články -patopsychologie

Childhood maltreatment is a risk factor for the development of post-traumatic stress (PTS) symptoms. Current estimates of trauma-related symptomatology in the general population indicate that about 2.2% of adolescents manifest heightened PTS symptoms as measured by the Trauma Symptoms Checklist for Children (TSCC; Copeland, Keeler, Angold, & Costello, 2007). However, higher rates of PTS symptoms are found in adolescents in the child welfare system. In a nationally representative U.S. sample of 1848 child-welfare-involved children and young adolescents (ages 8–14) with varied maltreatment histories, Kolko et al. (2010) recorded heightened PTS symptoms for about 12% of the participants.

However, research also suggests that a substantial proportion of child-welfare-involved adolescents exhibit resilience (Guibord, Bell, Romano, & Rouillard, 2011), which is often conceptualized as positive adaptation and functioning following exposure to significant adversity (Masten & Wright, 1998). In a study examining the mental health outcomes of one hundred twenty-two 12- to 15-year-olds in the child welfare system in Ontario (Canada), findings indicated that slightly more than half (52.5%) displayed resilient functioning, which was defined as the absence of depressive symptoms or alcohol/drug use over the past year (Guibord et al., 2011). Even studies using more stringent definitions of resilience that require individuals to be functioning well across multiple domains (e.g., behavioral, social, and academic) have found that over half of the adolescents in child welfare exhibit resilience (Daining and DePanfilis, 2007, Jones, 2012). Because there is individual variability in the response to child maltreatment, empirical efforts have been made to understand the way certain socio-demographics, maltreatment-related, and welfare-related variables may influence the development of psychopathology (or lack thereof) in maltreated adolescents.

Studies of adolescents in child welfare that have examined the relation between various types of maltreatment and mental health outcomes have typically shown that psychological distress is highest among those adolescents who have experienced sexual abuse (Burns et al., 2004, McMillen et al., 2005). Sexual abuse may be associated with worse outcomes because it constitutes a gross violation of physical boundaries and often occurs alongside other forms of maltreatment (e.g., physical abuse, emotional neglect; Perez-Fuentes et al., 2013). Moreover, sexual abuse has specifically been linked to trauma-related symptoms in several general population studies (Boney-McCoy & Finkelhor, 1996; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) as well as in studies with child-welfare-involved adolescents (Petrenko, Friend, Garrido, Taussig, & Culhane, 2012).

A substantial number of adolescents in child welfare experience multiple types of maltreatment (Richardson, Henry, Black-Pond, & Sloane, 2008; Trocmé et al., 2010). Results from the OIS-2013 indicated that 13% of newborn to 15-year-olds had experienced more than one type of maltreatment (Fallon et al., 2015). This finding is based on substantiated cases of child maltreatment. Though, whereas studies of child welfare samples using self-report questionnaires and/or interviews that do not require substantiation have typically yielded higher rates of multiple victimization (e.g., 72%; Lawrence, Carlson, & Egeland, 2006). Within the child welfare setting, some studies suggest a dose-response relationship, whereby those individuals experiencing more types of maltreatment show elevated levels of dysfunction relative to those experiencing only a single type (Griffin et al., 2011, McMillen et al., 2005).