Detection of complex interpersonal trauma and asset-based resilience factors in foster care youth five years or younger using latent class analysis

Background: Children less than five years of age comprise the largest entry into foster care in the United State at approximately 30% in 2020. Very young children can respond differently to the same adverse life events. Detection of complex interpersonal traumas are core to providing appropriate interventions and prevention of reoccurring negative outcomes in these youth. Methods: Children with complex interpersonal trauma and who did not have traumatic stress symptoms were identified using Child and Adolescent Needs and Strengths data in a large midwestern state from 2010 to 2021. A logistic model was fit to determine effect of cumulative traumatic exposures (e.g. adverse childhood experiences) with increased events resulting in increased likelihood of symptomatic detection. We conducted a latent class analysis to understand the relationship between traumatic experiences, asset-based factors, and the detection of traumatic stress in children aged five years and under who had exposure to traumatic events but did not have detectable traumatic stress symptoms. Results: We detected three classes of youth described as resilient, missed, and unfolding. Very young children do demonstrate asset-based resilience when faced with traumatic experiences. A subset of children with missed diagnoses exhibit behavioral and mental health types similar to those with detected traumatic stress symptoms. Recognition of resilience in very young children is critical for designing systems that customize approaches of trauma-informed care. Conclusions: Detection of traumatic stress may be more difficult in young children. It is important to assess both traumatic stress and strengths to ensure that children who are resilient after exposure to traumatic experiences (i.e., do not demonstrate traumatic stress symptoms) are not referred to unnecessary interventions. Additional educational approaches are needed to help caseworkers identify symptoms of traumatic stress that mirror symptoms of other behavioral and emotional challenges. Precision medicine approaches are required to best match the interventions to specific needs of young children.