Psychological Reports, 1991, 69, 920-922. O Psychological Reports 1991
SYMPTOM CORRELATES AMONG ADOLESCENTS SHOWING POSTTRAUMATIC STRESS DISORDER VERSUS CONDUCT DISORDER1 J. A. ATLAS, W. J. DI SCIPIO, R. SCHWARTZ, AND L. SESSOMS
Bronx Children's Hospital Summary.-21 adolescents with a primary diagnosis of Posttraumatic Stress Disorder, 24 Conduct Disordered, and 23 control adolescents were compared on measures of depression, anxiety, behavior problems, and fears. Analyses showed that posttraumatic adolescents showed associated symptoms of depression and state-anxiety, Conduct Disordered adolescents showed depressive trends, and both groups were evaluated by their teachers as showing significant behavior problems.
The applicability of the term Posttraumatic Stress Disorder to adolescents was evaluated by comparing adolescents diagnosed with Posttraumatic Stress Disorder and Conduct Disorder [by psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987)l and a control sample. While the DSM-111-R does not have a childhood category of Posttraumatic Stress Disorder, its specification of Conduct Disorder includes a reference to harsh environmental conditions as a predisposing factor in Conduct Disorder. In this context one may posit a social-environmental factor in both forms of pathology, raising the question of overlapping versus differentiating features of the two conditions. Twenty-one subjects with a primary diagnosis of Posttraumatic Stress Disorder, 24 Conduct Disordered, and 23 control adolescents were compared. They ranged in age from 11.0 to 18.2 yr., with a mean of 14, and showed no differences among groups. Ethnicity data yielded no group differences. Of 68 subjects, all were nonwhite except two who were white adolescents, one in the posttraumatic group and one in the control group. Eighteen of 21 posttraumatic subjects were drawn from an Acute Adolescent Inpatient Unit (3 were from a day school for emotionally handicapped youngsters), the 24 conduct-disordered subjects were from the same unit, and the 23 control subjects were drawn from a parochial school. The posttraumatic group included 4 boys, the conduct-disordered group 13 boys, and the control group 12 boys. It should be noted that almost all of the hospitahzed adolescents were on psychotropic medication, while the control subjects were not. Available data on the Goodenough-Harris Drawing Test (Harris, 1963)
'Thanks ate expressed to J. Price and A. Miller for research assistance, and to A. Diaz for typing. Request reprints from J. A. Atlas, Bronx Children's Hospital, Albert Einstein College of Medicine, 1000 Waters Place, Bronx, N Y 10461.
SYMPTOM CORRELATES AMONG ADOLESCENTS
92 1
for 15 posttraumatic, 22 conduct-disordered, and 22 control subjects yielded a mean score of 76.0 (range =50-120, SD= 16.7), with no differences among groups, suggesting that differences on the experimental measures were not attributable to nonverbal intelligence. On the Beck Depression Inventory (Beck, 1978) a one-way analysis of variance yielded significant differences (F,,,, = 6.3, p = .003). The 2 1 posttraumatic subjects (M = 23.9, SD = 13.5) showed greater depression than the 23 conduct-disordered (M = 17.0, SD = 13.0) and 23 control subjects (M = 11.9, SD = 5.9), at the 5 % significance level (Fisher score of 6.8). Descriptively, scores indicate moderate to severe depression for the posttraumatic subjects and significant depressive trends for the conduct-disordered subjects. On the State-Trait Anxiety Inventory (Spielberger, 1983) only posttraumatic subjects showed significantly h g h (Fisher score = 6.9, p = .05) stateanxiety (n = 21, M = 47, SD = .2) compared with controls (n = 23, M = 39.1, SD = 7.8). A one-way analysis of variance for scores on the Revised Behavior Problem Checklist (Quay, 1979), completed by the adolescents' primary teacher (one for the two hospitalized samples, different ones for the control) yielded robust results (F,,,, = 73.5, p = .0001). Conduct-disordered subjects (M= 88.5, SD = 19.4) differed (p = .05) from posttraumatic subjects (Fisher score of 12.7; M = 61.4, SD = 25.7) and control subjects (Fisher score of 12.4; M = 13.0, SD = 18.5). Descriptively, while conduct-disordered subjects showed more behavior problems than posttraumatic subjects, both displayed severe conduct problems relative to normal controls. A two-way (sex by group) analysis of variance showed that girls earned higher Beck depression scores than boys (F,,,, = 7.8, p = .007), higher traitanxiety (F,,, = 4.2, p = .05), and greater fear on the Wolpe and Lange (1969) Fear Survey Schedule (F,,,, = 6.4, p = .05). These findings are consistent with Western cultural tendencies engendering females' internalizing and males' externalizing of anger. There were no significant interactions of group by sex, indicating that the different sexual composition of the groups did not explain the earlier reported group differences. In summary, posttraumatic adolescents showed associated symptoms of . depression and state-anxiety on self-report measures, conduct-disordered adolescents showed depressive trends, and both groups were evaluated by their teachers as showing significant behavior problems. While the present analyses are consistent with a view of Posttraumatic Stress Disorder and Conduct Disorder as differentiable childhood conditions, further study is warranted to specify environmental antecedents of pathology and how these may contribute to different etiological pathways with potential implications for treatment.
J. A. ATLAS, ETAL. REFERENCES AMERICANPSYCHIATRIC ASSOCIATION. (1987) Diagnostic and statistical manual of mental disorders. (3rd ed., Rev.) Washington, DC: Author. BECK,A. T. (1978) Beck Depression Inventory. Philadelphia, PA: Center for Cognitive Therapy. HARRIS,D. B. (1963) Children's drawings as measures of intellectual maturity. New York: Harcourt, Brace & World. QUAY,H. (1979) Reuised Behavior Problem Checklist. Coral Gables, FL: Univer. of Miami Press. SPIELBERGER, C. D. (1983) Manual for the State-Trait Anxiety Inventory (Se[f-eualuation Questionnaire). Palo Alto, CA: Consulting Psychologists Press. WOLPE, ., & LANG,P. J. (1969) Fear Survey Schedule. San Diego, CA: Educational & Industrial Testing Service. Accepted November 4, 1991.
SYMPTOM CORRELATES AMONG ADOLESCENTS SHOWING POSTTRAUMATIC STRESS DISORDER VERSUS CONDUCT DISORDER1 J. A. ATLAS, W. J. DI SCIPIO, R. SCHWARTZ, AND L. SESSOMS
Bronx Children's Hospital Summary.-21 adolescents with a primary diagnosis of Posttraumatic Stress Disorder, 24 Conduct Disordered, and 23 control adolescents were compared on measures of depression, anxiety, behavior problems, and fears. Analyses showed that posttraumatic adolescents showed associated symptoms of depression and state-anxiety, Conduct Disordered adolescents showed depressive trends, and both groups were evaluated by their teachers as showing significant behavior problems.
The applicability of the term Posttraumatic Stress Disorder to adolescents was evaluated by comparing adolescents diagnosed with Posttraumatic Stress Disorder and Conduct Disorder [by psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987)l and a control sample. While the DSM-111-R does not have a childhood category of Posttraumatic Stress Disorder, its specification of Conduct Disorder includes a reference to harsh environmental conditions as a predisposing factor in Conduct Disorder. In this context one may posit a social-environmental factor in both forms of pathology, raising the question of overlapping versus differentiating features of the two conditions. Twenty-one subjects with a primary diagnosis of Posttraumatic Stress Disorder, 24 Conduct Disordered, and 23 control adolescents were compared. They ranged in age from 11.0 to 18.2 yr., with a mean of 14, and showed no differences among groups. Ethnicity data yielded no group differences. Of 68 subjects, all were nonwhite except two who were white adolescents, one in the posttraumatic group and one in the control group. Eighteen of 21 posttraumatic subjects were drawn from an Acute Adolescent Inpatient Unit (3 were from a day school for emotionally handicapped youngsters), the 24 conduct-disordered subjects were from the same unit, and the 23 control subjects were drawn from a parochial school. The posttraumatic group included 4 boys, the conduct-disordered group 13 boys, and the control group 12 boys. It should be noted that almost all of the hospitahzed adolescents were on psychotropic medication, while the control subjects were not. Available data on the Goodenough-Harris Drawing Test (Harris, 1963)
'Thanks ate expressed to J. Price and A. Miller for research assistance, and to A. Diaz for typing. Request reprints from J. A. Atlas, Bronx Children's Hospital, Albert Einstein College of Medicine, 1000 Waters Place, Bronx, N Y 10461.
SYMPTOM CORRELATES AMONG ADOLESCENTS
92 1
for 15 posttraumatic, 22 conduct-disordered, and 22 control subjects yielded a mean score of 76.0 (range =50-120, SD= 16.7), with no differences among groups, suggesting that differences on the experimental measures were not attributable to nonverbal intelligence. On the Beck Depression Inventory (Beck, 1978) a one-way analysis of variance yielded significant differences (F,,,, = 6.3, p = .003). The 2 1 posttraumatic subjects (M = 23.9, SD = 13.5) showed greater depression than the 23 conduct-disordered (M = 17.0, SD = 13.0) and 23 control subjects (M = 11.9, SD = 5.9), at the 5 % significance level (Fisher score of 6.8). Descriptively, scores indicate moderate to severe depression for the posttraumatic subjects and significant depressive trends for the conduct-disordered subjects. On the State-Trait Anxiety Inventory (Spielberger, 1983) only posttraumatic subjects showed significantly h g h (Fisher score = 6.9, p = .05) stateanxiety (n = 21, M = 47, SD = .2) compared with controls (n = 23, M = 39.1, SD = 7.8). A one-way analysis of variance for scores on the Revised Behavior Problem Checklist (Quay, 1979), completed by the adolescents' primary teacher (one for the two hospitalized samples, different ones for the control) yielded robust results (F,,,, = 73.5, p = .0001). Conduct-disordered subjects (M= 88.5, SD = 19.4) differed (p = .05) from posttraumatic subjects (Fisher score of 12.7; M = 61.4, SD = 25.7) and control subjects (Fisher score of 12.4; M = 13.0, SD = 18.5). Descriptively, while conduct-disordered subjects showed more behavior problems than posttraumatic subjects, both displayed severe conduct problems relative to normal controls. A two-way (sex by group) analysis of variance showed that girls earned higher Beck depression scores than boys (F,,,, = 7.8, p = .007), higher traitanxiety (F,,, = 4.2, p = .05), and greater fear on the Wolpe and Lange (1969) Fear Survey Schedule (F,,,, = 6.4, p = .05). These findings are consistent with Western cultural tendencies engendering females' internalizing and males' externalizing of anger. There were no significant interactions of group by sex, indicating that the different sexual composition of the groups did not explain the earlier reported group differences. In summary, posttraumatic adolescents showed associated symptoms of . depression and state-anxiety on self-report measures, conduct-disordered adolescents showed depressive trends, and both groups were evaluated by their teachers as showing significant behavior problems. While the present analyses are consistent with a view of Posttraumatic Stress Disorder and Conduct Disorder as differentiable childhood conditions, further study is warranted to specify environmental antecedents of pathology and how these may contribute to different etiological pathways with potential implications for treatment.
J. A. ATLAS, ETAL. REFERENCES AMERICANPSYCHIATRIC ASSOCIATION. (1987) Diagnostic and statistical manual of mental disorders. (3rd ed., Rev.) Washington, DC: Author. BECK,A. T. (1978) Beck Depression Inventory. Philadelphia, PA: Center for Cognitive Therapy. HARRIS,D. B. (1963) Children's drawings as measures of intellectual maturity. New York: Harcourt, Brace & World. QUAY,H. (1979) Reuised Behavior Problem Checklist. Coral Gables, FL: Univer. of Miami Press. SPIELBERGER, C. D. (1983) Manual for the State-Trait Anxiety Inventory (Se[f-eualuation Questionnaire). Palo Alto, CA: Consulting Psychologists Press. WOLPE, ., & LANG,P. J. (1969) Fear Survey Schedule. San Diego, CA: Educational & Industrial Testing Service. Accepted November 4, 1991.
