EARLY DEVELOPMENTAL HISTORY AND PEDIATRIC POSTTRAUMATIC-STRESS-DISORDER

Objective: To determine which factors from the early developmental his tories of maltreated children are associated with the risk of developi ng;posttraumatic stress disorder(PTSD). Design: Retrospective cohort a nalytic study. Setting: A county juvenile/family court (not a criminal court). Sample: The sample consisted of 117 severely maltreated child ren, aged 5 to 12 years, whose maltreatment was so severe that they we re removed from parental custody. Forty-one (35%) of these children me t criteria of the Diagnostic and Statistical Manual of Mental Disorder s, Revised Third Edition, for PTSD. Main Outcome Measures: Individual developmental and temperament-independent variables were used to compa re children with PTSD and the maltreated children who did not reach PT SD inclusion criteria. The child's PTSD status was the primary depende nt variable. Results: Variables representing the three factors from th e early developmental history, along with markers for sex and race (bl ack vs other), were entered into a logistic regression, with PTSD stat us as the outcome variable. Indicators of five different types of chil d maltreatment were also entered as predictors, to control for previou sly discovered effects associated with the type of trauma suffered by the children. This analysis disclosed that, while we controlled for th e other predictors, one of the developmental factors remained statisti cally significant, one was marginally significant (P = .07), and one m ade 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 developin g PTSD. Conclusions: We conclude that PTSD may be caused by factors di scernible in the first year of life that leave a maltreated child vuln erable to this disorder. These include birth weight less than 2.25 kg, jaundice, vomiting, diarrhea, infections, sleep problems, frequent cr ying, poor weight gain, fussiness, jumpiness, and distress when moved. The seemingly protective effect of being black was an unexpected, alt hough provocative, finding whose interpretation will require further i nvestigation.