Children who have been maltreated, particularly those who have experienced complex trauma, may experience higher rates of mental health issues and more mental health diagnoses than other children. Some of the most common diagnoses of maltreated children include:
- Post-traumatic stress disorder (PTSD)
- Attention deficit/hyperactivity disorder (ADHD)
- Major depressive disorder (MDD)
- Conduct disorder (CD)/oppositional defiant disorder (ODD)
Since many of the children entering the child welfare system meet the diagnostic criteria for mental health disorders before they enter foster care, it is important that child welfare agencies promote mental health screening and assessment early in the child’s involvement with the system. It is equally important to remember that there is currently no single diagnosis for the full range of issues that can be experienced by children affected by complex trauma. Behavioral health specialists may instead use one or several mental health diagnoses in an attempt to categorize the array of difficulties shown by many traumatized children. However, traditional mental health treatments may not aid traumatized children to better control behaviors and improve social relationships.
For example, in a comprehensive analysis of trauma-informed assessments administered to children who entered foster care in Illinois between 2005 and 2011, the researchers found that it was possible for children to have a mental illness and, at the same time, display trauma symptoms. The primary concern identified was that children did not receive trauma-focused treatment when they were either misdiagnosed with a mental illness or did not meet the criteria for PTSD. In both cases, the critical need to effectively address the trauma symptoms was neglected.
Child welfare agencies must focus on developing effective trauma-based screenings and assessments to capture trauma history and symptoms in children whom they serve, rather than relying solely on mental health screening and diagnoses to pinpoint behavioral and mental health needs. To be effective in this task, the relationship between trauma and mental health, and how decisions about treatment are affected by this interplay, must be understood. Otherwise, a traumatized child's condition may be treated in isolation, thereby ignoring the disarray of the traumatized child’s condition as a whole.