -6.1 points (SE = 1.1). The difference on math was trivial and not significant, when IQ and neuropsychological tests at age 6 were controlled. Level of LBW was unrelated to reading, but it had a gradient relationship with math, with birthweight < or = 1,500 g associated with a greater deficit than heavier LBW. The results imply that most of the LBW-NBW gap in academic achievement at age 11 could be eliminated by eliminating differences in cognitive abilities at age 6. Interventions to improve academic performance of LBW children should focus on the preschool years.