Fifteen years of dissociation in maltreated children: where do we go from here?
Controversies have centered on the prevalence of dissociative symptoms and disorders in children and adolescents, recommended treatment approaches, and the potential effects of suggestive interpersonal influences. Convergence among diverse practitioners describing dissociative children and adolescents with similar symptoms and maltreatment histories supports the occurrence of these symptom patterns. Although prevalence information has not been well studied, dissociative symptoms may be found in children from a variety of settings across a continuum of severity. There is not yet agreement on exact treatment protocols, but successful treatment outcomes have been reported. A challenge for future research is to develop assessment protocols that are derived from multiple sources of data, and to incorporate the latest developmental research findings into theory development that addresses psychobiological, family, and cultural factors. The study of dissociation in children and adolescents has the potential to clarify some puzzling child and adolescent presentations and to identify a process by which some children respond and adapt to traumatic environments.
Sheppard Pratt Health System, 6501 N. Charles Street, P.O. Box 6815, Baltimore, MD 21285-6815, USA. jlsilberg@aol.com
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D001521:Behavior Therapy; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy; D002985:Clinical Protocols; D004213:Dissociative Disorders / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome