They ask what would be construed as leading or contaminating questions , said James Rosenberg , MD
, director of the Forensic Neuropsychiatry Medical Group
, Westlake Village , Calif..The American Academy of Child and Adolescent Psychiatry
adopted standards for the assessment and treatment of PTSD in children and adolescents in 1998 that help provide a foundation for forensic examinations ( http : //www.aacap.org/new%5Fweb/clinical/.ptsdsum.htm )
Expert witnesses often are asked to describe the typical course of PTSD and to predict outcomes for a particular child.There's no consensus on whether one sex is more likely than the other to develop the disorder , Rosenberg
said.Girls are sexually assaulted more often than boys , for example.Boys experience more serious unintentional injuries and physical trauma.
After exposure to the same traumatic event , such as a school shooting , older children are more likely to develop reexperiencing and hyperarousal symptoms , Rosenberg
said , while younger ones more often display avoidance symptoms.In adolescence , he
noted , PTSD may delay or impair development of independence and self-sufficiency.
Debate continues on whether a child who meets some but not all criteria for PTSD has as serious a problem as a child with a full range of symptoms.This is particularly a concern in younger children who may have dramatic symptoms in one category , Rosenberg
said , yet appear to have few or none in another.What's at stake is the extent of damages for emotional distress the child is entitled to receive in a civil case.
Trauma in several populations thought to be at increased risk for PTSD is understudied.Some 500 000 children are in foster care , most of whom typically entered this system at age 3 years.Many have a history of physical and sexual abuse , neglect , and abandonment.One study found that boys with substance abuse problems engaged in high-risk behaviors that put them at risk for trauma , such as driving while drunk or hanging out in alleys.
For a child , testifying in a courtroom may be stressful , even traumatic , Rosenberg
said.Younger children are more susceptible to suggestion , intimidation , and inappropriate cross-examination than older ones.
In one study , however , 20% of girls reported having been forced to have sexual intercourse before age 14 ( James
, CB.Incarcerated Youth Needs Assessment Survey.Los Angeles : Charles Drew University
; 1999 ).