October 1994

Early Developmental History and Pediatric Posttraumatic Stress Disorder

Author Affiliations

From the Boston Juvenile Court, Massachusetts Department of Mental Health (Dr Famularo); Department of Child Psychiatry and Pediatrics, Boston University School of Medicine (Dr Famularo); Department of Pediatrics, Franciscan Children's Hospital (Dr Famularo), and Department of Biostatistics, Harvard School of Public Health (Dr Fenton), Boston.

Arch Pediatr Adolesc Med. 1994;148(10):1032-1038. doi:10.1001/archpedi.1994.02170100030007

Objective:  To determine which factors from the early developmental histories of maltreated children are associated with the risk of developing posttraumatic stress disorder (PTSD).

Design:  Retrospective cohort analytic study.

Setting:  A county juvenile/family court (not a criminal court).

Sample:  The sample consisted of 117 severely maltreated children, aged 5 to 12 years, whose maltreatment was so severe that they were removed from parental custody. Forty-one (35%) of these children met criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, for PTSD.

Main Outcome Measures:  Individual developmental and temperament-independent variables were used to compare children with PTSD and the maltreated children who did not reach PTSD inclusion criteria. The child's PTSD status was the primary dependent variable.

Results:  Variables representing the three factors from the early developmental history, along with markers for sex and race (black vs other), were entered into a logistic regression, with PTSD status as the outcome variable. Indicators of five different types of child maltreatment were also entered as predictors, to control for previously discovered effects associated with the type of trauma suffered by the children. This analysis disclosed that, while we controlled for the other predictors, one of the developmental factors remained statistically significant, one was marginally significant (P=.07), and one made no contribution toward predicting the probability of PTSD. Sex did not make a significant contribution to the logistic model, but being black continued to be associated with a lower probability of developing PTSD.

Conclusions:  We conclude that PTSD may be caused by factors discernible in the first year of life that leave a maltreated child vulnerable to this disorder. These include birth weight less than 2.25 kg, jaundice, vomiting, diarrhea, infections, sleep problems, frequent crying, poor weight gain, fussiness, jumpiness, and distress when moved. The seemingly protective effect of being black was an unexpected, although provocative, finding whose interpretation will require further investigation.(Arch Pediatr Adolesc Med. 1994;148:1032-1038)