From symptom to diagnosis: Gap between clinical observations and PTSD recognition in child protection

In France, approximately 381,000 minors receive Child Welfare Services (Aide Sociale à l'Enfance, ASE) measures, a population highly exposed to early adversities. Despite the expected high prevalence of trauma-related disorders, screening for post-traumatic stress disorder (PTSD) remains insufficient.

To assess the prevalence of PTSD and complex trauma indicators through systematic analysis of educational case files of adolescents in child protection services. To assess the training needs of child protection professionals regarding psychotrauma.

Retrospective analysis of 50 case files (mean age: 16.7 years) followed by ASE/PJJ between June 2021 and October 2022. Systematic coding of symptoms according to DSM-5 criteria for PTSD and DESNOS (Disorders of Extreme Stress Not Otherwise Specified). Presence criterion: symptom mentioned at least twice in two separate documents. Measuring professionals' own recognition of their training needs on PTSD and complex trauma, following a targeted awareness intervention.

94% of participants exhibited significant PTSD symptomatology indicators (≥15 symptoms out of 30); no formal PTSD diagnosis had been established in any case. Criteria D and E were particularly over-represented. Analysis according to DESNOS confirmed the complex nature of the trauma. All participants had experienced criminally characterized violence, but only 29.7% of incidents had led to a report. All (100%) of the 100 professionals who received psychotrauma awareness training expressed a need for in-depth training.

This study reveals a paradox: a massive prevalence of traumatic indicators (94%) finely described by professionals but not identified as PTSD, due to lack of specific training. These results underscore the need to integrate systematic psychotrauma screening and social worker training into child protection services.