The research article being critiqued in this paper is titled as “Pathways to PTSD, Part II: Sexually Abused Children” coauthored by Julie B. Kaplow, Kenneth A. Dodge, Lisa Amaya-Jackson and Glenn N. Saxe. The objective of the paper was to build and analyze a probable model of posttraumatic stress symptoms in sexually abused juveniles, which include pre-trauma, trauma, and disclosure related pathways. A qualitative approach was used in this article to carry out the research, which was well coded and analyzed statistically to arrive to conclusions.
The paper elaborately explains the background of the research at the onset of the document. It states that child sexual abuse is a common happening and can lead to rigorous psychological harm both in the short and long term. Various previously conducted researches highlight the materialization of posttraumatic stress disorder (PTSD) in sexually abusive cases given that the symptoms of this disorder are observed quite often in children who undergo this traumatic experience. The paper notifies that although long-term effects and later symptoms of PTSD have been subject to wide research by means of retrospective of adults, there has been a significant lack of research on the more instantaneous PTSD fallouts. The authors consider their research to be the earliest examination of pre-traumatic exposures, trauma attributes, and nervous tension responses at the time of disclosure as pathways to PTSD symptoms in sexually abused children. It discusses about the various factors that put the children in jeopardy, which had been observed as the immediate repercussions of the traumatic experiences. Significantly notable in that context was the demonstration of dissociation during the disclosure, which could be an indication of long-term PTSD. Apart from dissociation, observations revealed that anxiety/arousal could also be a determining factor in PTSD forecasting. The paper lists Avoidance coping as a vital aspect of anxiety/arousal. Cognitively restraining from disclosing information and other avoidance strategies could habitually lead to crisis in various domains in due course. However, they testify that evaluating such strategies could be problematical. Thus, a strategy employing behavioral coding system to mark the respondent’s avoidant conduct during interviews was adopted to overcome the complication.
The 156 children constituting the sample for the research purpose were aged between 8 to 13 years and belonged to state of North Carolina. They were clinically examined, interrogated, and the interviews were video recorded for forensic reasons. The event of sexual abuse for the interviewed children was marked by an assessment team comprising of members from multiple disciplines “as confirmed, probable, suspicious, unknown or else ‘no evidence’.” Each of these interviews was well documented for subsequent evaluation. The reliability of the research was greatly enhanced by the method of research approach. It research was conducted in two phases. During the first phase, a number of procedures were adhered to, in order to examine pre-trauma variables, trauma variables and then the responses of the 156 children were carefully scrutinized during disclosure of the experience. During the second phase, ranging from seven to 36 months consequent to the preliminary interview, the observation concentrated on examining the symptoms of PTSD, which might have occurred in the children. A statistical modeling was carried out to prepare the obtained data from various interviews to facilitate analysis.
A maximum likelihood estimation approach was adopted for dealing with the issue of missing data. A path analysis approach was adopted for data analysis. A sequence of hierarchically nested ordinary least square multiple regression analysis were employed to approximate the direct as well as indirect impacts of the various categorized variables.
After a thorough analysis, the authors reached a conclusion that the threat of Post Traumatic Stress Disorder is greater in children who demonstrate symptoms of averting, anxiety/arousal or dissociation while or just after the disclosure of the abusive experiences. Thus, they suggest that it is imperative that the response of the children post disclosure should be analyzed with immediate effect. The research brings out that dissociation is the most significant predictor of PTSD. Thus, the authors carry out a detailed discussion with relation to dissociation and the impacts it may cause. The paper also provides appropriate references to other relevant works in the field.
The research article also boldly goes on to state the limitations of the study, which was carried out. Although it brought out various significant revelations, the article highlights that the generalization of the sample selected for the study is subject to ambiguity. In addition to that, the authenticity of the fact that the disclosure during the interviews was the first instance when the child talked about their traumatic experiences is unconfirmed.
The article further goes on to list the clinical implications of the study. It states the identified group exhibiting avoidance, anxiety or dissociation faces a greater risk of developing PTSD symptoms later on and thus requires immediate clinical attention. It also identifies demonstrators of coping strategies as an intervention targets in need of therapy.
Overall, it is a comprehensive and well-structured research document, which ventures out to a much under researched subject of study. The research design, although exposed to a few limitations, is consistent with the research philosophy. The concepts of reliability and validity of the research are taken care of with utmost concern by the authors. Finally, it might be said that the article would act as an important literature for future researches, provide essential guidelines, and aid for the same.
Kaplow, J, Dodge, K, Amaya-Jackson & Saxe, G; Pathways to PTSD, Part II Sexually abused children; Psychiatry; 2005, 162; pp-1305-1310.