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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), Abused children who develop post-traumatic stress disorder (PTSD) may exhibit some behavioral and medical conditions in their first year of life. PTSD is an anxiety disorder that can result from extreme stress. Researchers interviewed 117 badly abused children who had been removed from their parents' custody by court order. Investigators also interviewed the childrens' parents and reviewed the court records. Thirty-five percent of the children were diagnosed with PTSD. PTSD children tended to be male, non-black, and mistreated within the first year of life. Four characteristics or experiences of abused children each could independently predict the child would be likely to develop PTSD. These factors were childhood sexual abuse, the observation of domestic violence, distress when moved in a non-threatening manner, and infections. Children who were black had a decreased likelihood of developing PTSD, independent of other factors.

Objective: This study sought to determine whether neurocognitive factors could discriminate delinquents brought before a juvenile court in a large urban area from nondelinquent status offenders brought before the same court. Method: Psychological tests were administered to 21 6 adolescents, aged 13-1 S years, presenting to a large urban juvenile court. One hundred ten delinquents (6S male and 45 female) were compared to 106 high-risk nondelinquents (65 male and 41 female) on the WISC-R subtests, the Wide Range Achievement Test, and the Memory for Designs Test. Results: Discriminant analysis revealed that the male delinquents could not be discriminated from the comparison group of male status offenders on the basis of scores on any of the measures. Among the female subjects, scores on reading, arithmetic, digit span, and picture completion subtests and the Memory for Designs Test differed significantly between groups, with some of the findings favoring status offenders and others favoring delinquents. Conclusions: Overall, the findings did not support the hypothesis that inferior intelligence is an independent risk factor for delinquent behavior.

Borderline personality disorder (BPD) is a personality disorder characterized by instability in a variety of areas, including interpersonal relationships, behavior, mood, and self-image. Childhood maltreatment (physical or sexual abuse) has been associated with BPD, but the relationships among posttraumatic stress disorder (PTSD), BPD, and maltreatment in childhood are not clear. The present study explored the relationship between PTSD and BPD in childhood by evaluating children diagnosed with BPD for the presence of PTSD. Nineteen children, ages 7 to 14, were studied. All were diagnosed with BPD and three had also been diagnosed with PTSD. A structured clinical interview was performed using the Diagnostic Interview for Children and Adolescents. When asked about trauma, 15 of the 19 children answered positively - a necessary but not sufficient condition for the diagnosis of PTSD. They reported witnessing or experiencing such events as sexual assault or maltreatment, physical assaults, or natural disasters. Upon further evaluation, seven children met the criteria for PTSD (including the three previously diagnosed with that condition). It is noteworthy that 80 percent of the children with BPD in this sample reported histories of childhood trauma, and that almost 37 percent met the criteria for PTSD. The question of whether BPD and PTSD coexist as separate conditions is raised. It is more likely that PTSD symptoms are confused with symptoms of childhood BPD; the issue is discussed. These results are consistent with a view of BPD as a complicated posttraumatic syndrome manifested by maladaptive personality characteristics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physical or sexual maltreatment of children increases the likelihood of later psychiatric problems and may impair developmental areas such as socialization, cognition, formation of character, and adaptive ability. A causal relationship between delinquency and a history of child abused is not totally clear, although adults maltreated as children do have a higher incidence of criminal behavior and violence than do controls. A study was undertaken of 378 children and adolescents brought to juvenile court to investigate the relationship between the type of delinquent behavior, crime, or noncriminal behavior (running away or school truancy) and a history of abuse. Two other goals were to determine if a history of maltreatment was particularly prevalent among runaways, and if specific types of abuse were associated with particular types of crimes or noncriminal behavior. A history of documented abuse was found in 55 percent of the noncriminal children and in 45 percent of the criminal or delinquent children. Within the noncriminal behavior group, the percent of children who had been sexually abused was seven times higher among the runaways (35 percent) than among the other children (5 percent). Among those delinquents who committed violent crimes, the percent who had been physically abused was significantly higher (27 percent) than among the non-violent delinquents. It is concluded that child abuse may significantly contribute to delinquent behavior. (Consumer Summary produced by Reliance Medical Information, Inc.)

• We report 11 cases of posttraumatic stress disorder. Each child had been physically abused or sexually abused or both and presented in an agitated, hyperaroused state. Using a B-A-B (off-on-off) medication design in a clinical setting, the children were treated with the beta-adrenergic antagonist propranolol. Scores on an inventory of symptoms of posttraumatic stress disorder indicated that patients exhibited significantly fewer symptoms while receiving medication than either before or after they received medication.(AJDC 1988;142:1244-1247)