Longitudinal Association between Posttraumatic Stress Symptoms and Externalizing Symptoms Among Child Welfare Involved Youth: The Role of Physical Abuse

Background and Purpose: A solid body of literature suggests that youth in the child welfare system are at a heightened risk of experiencing posttraumatic stress (PTS) symptoms and externalizing symptoms (e.g., aggression, delinquency). Although there is some evidence that these two symptoms often co-occur, it is not clear how developmental patterns of PTS symptoms and externalizing symptoms are interrelated among child welfare-involved youth in early- to mid- adolescence. Furthermore, while child physical abuse has been identified as a strong risk factor for both PTS symptoms and externalizing symptoms, the effects of physical abuse on the developmental patterns of these symptoms are yet to be fully delineated. To address the limited understanding in this area, this study examines the longitudinal association (i.e., co-development) between PTS and externalizing symptoms among child welfare involved youth and assesses whether physical abuse predicts the co-development of the symptoms in early to mid adolescence.

Methods: Using data from the National Survey of Child and Adolescent Well-being (NCSAW-II), parallel process latent growth curve modeling was performed on a sample of 491 adolescents who were between 11 and 13 years of age at Time 1. Three waves (T1: baseline, T2: 18 months after baseline, T3: 36 months after baseline) of data were used. Externalizing behavior problems were measured using the caregiver ratings of the Child Behavior Checklist (CBCL 4−18) and PTS symptoms were measured using the youth self-report of the posttraumatic stress (PTS) scale of the Trauma Symptoms Checklist for Children at three time points. Youth physical abuse was assessed at three time points using the youth self-report of Parent-Child Conflicts Tactic Scale (CTS-PC). Control variables included the child’s race, sex, receipt of behavioral health services, out-of-home placement status, and maternal education.

Results: The parallel process model fit the data well [CFI=.95, RMSEA=.04, SRMR=.04]. Adolescents exhibited decreasing patterns of PTS symptoms (intercept: 49.03, p<.001; slope: -.76, p<.001) and externalizing symptoms (intercept: 56.74, p<.001; slope: -.66, p<.001) over the three year period. Higher levels of initial PTS symptoms were associated with higher levels of externalizing behavior problems (r =.18, p=.043), but the rate of change in PTS symptoms were not significantly associated with the rate of change in externalizing symptoms over time (r =.14, p=.627). Higher physical abuse frequency at baseline was associated with higher initial levels of PTS symptoms (β =.20, p=.001) and higher initial levels of externalizing behavior problems (β =.15, p=.003). Later physical abuse (T3) was associated with slower decrease in PTS symptoms (β =.15, p=.020) and externalizing symptoms (β =.21, p=.009) over time.

Conclusions and Implications: Findings suggest that providing integrated mental health and behavioral health services may be helpful in promoting the well-being of adolescents who have experienced physical abuse. The negative effects of ongoing physical abuse warrant the need for continued assessment of and protection from physical abuse during adolescence to address recovery of PTS and externalizing symptoms among youth involved with the child welfare system.