Study finds high rates of posttraumatic stress symptoms in a US national sample of children referred to child welfare

Date Published: 

Kolko, D.J., Hurlburt, M.S., Zhang, J., Barth, R.P., Leslie, L.K., & Burns, B.J. (2010). Posttraumatic stress symptoms in a national sample of in-home and out-of-home care. Child Maltreatment, 15(1), pp. 48-63.

Reviewed by: 
Melissa Van Wert

Children and adolescents coming into contact with the child welfare system may be at increased risk for developing posttraumatic stress disorder (PTSD). The present study used the National Survey of Child and Adolescent Well-Being (a nationally representative survey of child maltreatment investigations) to determine the national prevalence of posttraumatic stress (PTS) symptoms in children referred to child welfare services in the United States due to alleged maltreatment. Examining the total sample of children investigated for maltreatment, 11.7% of children and adolescents reported clinically elevated levels of PTS symptoms. This figure should be considered in relation to the findings of Copeland and colleagues (2007), which indicate that only 0.5% of a community sample of young people age nine to 16 met the criteria for subclinical PTSD and 0.1% met the criteria for clinical PTSD. This comparison implies that children and adolescents referred to child welfare services are experiencing elevated levels of PTS in much higher numbers than the general population of children and adolescents.

When controlling for all variables of interest (demographic information, placement status, family risk, maltreatment type, prior child welfare investigation), the following factors were associated with elevated levels of PTS: younger age (age 8 to 10 years versus age 11 to 14 years), perpetrator of maltreatment who was not the biological parent, experiences of victimization in the home, and child depression. The estimate for elevated PTS following a referral for physical or sexual abuse was four times higher if the perpetrator was someone other than a biological parent, however this difference did not exist for neglect referrals. Notably, maltreatment referral type was not associated with elevated PTS in the final model, which contradicts the traditional assumption that some forms of maltreatment are more traumatic than others (e.g., sexual abuse compared to neglect).

Methodological notes: 

This study examined data from the NSCAW, a nationally representative longitudinal study of youth referred to child welfare authorities for alleged maltreatment and assessed during the sampling period of October 1999 to December 2000. Interviews with families and child welfare workers were conducted by trained professionals and occurred for the first time between three and six months after the investigation had been completed. This study examined children ages eight to 14 (N = 1,848). All potential predictors of PTS were entered into the final hierarchical logistic regression model. Blocks of variables were entered into the multivariate model, beginning with demographics and followed by maltreatment characteristics, level of violence exposure, and depression symptoms.


There are limitations in this study. Placement status was measured by noting the residence of the sampled children and adolescents at the time of the NSCAW intake survey. However, the young person may have been in more than one type of placement between the beginning of the investigation and the NSCAW intake survey. In addition, substantiation status was not measured nor controlled for in the analysis. Finally this particular analysis of NSCAW data only used the first wave of data from the study and represents a point prevalence of PTS symptoms rather than lifetime prevalence. Thus the causal association between maltreatment and PTS cannot be assumed and the findings are likely an underestimate of the lifetime prevalence of PTS in maltreated children.


Copeland, W.E., Keeler, G., Angold, A., & Costello, E.J. (2007). Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry, 64, 577 – 586.