Psychiatr News January 19, 2007
Volume 42, Number 2, page 14
© 2007 American Psychiatric Association
Behavior, Reading Skill at Age 6 Linked to Later Trauma Risk
Aaron Levin
Good reading skills may not only earn children better grades in school
but may keep them safer too.
Difficult kids lead difficult lives, depressed kids lead psychologically
vulnerable lives, but good readers have a better chance of avoiding trouble
and its aftermath, according to a 15-year prospective study connecting
childhood personality and behavior to later trauma exposure.
Researchers from Johns Hopkins University and Michigan State University
studied 2,311 children who entered first grade in the mid-1980s in a large
mid-Atlantic city and followed them until young adulthood. About 67 percent
were members of minority groups, 52 percent received subsidized or free
lunches (an indicator of poverty status), and there was about an equal number
of boys and girls.
When they entered school, the students were evaluated by reading-readiness
tests, depression and anxiety self-reports and by their teachers for
aggressive or disruptive behaviors, concentration problems, and low social
interaction or shyness. When the students were between the ages of 20 and 23,
the 1,698 available for follow-up (about 75 percent of the original group)
were interviewed about traumatic events in their lives and PTSD symptoms.
Traumatic events included assaultive violence (such as being raped, beaten, or
shot) and other experiences such as serious accidents, natural disasters, or
hearing of a close friend's or relative's injury or unexpected death.
An estimated 82.5 percent of these children experienced one or more
DSM-IV qualifying traumatic events in their lives. Among that group,
47.2 percent experienced assaultive violence.
"We found that the occurrence of traumatic events up to age 6-7 was
less than 1 percent, and that age-specific occurrence rose markedly after age
15, with the highest rate observed between 16 and 18 years of age," said
Carla Storr, Sc. D., and Nicholas Ialongo, Ph.D., of Johns Hopkins University
and James Anthony, Ph.D., and Naomi Breslau, Ph.D., of Michigan State
University. Their findings appear in the January American Journal of
Psychiatry. Grants from the National Institute of Mental Health and
National Institute on Drug Abuse funded the study.
Teacher ratings in the first grade of aggressive or disruptive behavior
that fell into the highest two quartiles pointed to nearly double the risk of
exposure to an assaultive event, but not to other traumatic events in the
absence of assaultive violence.
Children in the highest quartile of concentration problems were also at
higher risk for exposure to assaultive violence, but not other kinds of
trauma. Those with the highest reading-readiness scores were less likely to
experience assaultive violence than were children scoring in the lowest
quartile.
About 8.8 percent of children who experienced a traumatic event developed
posttraumatic stress disorder (PTSD). There was an association between risk of
PTSD and first-grade levels of anxious or depressive mood (relative risk=1.4),
but it was not statistically significant.
"The results suggest potential risk factors for PTSD that can be
identified early in life and might be amenable to interventions," the
researchers noted.
In a separate long-term study, Breslau, Victoria Lucia, Ph.D., and German
Alvarado, M.D., M.P.H., all from the Department of Epidemiology at Michigan
State University, examined the relationship of IQ measurements to trauma and
PTSD. That study appeared in the November 2006 Archives of General
Psychiatry. It included children randomly selected from 1983-1985
discharge lists of one urban and one suburban hospital in southeast Michigan
and was originally designed to look at the sequelae of low birth weights in
the communities served by the hospitals. Of the 823 children enrolled in the
study, 713 were followed until age 17. Breslau and her colleagues adjusted
their results to account for a disproportionately high percentage of children
born at less than normal
weight.
The most common traumatic event in this cohort was learning of the sudden,
unexpected death of a close friend or relative. Traumatic events occurred more
often among boys than girls and more often among urban than suburban
youth.
The researchers found that children who had an IQ of at least 115 at age 6
were at lower risk for exposure to traumatic events or assaultive trauma or to
have PTSD by age 17.
Exposure to traumatic events and PTSD was determined at age 17 through a
computerized version of the National Institute of Mental Health Diagnostic
Interview Schedule. After all lifetime DSM-IV-qualifying traumatic
events were identified, respondents selected the worst event they had
experienced. DSM-IV algorithms were then applied to diagnose PTSD.
Above-normal ratings of externalizing problems for 6-year-olds indicated
increased risk of exposure to assaultive violence.
The researchers did note that while high IQ—at least one standard
deviation above the population mean—appeared protective against PTSD,
lower than normal IQ did not increase risk.
At present, Breslau told Psychiatric News, she can only speculate
about the mechanisms by which reading or higher IQ (which are related) are
protective. For instance, people with higher IQs may become better educated
and take greater care to avoid potentially traumatic events. Or they may be
able to cope better after experiencing trauma.
"If exposed to a difficult situation, they face a cognitive challenge
to their views of themselves and their world, but they may tell themselves,
I've solved problems before, I'm capable, I can handle this
situation,'" she said.
Children with behavioral problems may choose more dangerous peers or take
more risks, making them more likely to become victims of crime or
accidents.
This IQ-PTSD link applies to both urban and suburban youth, she noted.
Breslau, a sociologist and psychiatric epidemiologist, is continuing to
analyze study data to track the interaction of cognitive abilities, conduct
problems, and emotional problems through the elementary-school years.
Conceivably, better understanding of predisposing factors for trauma and PTSD
may allow early interventions that could lessen their risk as the child passes
through life.
"Intelligence and Other Predisposing Factors in Exposure to
Trauma and Posttraumatic Stress Disorder" is posted at
<http://archpsyc.ama-assn.org/cgi/content/full/63/11/1238>.
"Childhood Antecedents of Exposure to Traumatic Events and Posttraumatic
Stress Disorder" is posted at
<http://ajp.psychiatryonline.org/cgi/content/full/164/1/119>.
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