Dissociative Symptoms and Academic Functioning in Maltreated Children: A Preliminary Study

Abstract

Research has identified numerous negative sequelae of child maltreatment that may adversely impact academic functioning (AF). There is limited research, however, on the relationship between specific trauma symptoms, such as dissociation, and poor AF. This cross-sectional study examined the association between dissociative symptoms and multi-informant reports of AF in a sample of maltreated youth with a history of out-of-home care. Participants included 149 youth and their caregivers and teachers. Dissociative symptoms were measured based on youth report, while AF was assessed using: 1) standardized measures of academic achievement, 2) youth-report measures of school membership and perceived academic competence, 3) caregiver reports of youths’ performance in school, and 4) teacher reports of student grades. Results of multiple regression analyses suggested that dissociative symptoms were generally related to poorer AF after controlling for IQ, age, gender, and the total number of school and caregiver transitions. Implications for school personnel are discussed.

Introduction

Child maltreatment is a significant public health problem that affects over one million children in the United States each year (Sedlak et al., 2010). Maltreated children perform significantly worse on standardized achievement tests (Eckenrode, Laird, & Doris, 1993), receive lower grades (Kendall-Tackett & Eckenrode, 1996), need more academic assistance (Crozier & Barth, 2005; Leiter & Johnsen, 1997), have higher absenteeism rates (Leiter & Johnsen, 1997), are more likely to repeat a grade (Kendall-Tackett & Eckenrode, 1996; Scarborough & McCrae, 2010) and are more likely to drop out of school (Buzi, Smith, & Weinman, 1998; Ensminger, Lamkin, & Jacobson, 1996) than children in the general population.

Maltreatment is also associated with mental health problems, such as dissociation, that may impair AF (Hulette, Freyd, & Fisher, 2011; Macfie, Cicchetti, & Toth, 2001). Dissociation is defined as “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment” (APA, 2000, p.519). This psychological response is commonly believed to be a way of coping with severe trauma such as childhood maltreatment (Freyd, 1996; Putnam, 1993). Dissociative symptoms can cause significant problems in everyday life. While the experience of dissociation varies, common symptoms include memory problems, unresponsiveness, and flashbacks (Putnam, 1993). These symptoms might interfere with a child's ability to focus their attention in class and/or bond with their classmates, both of which could lead to poor AF. No known studies have examined the specific relationship between dissociative symptoms and AF, even though dissociation has been associated with other mental health and cognitive problems (e.g., ADHD, impaired executive functioning; DePrince, Weinzierl, & Combs, 2008, 2009; Matsumoto & Imamura, 2007).

This study examined the relationship between dissociative symptoms and AF within a sample of youth placed in foster care as a result of maltreatment. It was hypothesized that maltreated children with greater dissociative symptoms, relative to those with fewer, would evidence poorer AF as measured by standardized test scores, sense of school membership, perceived academic competence, and caregiver- and teacher-rated academic competence.

Method

Participants

Recruitment

Participants were youth involved in a longitudinal evaluation of Fostering Healthy Futures (FHF), a preventive intervention for maltreated children placed in out-of-home care (see Taussig, Culhane, & Hettleman, 2007). The current study did not evaluate the impact of the intervention program. Participants were recruited for the original study if: 1) they were 9-11 years old and had been court-ordered into out-of-home care within the preceding year due to maltreatment; 2) they were proficient in English; and 3) they were not known to be developmentally delayed. Ninety-three percent of eligible youth and their caregivers were recruited (n=162). Data for the current study were collected cross-sectionally during a follow-up assessment conducted approximately 11 months post-baseline. Of those interviewed at baseline, 92% (n=149) completed the follow-up assessment. Participants who were lost to follow-up did not differ from study participants on age, gender, ethnicity, or baseline placement type.

Participant Characteristics

The final sample was 53% female (n=79), with a mean age of 11.33 years (Range=9.50-12.99; SD=0.88 years) at follow-up. Placement types included: kinship care (37.6%), non-relative foster care (32.9%), reunification with biological parents (21.5%), and institutional care (8.0%). The sample of youth was ethnically diverse: 49% Hispanic or Latino/a, 43.6% Caucasian, 30.9% African-American, 12.8% American Indian or Alaska Native, 2.7% Asian, and 0.7% Hawaiian or Pacific Islander (non-exclusive categories).

Procedures

The study was approved by the university's institutional review board and informed consent/assent was obtained. All measures were administered verbally by trained interviewers. Youth and caregivers were each paid $40. Teachers completed a pen and paper survey regarding the child's AF and were paid $25.

Measures of Independent Variables

Dissociative symptoms were measured using the dissociation subscale (DIS) of the Trauma Symptom Checklist for Children (TSCC). The DIS subscale score is a standardized T-score that measures dissociative symptomatology including derealization, emotional numbing, and memory problems. Items include, “going away in my mind” and “feeling like things aren't real.” The DIS subscale has demonstrated good reliability (r=.80-.89) among clinical and non-clinical samples (Briere, 1996).

Control variables included age, gender, total number of school and caregiver transitions, and IQ as measured by the Kaufman Brief Intelligence Test (K-BIT). The K-BIT is a screening measure of intellectual functioning that yields standard scores with a mean of 100 and a standard deviation of 15. The composite score was used for the current study. The composite score is highly correlated with more comprehensive measures of IQ (e.g., the K-BIT IQ Composite is correlated r=.80 with the Wechsler Intelligence Scale for Children Full Scale IQ) and has demonstrated good split-half reliability (r=.88-.95) (Kaufman & Kaufman, 1990).

Measures of Dependent Variables

The Psychological Sense of School Membership (PSSM) scale consists of 18 youth-report items measuring inclusion, involvement, and the student-teacher relationship. Items are rated on a scale from 1 (not at all true) to 3 (very true). Ratings across all items were averaged for each participant. The PSSM has demonstrated high split-half reliability (r=.77-.88) and validity across samples (Goodenow, 1993; Hagborg, 1994, 1998).

The Scholastic Competence (SC) subscale of the Self-Perception Profile for Children consists of 16 items measuring children's perceptions of their academic abilities. This study examined the mean response for each participant, with possible scores ranging from 1 (low SC) to 4 (high SC). This scale has demonstrated high split-half reliability (r=.80-.85) and validity across samples (Harter, 1985).

Caregivers completed the School Scale of the Child Behavior Checklist (CBCL), which incorporates ratings of grades, school problems, and special education or grade repetition. Teachers completed the Academic Performance Scale of the Teacher Report Form (TRF), which reflects teachers’ ratings of youth performance (i.e., grades) relative to his/her grade level. On both scales, higher scores indicate better AF. These measures have demonstrated good test-retest reliability (CBCL r=.80-.94, TRF r=.60-.96) and validity across samples (Achenbach & Rescorla, 2001).

The Wechsler Individual Achievement Test (WIAT) Screener is a brief measure of academic achievement designed for children ages 5-19. The composite score was used in the current study. The WIAT has been shown to have excellent reliability (r=.88-.97) and validity for the age range of the present sample (The Psychological Corporation, 1992).

Data Analysis

Descriptive statistics and bivariate correlations were calculated for independent, dependent, and control variables. Sample sizes varied due to some missing data on dependent variables and are reported in Table 3. A series of multiple regression models was used to estimate the relationships between dissociation and measures of AF, controlling for IQ, age, gender, and number of school and caregiver transitions.

Table 3.

Association between dissociative symptoms and academic functioning

Variables	β	t	p	sr2	Adj. R2
School Membership (n=137)					.10**
Dissociation	−.29	−3.48**	.001	.0 9
IQ	.12	1.50	.137	.02
Gender	−.03	−0.39	.694	.00
Age	−.10	−1.12	.265	.01
Number of Schools	.01	0.12	.906	.00
Number of Caregivers	−.13	−1.42	.159	.02
Academic Competence (n=139)					.10**
Dissociation	−.23	−2.84**	.005	.06
IQ	.26	3.14**	.002	.07
Gender	.02	0.19	.847	.00
Age	−.14	−1.61	.111	.02
Number of Schools	.01	0.15	.884	.00
Number of Caregivers	.06	0.67	.502	.00
WIAT Composite Score (n=136)					.34**
Dissociation	−.15	−2.16*	.033	.0 3
IQ	.57	8.03**	< .001	.33
Gender	.10	1.46	.148	.02
Age	−.05	−0.71	.479	.00
Number of Schools	−.02	−0.27	.784	.00
Number of Caregivers	.02	0.28	.781	.00
Teacher Academic Ratings (n=129)					.20**
Dissociation	−.03	−0.40	.689	.00
IQ	.47	5.82**	< .001	.22
Gender	.07	0.91	.363	.01
Age	−.04	−0.45	.654	.00
Number of Schools	.04	0.47	.640	.00
Number of Caregivers	−.03	−0.39	.699	.00
Caregiver Academic Ratings (n=127)					.28**
Dissociation	−.13	−1.64	.104	.02
IQ	.52	6.79**	< .001	.28
Gender	.03	.44	.658	.00
Age	.02	.30	.764	.00
Number of Schools	−.05	−.53	.597	.00
Number of Caregivers	−.05	−.59	.559	.00

^*p<.05

^**p<.01

Results

Descriptive Statistics and Bivariate Correlations

Descriptive statistics for all study variables can be found in Table 1. Nine percent of youth had dissociation scores within the clinical (T>65) or borderline (T>60) range. The distribution of dissociation scores was relatively normal (M=45.82, SD=9.27) and displayed good variability. The data suggest that, on average, participants felt a strong sense of membership to their schools and reported relatively positive perceived academic competence. The mean score on the WIAT composite scale was 95.22, which is somewhat lower than the mean for the standardization sample. On average, teachers and caregivers tended to rate students on academic performance and school behavior within one standard deviation below the mean of the standardization sample.

Table 1.

Descriptive statistics

Variables	N	M	SD
Dissociation	147	45.82	9.27
IQ Score	149	97.6	12.25
Age	146	11.33	0.88
School Transitions	144	5.85	2.89
Caregiver Transitions	145	5.2	2.71
School Membership	143	2.49	0.33
Academic Competence	145	3.02	0.74
WIAT Composite Score	141	95.22	12.38
Teacher Academic Ratings	136	43.15	8.12
Caregiver Academic Ratings	132	42.10	8.66

Table 2 displays correlations between study variables. Greater dissociative symptoms were associated with lower sense of school membership, poorer perceived academic competence, and lower WIAT scores. Of the control variables, only IQ and number of caregiver transitions were related to dissociation and AF. IQ was positively associated with all five measures of AF. Caregiver transitions were positively related to youths’ sense of school membership. Correlations among control variables indicated that older youth and those who had experienced more caregiver transitions had attended more schools. Generally, measures of AF were positively correlated with one another except that youth-reported school membership and teachers’ academic ratings were not related.

Table 2.

Bivariate correlations

Variable	1	2	3	4	5	6	7	8	9	10	11
1. Dissociation	--
2. IQ Score	−.11	--
3. Gender	−.07	.01	--
4. Age	−.00	.02	.08	--
5. School Transitions	.11	.07	.09	.27**	--
6. Caregiver Transitions	.11	−.09	−.01	.09	.34**	--
7. School Membership	−.28	.18*	−.02	−.06	−.08	.18*	--
8. Academic Competence	−.22	.25**	.02	−.08	−.02	−.02	.46**	--
9. WIAT Composite Score	−.20*	.60**	.10	.02	.01	−.07	.29**	.30**	--
10. Teacher Academic Ratings	−.06	.48**	.08	.01	.06	−.06	.09	.29**	.61**	--
11. Caregiver Academic Ratings	−.17	.54**	.05	.02	−.03	−.11	.19*	.29**	.52**	.36**	--

^*p<.05

^**p<.01

Association between Dissociative Symptoms and Academic Functioning

Table 3 summarizes the results of multiple regression models examining the association between dissociative symptoms and AF. Dissociation was negatively associated with youth reports of school membership, perceived academic competence, and WIAT composite scores, accounting for 9%, 6%, and 3% of the variance in these measures, respectively. Although dissociation was not significantly associated with caregiver or teacher reports of AF, the direction of these relationships was consistent with hypotheses. IQ was significantly related to youth perceptions of academic competence, WIAT composite score, teacher academic ratings, and caregiver academic ratings after controlling for other variables. IQ was not associated with school membership. Age, gender, caregiver transitions, and school transitions were not associated with any measures of AF after controlling for the other variables in the models.

Discussion

The current study examined the relationship between dissociative symptoms and academic functioning (AF) in maltreated children with a history of out-of-home placement. This study used a multi-method, multi-informant design that controlled for age, gender, IQ, and total number of caregiver and school transitions. This study adds to the extant literature by providing a novel explanation for the finding that maltreated children are more likely to struggle in school.

The results suggest that children with more dissociative symptoms tended to have poorer AF as indexed with measures of school membership, academic competence, and standardized achievement tests. Dissociation may hinder children's ability to become actively involved in school, thereby decreasing the likelihood that they will participate in scholastic and/or extracurricular activities, resulting in a poorer sense of school membership. Lack of engagement may explain the relationship between dissociation and lower perceived academic competence. Children who are less engaged in classroom activities or relationships at school may receive lower grades and less frequent praise from teachers and peers, which could precede lower perceived academic competence. Alternatively, poor academic performance may lead to lower perceived competence and school membership, but it is impossible to test the causal direction of the relationships in this study. Future research examining the temporal sequence of these constructs is needed. Finally, children who dissociate may have trouble focusing while taking tests, which could explain why these children score lower on achievement tests.

IQ accounted for a significant amount of variance in all measures of AF except perceived school membership. Factors other than IQ, such as social support from teachers or peers and involvement in extracurricular activities, may play a larger role in children's sense of school membership. Although IQ was highly predictive of almost all outcomes, IQ and dissociation were unrelated bivariately and dissociation predicted academic outcomes even after controlling for IQ. Dissociative symptoms were not predictive of teacher- or caregiver-ratings of AF, although the pattern of findings was similar to the pattern observed for other measures of AF. The caregivers and teachers included in this study might have been suboptimal reporters of AF because the children in this sample frequently changed placements and schools. Caregivers and teachers might not have known children well enough to provide accurate reports.

Future research is needed to investigate potential mechanisms underlying the relationship between dissociation and AF. Impaired executive functioning is one hypothesized mechanism that may explain this relationship. Dissociation is inversely related to executive functions including processing speed, auditory processing, working memory, inhibition, and interference control in school-aged youth (DePrince et al., 2008; 2009). These functions are imperative for academic success. High levels of dissociation may place youth at risk for poor AF, as many of the abilities required for learning and functioning have a high likelihood of impairment. However, dissociation may be adaptive for traumatized youth, as it may help them cope with trauma symptoms (Becker-Blease, Freyd, & Pears, 2004; Freyd, 1996; Putnam, 1993). While it is important to improve AF among maltreated and traumatized children, eliminating dissociative symptoms may not be effective unless trauma symptoms are also remediated and other coping strategies replace dissociation.

Despite the strengths of this study, a number of important factors, including other types of psychopathology, type and severity of abuse, and placement type were not examined. Another limitation is that despite the high-risk nature of the sample, few children (9%) self-reported dissociative symptoms in the borderline or clinical range. This is in contrast to previous studies that have found rates of dissociation ranging from 17%-21% in maltreated samples (Hulette et al., 2011; Macfie et al., 2001; Putnam, 1996). The low level of clinical severity in dissociation scores may limit generalizability to other maltreated samples and may have attenuated the present findings. Future studies are needed to determine whether the relationships found here can be replicated using caregiver or other observer reports of youth dissociation.

Despite these limitations, dissociation offers one cogent explanation for why maltreated children struggle academically. The results of this study have important implications for schools. Violence exposure, a potentially traumatic experience that could induce dissociation, is a problem that extends beyond abuse and neglect. Community violence exposure, for example, is a significant public health concern. Teachers, principals, and other school personnel might benefit from comprehensive education on the prevalence and impact of childhood trauma. A better understanding of the negative consequences of violence exposure will allow schools to provide children with the services they need to reach their full academic potential.