Children who have suffered early abuse or neglect may later present with abstract significant health and behavior problems that may persist long after the abusive or neglectful environment has been remediated. Neurobiological research suggests that early maltreatment may result in an altered psychological and physiologic response to stressful stimuli, a response that deleteriously affects the child’s subsequent development. Pediatricians can assist caregivers by helping them recognize the abused or neglected child’s emotional and behavioral responses associated with child maltreatment and guide them in the use of positive parenting strategies, referring the children and families to evidence-based therapeutic treatment and mobilizing available community resources.
Symptoms of child traumatic stress and comorbid disruptions in the parent-child relationship can present to the pediatrician in a variety of ways. 11–13
The most trauma-specific psychiatric diagnosis associated with child maltreatment is posttraumatic stress disorder (PTSD). 14 The diagnostic criteria for PTSD in children are described in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and may be summarized as follows: (1) a tendency to persistently reexperience the traumatic event through intrusive thoughts, feelings, dreams, and “flashback” recollections; (2) avoidance of stimuli associated with the event (ie, avoiding people, places, or other cues that remind the child of the traumatic event); (3) negative alterations in cognitions and mood (ie, negative beliefs and expectations about oneself or world; persistent emotions of fear, horror, anger, guilt, or shame; and detachment or estrangement); and (4) alterations in arousal and reactivity (ie, hypervigilance, exaggerated startle, and irritability or anger outbursts and reckless behavior as well as decreased attention, poor concentration, and sleep disturbance). 15
Effects of Maltreatment Persist Into Adulthood