The impact of abuse and gender on psychopathology, behavioral disturbance, and psychotropic medication count for youth in residential treatment.

Abstract

This study examined the relationship between gender, abuse history, and clinical change in a residential treatment program for youth with emotional and behavioral disturbance. Admission data and data collected after 1 year of treatment or at discharge were examined for 1,303 youth. Measures included the Suicide Probability Scale, Child Behavior Checklist, and the Diagnostic Interview Schedule for Children. Data also included medication count, demographic data, and history of sexual or physical abuse or both. At intake, girls scored significantly more pathologically than boys on 9 out of 12 measures. At intake, abused youth indicated more hostility, anxiety, and mood disorder symptoms as well as psychotropic medication usage than nonabused youth. Youth improved significantly on all outcome measures with treatment, although interaction effects indicate some differing treatment responses by abuse history or gender. After treatment, girls still scored significantly higher than boys on 6 of 8 outcome measures, and abused youth, especially youth experiencing both sexual and physical abuse, had significantly higher anxiety, affective, behavior, and eating disorder symptom counts and were on more psychotropic medications than nonabused youth. Although behaviorally focused treatment was associated with improvement on every measure, the most important implication of our study is that a singular treatment approach does not fit all youth completely as reflected by continuing treatment needs in our most troubled youth. Additional symptom-focused treatment and research attention must be given to girls and abused youth in residential care to maximize their therapeutic outcomes.

Patterns of maltreatment and diagnosis across levels of care in group homes

“…Neglect was most prevalent, followed by physical abuse and sexual abuse, and lower rates of emotional abuse. These findings align with patterns of maltreatment found in previous studies on group homes (Brack et al, 2012; Lee & Thompson, 2009), other residential programs (e.g., James, Zhang, et al, 2012), and youth involved with the child welfare system (Burns et al, 2004). The high prevalence of maltreatment supports the need for trauma-informed assessment and services for youth in residential programs (Briggs et al, 2012).…”

“…For instance, a history of certain maltreatment types may be associated with different constellations of psychiatric symptoms or disorders (e.g., more externalizing symptoms following sexual or physical abuse; Fergusson, Boden, & Horwood, 2008; Petrenko et al,, 2012) and increasingly complex maltreatment histories (e.g., more types of maltreatment) may be related to more psychiatric symptoms or disorders (e.g., Brack et al, 2012). In efforts to build a more comprehensive picture of youth clinical needs in group homes and to inform treatment efforts, future studies should examine relationships between specific types of maltreatment and diagnoses, and the complexity of such profiles (e.g., number of maltreatment types and diagnoses; maltreatment severity).…”

“…Although much is known about patterns of maltreatment and psychiatric diagnoses among youth in residential programs, in general, less is known about these patterns among youth in group homes, specifically (e.g., Brack, Huefner, & Handwerk, 2012; Chow et al, 2012; Hagaman, Trout, Chmelka, Thompson, & Reid, 2009). A number of studies with youth in group homes have examined emotional and behavioral problems (externalizing and internalizing symptoms) and academic problems (reading, math, academic knowledge), and improvement in these difficulties over time (e.g., Hagaman et al, 2009; Larzelere, Daly, Davis, Chmelka, & Handwerk, 2004).…”

“…Another study of youth in a single group home documented high rates of behavior disorders (conduct disorder or oppositional defiant disorder: 38%), externalizing and internalizing behavior problems, and maltreatment (parental neglect: 40%; physical abuse: 25%; sexual abuse: 16%; Lee & Thompson, 2009). More recently, Brack and colleagues (2012) found high rates of physical abuse (30%), sexual abuse (14%), or both abuse types (21%) among youth in a single group home. Youth with both physical and sexual abuse had more symptoms of anxiety and affective disorders than those with only one abuse type or no maltreatment history (Brack et al, 2012).…”

“…More recently, Brack and colleagues (2012) found high rates of physical abuse (30%), sexual abuse (14%), or both abuse types (21%) among youth in a single group home. Youth with both physical and sexual abuse had more symptoms of anxiety and affective disorders than those with only one abuse type or no maltreatment history (Brack et al, 2012). To advance the literature on group homes, more studies are needed that focus on multiple homes rather than a single home and that further examine distinct characteristics and treatment needs across the youth populations being served.…”