Assessment of mental health problems in children following early maltreatment: What will the new diagnosis of complex PTSD add?

Abstract

Complex post-traumatic stress disorder (CPTSD) is a new diagnosis which has been developed for the forthcoming International Classification of Diseases 11th Revision criteria. This is in recognition of the impact of repeated, interpersonal trauma and an emerging evidence base supporting a distinction between PTSD and CPTSD, with its disturbances in self-organization in addition to the core features of reexperiencing, avoidance, and hypervigilance. The new diagnosis is discussed in the context of assessing children who have experienced maltreatment, many of whom will have affect dysregulation, interpersonal difficulties, and negative thoughts about themselves. However, not all maltreated children will have the core features of PTSD, and they may be affected in various other ways, which are discussed in the experience of a specialist clinic taking referrals for children who have been abused or neglected. The assessments recognize that maltreated children are typically exposed to multiple genetic and environmental risk factors. Traumatic symptoms are seen an adaptation to chronic threat, and close attention is also paid to systemic factors such as family relationships. Young children with PTSD will require developmentally sensitive assessment. Maltreated children are at high risk of mental health and neurodevelopmental problems but may present with symptoms in various domains which cumulatively are very impairing without always meeting diagnostic thresholds. Children may frequently be referred with possible autistic traits or symptoms of attention-deficit hyperactivity disorder, which need to be assessed in the light of their traumatic backgrounds. Assessing the role attachment in the development of children who have been abused or neglected is also considered.

The Impact of Parental Alienating Behaviours on the Mental Health of Adults Alienated in Childhood

“…Another consideration is that children exposed to early maltreatment are believed to be more vulnerable to a complex form of posttraumatic stress (CPTSD) [32]. CPTSD can occur in adulthood when social-emotional needs are neglected in childhood.…”

Cumulative risk exposure is associated with increased risk for PTSD but not depression or anxiety. Results from a UK clinical sample of children and adolescents

“…The findings suggest that where cumulative trauma exposure is observed, it would be important to assess for PTSD. This can be a challenging process in light of the complex presentation of difficulties commonly seen in children with multiple trauma histories (DeJong & Wilkinson, 2019). In cases of multiple trauma exposure, complex-PTSD is more likely to occur (Hyland, et al, 2017), which has implications for treatment.…”

“…The impact of adversity and trauma in childhood can be complex, with a range of mental health, psychosocial, conduct and behavioural difficulties seen (DeJong & Wilkinson, 2019; van der Kolk, 2005). Children exposed to trauma may also be at increased risk of a complex range of difficulties, including those presumed to be of predominantly genetic origin like intellectual disability and neurodevelopmental differences (Ford, et al, 2007).…”

Parent, carer and professional views of specialist child and adolescent mental health care during the COVID-19 pandemic

“…Alongside this, at times of stress, parents and carers are also more liable to struggle to tolerate alternative views, and may tend to a fixed view about what a child’s difficulties are (Adkins et al , 2018), which can be complicated by wider misunderstanding around the developmental sequelae of different forms of early adversity and distinctions between secure, insecure and disorganised attachment and related diagnostic labels and neurodevelopmental diagnoses (e.g. autism spectrum disorder) (see, for example, DeJong and Wilkinson, 2019; Woolgar and Pinto, 2016; National Institute for Health and Care Excellence, 2015; Ratnayake et al , 2014; Woolgar and Scott, 2014; Tarren-Sweeney, 2010).…”