eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Child Abuse & Neglect, Posttraumatic Stress Disorder: Follow-up

Author: Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Coauthor(s): Toi Blakley Harris, MD,, Assistant Professor and Director of Diversity and Education, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Founder and Director, Texas Regional Psychiatry Minority Mentor Network; Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Contributor Information and Disclosures

Updated: Jul 28, 2009

Follow-up

Further Inpatient Care

  • Inpatient psychiatric care should be considered in patients who are at risk of harming themselves or others. Children with posttraumatic stress disorder (PTSD) are at increased risk of suicide.

Further Outpatient Care

  • Most of the treatment of psychologically traumatized children is conducted on an outpatient basis; see Treatment recommendations.

Inpatient & Outpatient Medications

Deterrence/Prevention

  • A description of efforts to prevent child maltreatment and traumatization is beyond the scope of this article, as is the prevention of accidents in children.

Complications

  • Children who are exposed to abuse and neglect are at an increased risk for psychiatric complications. For example, sexually abused children are 4 times more likely to develop psychiatric disorders. PTSD diagnosis in children correlates significantly with at least transient suicidal ideation.
  • Anxiety and phobia: Approximately 30% develop social anxiety or specific phobia.
  • Major depression and dysthymia: As many as 40% of children with PTSD develop major depression by age 18 years (compared to 8% of their unaffected peers).
  • Aggression: Research findings are mixed as to whether children with PTSD are at increased risk for aggressive or oppositional behaviors.
  • Substance abuse and dependence: An estimated 46% develop alcohol dependence, and 25% develop drug dependence.
  • ADHD: The documented incidence of ADHD is higher in those with PTSD.
  • Suicide: People with PTSD have a higher risk of suicidal ideation, as well as increased mortality rate associated with suicide.
  • Physical comorbidities: In female children and adolescents, PTSD is associated with chronic fatigue, fibromyalgia, irritable bowel syndrome, chronic pelvic pain, and dysmenorrhea.

Prognosis

  • The outcome of PTSD depends on the severity and chronicity of the trauma and the impact on the life of the child, the reactions and behavior of caregivers, and the opportunity to receive treatment.
  • In a longitudinal study of teenagers and young adults aged 14-24 years who were observed for 34-50 months, 48% with a diagnosis of PTSD experienced no significant remission of their symptoms. Those with ongoing PTSD had an elevated risk for additional traumatic events during the follow-up period.
  • Patients with chronic PTSD have an increased risk of suicidal ideation and mortality from suicide.
    • Chronic PTSD is associated with work impairment, with an impact similar to that of major depression.
    • The prognosis tends to be worse in those experiencing ongoing trauma.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Controversy exists concerning whether therapists can induce false memories of abuse in vulnerable patients.
 
Acknowledgments

The authors acknowledge the encouragement and support of Dr. John Sargent, who has taught us much and who has set a standard for us in terms of his being an excellent mentor and modeling for us the highest degree of professionalism as a colleague who works tirelessly to ameliorate the effects of child abuse and neglect among the children and families we serve.



More on Child Abuse & Neglect, Posttraumatic Stress Disorder

Overview: Child Abuse & Neglect, Posttraumatic Stress Disorder
Differential Diagnoses & Workup: Child Abuse & Neglect, Posttraumatic Stress Disorder
Treatment & Medication: Child Abuse & Neglect, Posttraumatic Stress Disorder
Follow-up: Child Abuse & Neglect, Posttraumatic Stress Disorder
References
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Further Reading

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Keywords

posttraumatic stress disorder, post-traumatic stress disorder, traumatic stress disorder, child abuse, child neglect, child maltreatment, acute traumatic reaction, chronic or delayed traumatic disorder, PTSD, psychological trauma, physical trauma, acute stress reaction

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Contributor Information and Disclosures

Author

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Coauthor(s)

Toi Blakley Harris, MD,, Assistant Professor and Director of Diversity and Education, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Founder and Director, Texas Regional Psychiatry Minority Mentor Network
Toi Blakley Harris, MD, is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC is a member of the following medical societies: American Academy of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Medical Editor

Carol Diane Berkowitz, MD, Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center
Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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