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The relationship between dissociation and academic functioning in maltreated children

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Title:
The relationship between dissociation and academic functioning in maltreated children
Creator:
Perzow, Sarah Elisabeth Dwyer
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English
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viii, 80 leaves : ; 28 cm

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Dissociation (Psychology) ( lcsh )
Abused children ( lcsh )
Academic achievement ( lcsh )
Abused children ( fast )
Academic achievement ( fast )
Dissociation (Psychology) ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Bibliography:
Includes bibliographical references (leaves 70-80).
General Note:
Department of Psychology
Statement of Responsibility:
by Sarah Elisabeth Dwyer Perzow.

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|University of Colorado Denver
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|Auraria Library
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Resource Identifier:
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ocn747426931
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LD1193.L645 2011m P37 ( lcc )

Full Text
i
THE RELATIONSHIP BETWEEN DISSOCIATION AND ACADEMIC FUNCTIONING IN
MALTREATED CHILDREN
by
Sarah Elisabeth Dwyer Perzow
B.A., University of Colorado Boulder, 2009
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
Clinical Psychology
2011


This thesis for the Master of Arts
degree by
Sarah Elisabeth Dwyer Perzow
has been approved
by
Peter S. Kaplan
Kevin Everhart
Christie M. Petrenko
M//6//!
Date


Perzow, Sarah E. D. (MA, Clinical Psychology)
The Relationship Between Dissociation and Academic Functioning in Maltreated Children
Thesis directed by Professor Peter Kaplan
ABSTRACT
Research has identified numerous negative outcomes associated with child
maltreatment. Children who experience abuse or neglect are at high risk for delinquency,
mental and physical illness, and academic problems (Clark et al., 2010; Eckenrode et al.,
1993; Ford et al., 2010; Paolucci et al., 2001; Salzinger et al., 2007; Stith et al., 2009; Taussig,
2002;Thomas et al., 2008). Two factors that are especially prevalent in this population are
trauma symptoms (i.e., dissociation) and poor school performance. The current study
examines the impact of dissociative symptoms on various aspects of academic functioning in
a sample of maltreated youth placed in out-of-home care. Participants include 156 youth
and their caregivers and teachers. Dissociation will be measured through multi-informant
report from youth, caregivers, and teachers. Academic functioning will be assessed as
follows: 1) objective standardized measures of academic achievement, 2) youth perceptions
(e.g., students' sense of membership in their school and their own academic competence),
and 3) teacher reports of student functioning. The relationship between dissociative
symptoms and academic functioning will be examined with multiple regression techniques.
It is hypothesized that a higher level of youth, caregiver, and teacher reported dissociation
symptoms will be associated with poorer academic functioning. The findings of this study
may provide further insight into why maltreated children struggle in school, aide in the
conceptualization and development of intervention and prevention programs for
traumatized children, and lead to a more comprehensive understanding of the effects of
child maltreatment.
This abstract accurately represents the content of the candidate's thesis. I recommend its
publication.
Signed
PeterS. Kaplan


DEDICATION
I dedicate this thesis to my parents, who instilled in me an appreciation for education and
taught me the value of confidence and determination. I also dedicate this to my
grandmother, Ingeborg Perzow, whose support and generosity has enabled me to devote
my time to academics.


ACKNOWLEDGEMENT
Thank you to all of the members of my committee for their valuable insights and expertise. I
especially wish to thank Christie Petrenko, who dedicated so much time and thought to this
project. Finally, thank you to my boyfriend, Eason Jostad, for his unfaltering loyalty and
patience.


TABLE OF CONTENTS
Tables....................................................................viii
CHAPTER
1. INTRODUCTION..............................................................1
Child Maltreatment.......................................................1
Academic Functioning in Maltreated Children..............................4
Measuring Academic Functioning...........................................7
Mental Health and Child Maltreatment....................................10
The Current Study.......................................................14
Aims of the Current Study.......................................... 16
2. METHOD...................................................................17
Participants............................................................17
Recruitment..........................................................17
Participant Characteristics..........................................18
Procedures..............................................................18
Measures................................................................19
Psychological Sense of School Membership.............................19
Scholastic Competence Subscale of the Self-Perception
Profile for Children.........................................19
Teacher Report Form..................................................20
Wechsler Individual Achievement Test Screener........................21
Dissociation Subscale of the Trauma Symptom
Checklist for Children.......................................21
Dissociation Subscale of the Child Behavior Checklist................22
Dissociation Subscale of the Teacher Report Form.....................23
Control Variables..................................................23
Kaufman Brief Intelligence Test..............................24
vi


The "Things I Have Seen and Heard" Scale.....................24
Maltreatment Classification System...........................24
Age, Gender, Number of Schools, and Number of Caregivers.....25
Data Analysis...........................................................25
3. RESULTS.................................................................28
Descriptive Statistics and Bivariate Correlations.......................28
Association between Dissociation and Academic Functioning.............. 33
Youth Report.........................................................33
Teacher Report.......................................................36
Caregiver Report.....................................................39
Summary..............................................................41
Gender Analyses.........................................................41
Correlations by Gender...............................................41
Girls' Reports of Dissociation.......................................45
Teacher Report for Girls.............................................47
Caregiver Report for Girls...........................................49
Boys' Reports of Dissociation........................................51
Teacher Report for Boys..............................................53
Caregiver Report for Boys............................................55
Summary of Gender Differences........................................57
4. DISCUSSION..............................................................58
Limitations and Future Directions....................................67
Summary..............................................................68
REFERENCES..........................................................................70
vii


LIST OF TABLES
Table
3.1 Descriptive statistics of study variables.........................................29
3.2 Bivariate correlations among study variables......................................31
3.3 Association between youth report of dissociation and
academic functioning.....................................................35
3.4 Association between teacher report of dissociation and
academic functioning.....................................................38
3.5 Association between caregiver report of dissociation and
academic functioning.....................................................40
3.6 Bivariate correlations among study variables by gender...........................44
3.7 Association between girls' report of dissociation and
academic functioning.....................................................46
3.8 Association between teacher report of dissociation and
academic functioning for girls...........................................48
3.9 Association between caregiver report of dissociation and
academic functioning for girls...........................................50
3.10 Association between boys' report of dissociation and
academic functioning.....................................................52
3.11 Association between teacher report of dissociation and
academic functioning for boys............................................54
3.12 Association between caregiver report of dissociation and
academic functioning for boys............................................56
vm


CHAPTER 1
INTRODUCTION
Child Maltreatment.
Child maltreatment is a significant public health problem that is associated with
numerous negative outcomes. Child maltreatment encompasses physical abuse, sexual
abuse, neglect, emotional maltreatment, involving the child in illegal activities (i.e., moral
legal maltreatment), and educational maltreatment (Barnett et al., 1993). In 2006,
approximately 905,000 children in the United States (or 12.1 per 1,000) were confirmed
victims of maltreatment (US Department of Health and Human Services, 2008; Appleyard et
al., 2010). The prevalence of child maltreatment has decreased in recent years. In 1997
estimates were closer to 15 per 1,000 children (Veltman & Browne, 2001). Despite this
trend, child maltreatment remains a serious concern that places a large economic burden on
society (Corso & Fertig, 2010; Wang & Holton, 2007). In addition, over half of child
homicides are a result of abuse or neglect (Klevens & Leeb, 2010).
Research has identified multiple factors that place families at risk for child
maltreatment. Recent meta-analyses delineate three categories of risk factors: parent-child
interaction, parent characteristics independent of the child, and child characteristics
independent of the parent (Stith et al., 2009). Parent-child interaction risk factors include
parents perceiving their child as a problem, unplanned pregnancy, quality of the parent-
1


child relationship, parental use of corporal punishment, parenting behavior, and parenting-
related stress. Parent characteristics include mental and physical illness, self-esteem, a
history of child abuse, criminal behavior, personal stress, social support, substance abuse,
unemployment, being a single parent, age, gender, and approval of corporal punishment.
Finally, child characteristics include social competence, externalizing behavior, internalizing
behavior, gender, pre-/neonatal problems, disability, and age (Stith et al., 2009). Of these
factors, those that are especially predictive of child maltreatment include parent anger,
family conflict, family cohesion, parent-child relationship, parent perception of child as a
problem, parent stress, and parent self-esteem (Stith et al., 2009). Awareness of the
numerous factors that place families at risk of child maltreatment provides valuable
information for the treatment and prevention of this problem.
Children who experience maltreatment are at high risk for a number of adverse
outcomes. For example, maltreated children display a greater prevalence of mental health
problems such as depression, anxiety, and attachment disorders (Eckenrode et al., 1993;
Paolucci et al., 2001). These children also suffer from a greater number of physical health
problems than nonmaltreated children, including obesity, asthma, and stressor-related
autonomic nervous system dysfunction (Clark et al., 2010; Ford et al., 2010; Thomas et al.,
2008). Finally, maltreated children often experience adverse outcomes as they enter
adolescence and young adulthood. These include low educational attainment, delinquency,
and teen pregnancy (Paolucci et al., 2001; Salzinger et al., 2007; Taussig, 2002).
2


There are also community consequences associated with child maltreatment.
Estimates of the economic impact of child maltreatment in the United States range from
approximately $65 billion per year (Corso & Fertig, 2010) to upwards of $103 billion per year
(Wang & Holton, 2007), depending on how costs are defined. The majority of costs
associated with child maltreatment are associated with the child welfare system and related
medical and mental health care costs. Secondary costs, such as expenses of special
education and juvenile delinquency services, are also surprisingly high. For example, Wang
& Holton (2007) estimated that $28 billion, or 13%, of the adult criminal justice system costs
can be attributed to past child maltreatment.
Another consequence for some children who have been abused or neglected is out-
of-home placement. This includes foster care, kinship care (placement with relatives), and
institutional care such as residential treatment centers and group homes. Approximately
300,000 children are placed in out-of-home care each year as a result of child abuse or
neglect in the United States (US Department of Health and Human Services, 2009). Because
children who require out-of-home placement have often experienced particularly severe
maltreatment, these children often display especially high levels of delinquency, substance
use, risky sexual behaviors, and self-destructive behaviors (Taussig, 2002). Youth in out-of-
home care also have notably high rates of mental health and academic problems (Evans,
2004; Hulette et al., 2011; Leve & Chamberlain, 2007; Zima et al., 2000), which will be the
focus of the current study.
3


Academic Functioning in Maltreated Children.
Investigations of school performance among maltreated children have consistently
shown that children who have been victims of abuse or neglect struggle in school more than
their peers (e.g., Crozier & Barth, 2005; Eckenrode et al., 1993; Leiter and Johnsen, 1997).
Specifically, research has found that maltreated children perform significantly worse on
standardized achievement tests (Eckenrode et al., 1993), get lower grades (Kendall-Tackett
& Eckenrode, 1996), receive more academic assistance (Veltman & Browne, 2001; Crozier &
Barth, 2005; Leiter & Johnsen, 1997; Scarborough & McCrae, 2010), have higher
absenteeism (Leiter & Johnsen, 1997), and are more likely to repeat grades than children
who have not been abused or neglected (Kendall-Tackett & Eckenrode, 1996; Scarborough
& McCrae, 2010). Further, maltreated children drop out of school at much higher rates than
their non-abused peers (Buzi et al., 1997; Ensminger et al., 1996).
Academic functioning also varies depending on the type of maltreatment. For
example, one study found that children who had been neglected had the lowest academic
performance, whereas physically abused children had more disciplinary problems
(Eckenrode et al., 1993). Children who have experienced sexual abuse tend to have fewer
academic problems than children who have experienced other types of maltreatment
(Eckenrode et al., 1993; Kinard, 2001). However, many instances of child abuse and neglect
involve multiple types of maltreatment (e.g., physical abuse and neglect) (Dong et al. 2004;
Herrenkohl & Herrenkohl, 2007), which may complicate findings regarding these
relationships.
4


Many researchers have theorized about potential mechanisms underlying the
relationship between maltreatment and academic functioning. One possible explanation
stems from developmental theory (Leiter & Johnsen, 1997). Developmental theory suggests
that maltreatment hinders children's cognitive development and results in intellectual
limitations in areas such as language acquisition that negatively impact school performance
(Leiter & Johnsen, 1997). Behavior modification theory provides another theoretical
explanation for why maltreated children so often struggle in school. According to this
theory, child maltreatment is a form of punishment that results in the generalized inhibition
of all behavior, including school involvement (Leiter & Johnsen, 1997). For example, an
abused child may display diminished behavior across environments that may or may not be
directly related to the maltreatment, including less time spent on schoolwork and lowered
engagement in class.
Another explanation for why victims of child maltreatment struggle academically is
provided by social learning theory (Leiter & Johnson, 1997; Kinard, 2001). Social learning
theory states that humans learn behaviors by observing their environment and modeling
others' actions. When applied to child maltreatment, this theory implies that children who
are maltreated learn to respond to situations with violence or other undesirable behaviors.
Further, these children are reinforced to have this response so therefore it maintains into
adulthood (Mihalic & Elliott, 1997). Social learning theory is helpful in explaining the "cycle
of abuse" that is so often seen across generations in families with histories of child
maltreatment. It is also useful in understanding other negative outcomes of child abuse and
5


neglect, such as academic functioning. According to social learning theory, maltreated
children may apply what they learn at home to their academic lives as well, resulting in
disruptive behavior that affects school performance (Leiter & Johnsen, 1997).
Theories provide useful considerations for the mechanisms underlying observed
relationships. However, no theory can encompass all of the possible reasons for an observed
relationship. In the case of child maltreatment, there are countless underlying confounds,
many of which are difficult to isolate, that could be the actual cause of poor academic
performance. These potential confounds may include genetic, environmental, and social
factors. For example, parental cognitive ability and level of educational attainment may
influence children's academic functioning through genetic and social transmission (Plomin et
al., 2001; Harbison et al., 20007). Intrauterine exposure to alcohol or other drugs is highly
associated with lower cognitive ability and poor academic outcomes (Bada et al., 2002).
Other major environmental factors that place children at greater risk for academic failure
include poverty, race, and exposure to community violence (Chapell & Overton, 2002;
Henrich et al., 2004; Schwartz & Gorman, 2003; Wiggan, 2007). Gender has also been shown
to influence academic achievement. Specifically, boys consistently perform at a lower level
and are more likely to be held back a grade than girls (Entwisle et al., 2007).
Recent studies have attempted to address the issue of confounding variables by
controlling for co-occurring, potentially confounding variables. For example, one study
found that children with a history of maltreatment had significantly lower scores on a
commonly used measure of intelligence than non-maltreated children even after controlling
6


for age, type of maltreatment, gender, and ethnicity (Crozier & Barth, 2005). Many other
research studies have taken appropriate steps, such as using relevant control groups (e.g.,
children living in poverty), to control for these threats to validity (e.g., Boden et a I, 2007;
Whitney et al., 2010). These investigations have all supported the conclusion that
maltreated children demonstrate lower academic functioning than non-abused children,
which suggests that maltreatment plays an important mechanistic role in school
performance even after considering other possible explanations.
Measuring Academic Functioning.
Academic functioning can be conceptualized in a number of ways. Objective
assessments of student performance include grades and standardized test scores. As
mentioned above, maltreated children tend to have lower grades and test scores than non-
maltreated children on average (e.g., Crozier, & Barth, 2005; Eckenrode et al., 1993; Leiter &
Johnsen, 1997). Specifically, the standard scores of maltreated children often fall within the
low-average range.
Academic functioning can be also measured subjectively through teacher reports of
student functioning and youth perceptions of their own academic functioning. Teacher
reports have often been used as a method for assessing children's performance in the
classroom and have been shown to be especially effective for this purpose (e.g., Cabell et
al., 2009; Kendall et al., 2007; Vagh et al., 2009). Teachers have reported that maltreated
youth display more internalizing and externalizing problems and obtain lower scores on
7


standardized tests than non-maltreated children (DePaul & Arruabarrena, 1995; Milot et al.,
2010; Wodarski et al., 1990).
Youth perceptions of school functioning include a student's sense of membership or
belongingness to their school (Goodenow, 1993) and their opinions about their own
academic competence (Harter, 1985). Research has demonstrated that maltreated children
are less engaged in academics than their peers, and this disengagement has been found to
partially mediate the relationship between maltreatment and academic functioning (Shonk
& Cicchetti, 2001). Further, students' perceptions of their scholastic competence may be
strongly associated with class engagement, advancement in education, and even drop-out
(Goodenow, 1993). Therefore, school membership and academic self-concept may be
especially meaningful aspects of academic functioning. These constructs are discussed in
more detail below.
School membership has been identified as an important protective factor for
children at risk of poor academic performance or drop-out (Goodenow, 1993). This factor
encompasses four aspects: 1) attachment (a student's personal investment in their school
environment), 2) commitment (a student's compliance with school rules and expectations),
3) involvement (a student's participation in school activities), and 4) belief (a student's trust
in and value of the scholastic institution) (Hagborg, 1994). School membership influences
student grades, self-esteem, school attendance, motivation, drop-out, and classroom
engagement (Anderman, 2002; Barnett et al., 1996; Hagborg, 1994; Kinard, 2001). Further,
along with student goals, school membership has been found to mediate the relationship
8


between the school environment (e.g., quality of relationships with teachers, school
policies, and student motivation), and adolescents' behavioral functioning in school (Roeser
et al., 1996). There are no known studies examining school membership in maltreated
youth.
Academic self-concept, or a student's opinion of his/her own academic abilities, is
another important aspect of school performance (Harter, 1985). Research generally finds
that maltreated children have more negative representations of self than their non-
maltreated peers, even as early as preschool (Bolger et al., 1998; Egeland et al 1983; Harter,
1999; Kaufman & Cicchetti, 1989; Toth et al, 2000). In the general school population, various
studies have demonstrated that students' self-perceptions of their academic abilities
influence their actual achievements (Kinard, 2001; Marsh 2005). Previous studies have
generally not found differences between maltreated and nonmaltreated children's
academic self-perceptions (Kinard, 2001; Trickett et al., 1994; Vondra et al., 1989). However,
maltreated children between six and eight years of age are significantly more likely to
overestimate their abilities in reading and arithmetic than nonmaltreated children (Kinard,
2001). It has been hypothesized that overestimating academic abilities is a defense against
overwhelming feelings of inadequacy that maltreated children experience in so many other
aspects of their lives (Kinard, 2001; Harter, 1985). Maltreated students' global self-concept
has been found to relate to teacher perceptions of children's perceived competence as well
as teacher ratings of student effort and classroom performance (Vondra et al., 1989).
9


Mental Health and Child Maltreatment.
Although theoretical perspectives give insight into why victims of child
maltreatment tend to struggle in school, they do not adequately address the possibility that
poor school performance could be secondary to other negative outcomes of maltreatment.
Children who have been maltreated suffer from a wide array of mental health problems that
can impact school performance. For example, maltreated children often suffer from
internalizing disorders such as anxiety and posttraumatic stress disorder (PTSD), and have
been shown to display more externalizing problems that may result in diagnoses of
Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD)
(Clark et al., 2010; Brown et al., 2006; Kendall-Tackett & Eckenrode, 1996). Dissociation is
another mental health outcome that has received increased attention over recent years,
and will be a focus of the current study as it relates to academic functioning (e.g., DePrince
et al., 2010; Hulette et al., 2008; Kisiel & Lyons, 2001).
Dissociation is defined as "disruptions in the usually integrated functions of
consciousness, memory, identity, or perception of the environment" (American Psychiatric
Association, 1994). This psychological response is commonly believed to be a way of coping
with severe trauma, such as childhood maltreatment (Putnam, 1993). While dissociation
may be adaptive during trauma, these behaviors can cause significant problems in everyday
life. The experience of dissociation varies, and may result in memory problems,
unresponsiveness, and flashbacks (Putnam, 1993). Additionally, dissociation may be
10


extensively underestimated in children because it is a strictly internal experience that may
not be observable (DePrince et al., 2010).
While the Diagnostic and Statistical Manual of Mental Disorders (DSM) recognizes a
range of Dissociative Disorders that are characterized by severe dissociative experiences,
dissociative behavior is not uncommon among normally-developing children (Putnam,
1993). For example, children often daydream or engage in make-believe play, both of which
are aspects of dissociation. However, in severe cases, dissociation can be maladaptive and
harmful. Trauma often results in dissociation that can cause disturbances in memory and
sense of self (Putnam, 1993). In other words, chronic dissociation interferes with an
individual's ability to encode information and identify with the world around them.
Dissociative symptoms often occur in conjunction with other significant mental health
problems such as Posttraumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder
(OCD), and Reactive Attachment Disorder (RAD) (ISSD, 2004). While diagnosable dissociative
disorders are relatively uncommon in maltreated children, the prevalence of dissociative
symptoms reported in this population ranges from 19% to 73% (Silberg, 2000). This large
range could be a result of variation in measures used to assess dissociation or differences in
terms of sample characteristics and risk level.
Research has demonstrated that dissociation is much more common in children who
have experienced maltreatment. For example, Macfie et al. (2001) found that maltreated
children displayed more dissociative symptoms than nonmaltreated children, and that this
was especially true for physically and sexually abused children. Similarly, children who have
11


been maltreated and placed in out-of-home care have higher levels of dissociation than
children who have no history of maltreatment or out-of-home placement (Hulette et al.,
2011). Dissociation symptoms may also vary by gender. For example, one recent study
found that girls living in foster care as a result of maltreatment were significantly more likely
to experience dissociative symptoms than boys in the same situation (Hulette et al., 2011).
The literature on gender differences in dissociative symptoms in adulthood is more mixed.
Some studies have found higher levels of dissociative symptomatology and disorders in
women (e.g., American Psychiatric Association, 1994; Saxe et al., 1993), while others have
not found gender differences (e.g., Green, 1998; Spitzer et al., 2003; Tyler et al., 2004).
Additional studies are needed to better understand potential gender differences in
dissociation.
Like many other psychological constructs, it is debated whether dissociation is a
continuous or categorical variable. Dissociation has traditionally been considered
continuous, or dimensional (Putnam, 1997). This view maintains that dissociative
experiences range from normal to pathological levels along a continuum (Waller et al.,
1996). However, recent studies have suggested that dissociation is more typological in
nature (Chu & DePrince, 2006). The typological argument is known as the Discrete
Behavioral States (DBS) model. The DBS model proposes that pathological dissociation is a
distinct experience entirely separate from normal dissociation such as imaginary play. This
state is believed to result from children's inability to integrate different states of
consciousness (Chu & DePrince, 2006). Most dissociation scales (e.g., the Dissociative
12


Experiences Scale (DES), the Trauma Symptom Checklist for Children (TSCC)) are designed to
measure dissociation on a continuum (Waller et al., 1996).
Dissociative symptoms in children are most commonly assessed through self or
caregiver report of symptoms, clinical interviews, and/or observation (ISSD, 2004). While
not diagnostic, self-report questionnaires may be particularly useful for screening children
who are at heightened risk for dissociative symptoms. There are instruments that have been
developed specifically to assess symptoms of dissociation (e.g., the Dissociative Experiences
Scale [DES] and the Perceptual Alteration Scale [PAS]). In addition, broader instruments such
as the Trauma Symptom Checklist for Children (TSCC) measure multiple clusters of
symptoms, including dissociation, which can co-occur in children who suffer from other
psychological disorders (e.g., posttraumatic stress, anxiety, and depression). Caregiver-
report of dissociative symptoms can also provide insight into a child's posttraumatic
experience. Dissociative symptoms are often measured using caregiver report on the Child
Dissociative Checklist (CDC). The Child Behavior Checklist (CBCL) can also be used to derive
scales similar to those created for other studies measuring caregiver reports of youth
dissociation (e.g., Ogawa et al. 2001; Sim et al., 2005). These subscales have consistently
demonstrated good convergent validity with other measures of dissociation, including the
CDC (Hulette et al., 2008; Sim et al., 2005).
Dissociation can impact virtually all aspects of an individual's life. For example,
cognitive functioning may be impacted by dissociation. Dissociation has been shown to
influence performance on divided attention tasks such as the Stroop task, a laboratory test
13


that requires participants to read a word that is written in an incongruent color (e.g., the
word green appears in red) (DePrince et al., 2008; Freyd & DePrince, 1999). Research has
also identified a relationship between speech-language disorders and dissociation, finding
that children with speech-language problems report more dissociative symptoms (Yehuda,
2005). Additionally, Narang and Contreras (2003) found that dissociation may mediate the
intergenerational cycle of abuse, in which children who are abused grow up to become
abusive.
Although dissociation has been examined in conjunction with various problems, its
relationship with academic functioning has received limited study. As noted previously,
there is evidence that dissociation influences executive functioning (DePrince et al., 2008),
but there are no known studies that examine the effect of dissociation on school
performance. It is likely that children with dissociative symptoms have more trouble
focusing in class and may have more behavioral problems than those who do not have these
experiences. Therefore, research in this area is needed and could provide insight into
another reason why maltreated children struggle academically.
The Current Study.
The purpose of this study was to investigate the relationship between dissociation
and academic functioning in children with a history of trauma, which has not been examined
previously. Multi-informant reports were utilized to assess dissociative symptoms and
academic functioning. Multiple methods including objective assessment of academic
14


achievement as well as teacher and youth reports inform the conceptualization of academic
functioning. Although youth self-reports of school membership and academic self-concept
are less objective than other aspects of academic functioning, these concepts are especially
meaningful. A student's perceptions of school may be strongly associated with class
engagement, advancement in education, and risk of drop-out (Goodenow, 1993). Therefore,
a more in-depth understanding of school membership and academic self-concept and how
they relate to dissociative symptoms may help explain why traumatized children struggle in
school. These findings may also identify ways to prevent some of the consequences of poor
academic achievement. The inclusion of multi-method and multi-informant measures of
academic functioning results in a more reliable assessment of this variable.
The results of this study have the potential to provide further insight into the
experiences of children who have been maltreated and placed in out-of-home care. This
study identified whether dissociation is associated with the poor academic outcomes seen in
maltreated children. These findings could be used to aid in the conceptualization and
development of intervention and prevention programs for traumatized children and,
ultimately, lead to a more comprehensive understanding of the effects of child
maltreatment.
15


Aims of the Current Study.
Aim 1: To determine whether dissociation is associated with standardized test
scores of academic achievement in a preadolescent sample of maltreated youth in
out-of-home care. It is hypothesized that a higher level of youth, caregiver, and
teacher reported dissociation symptoms will be associated with lower standardized
test scores.
Aim 2: To determine whether dissociation is associated with teacher perception of
student classroom performance in a preadolescent sample of maltreated youth in
out-of-home care. It is hypothesized that a higher level of youth, caregiver, and
teacher reported dissociation symptoms will be associated with poorer classroom
performance as rated by teachers.
Aim 3\ To determine whether dissociation is associated with student self-
perceptions and sense of school membership in a preadolescent sample of
maltreated youth in out-of-home care. It is hypothesized that a higher level of
youth, caregiver, and teacher reported dissociation symptoms will be associated
with lower academic self-concepts and a poorer sense of school membership, as
reported by youth.
16


CHAPTER 2
METHOD
Participants.
Recruitment. Participants in the current study were nine to thirteen year-old youth involved in
a longitudinal evaluation of a preventive intervention program for maltreated children placed
in out-of-home care (see Taussig, Culhane, & Hettleman, 2007 for a description of the
intervention). All of the data analyzed in the current study were gathered as part of a follow-
up assessment conducted between eight and twelve months post-baseline. Participants were
recruited for the original study if they met the following inclusion criteria: 1) they were nine to
eleven years old and had been court-ordered into out-of-home care within the preceding
twelve months due to maltreatment; 2) they were proficient in English; and 3) they were not
cognitively impaired (all participants had a full scale IQ above 70). To avoid issues of non-
independence, when multiple members of a sibling group were eligible, one sibling was
randomly selected to be included in the longitudinal study. Ninety-two percent of eligible
youth and their caregivers completed interviews at the baseline assessment. Of the 171 youth
and their caregivers interviewed at baseline for the current study, 87.13% (n = 149) completed
the follow-up assessment. Results of t-tests and chi-square analyses indicated that
participants who were lost to follow-up (n = 22) did not differ from study participants on
17


demographic characteristics such as age, gender, and ethnicity or on placement type at
baseline.
Participant Characteristics. The final sample for the current study of 149 youth was 53%
female (n = 79), with a mean age of 11.33 years (Range = 9.50-13.00; SD = .88). Youth were
living in the following settings at the time of the follow-up: kinship care (36.9%), foster care
(31.5%), with biological parents (21.5%), and in institutional care (8.1%) (e.g., group homes,
shelters, and residential treatment centers). The sample of youth was ethnically diverse,
with 49% of youth reporting their race/ethnicity as Hispanic or Latino, 43.6% as Caucasian,
30.9% as African-American, 12.8% as American Indian or Alaska Native, 2.7% as Asian, and
0.7% as Hawaiian or Pacific Islander (non-exclusive categories).
Procedures.
All procedures and measures were approved by the university's institutional review
board and were carried out only after obtaining consent from caregivers and assent from
youth. Youth and caregivers were interviewed in separate rooms at their residence or another
community location. All measures were administered verbally by the interviewer. This
technique helped to ensure that participants were engaged in the assessment process and
understood the questions. Youth interviews took between two and four hours to complete,
while caregiver interviews lasted between one and three hours. Youth and caregivers were
each paid $40 for their participation. Following appropriate consents, teachers were contacted
18


by research staff and were asked to complete a survey regarding the child's academic, social,
emotional, and behavioral functioning in the classroom. Teacher surveys took approximately
thirty minutes to complete and teachers were paid with $25 for their participation.
Measures.
Academic functioning.
Psychological Sense of School Membership (PSSM). The PSSM is a youth-report
survey that measures children's sense of membership to their school. It consists of 18 items
that are rated on a scale from one to three (1 = not at all true, 2 = somewhat true, and 3 =
very true). These items measure feelings of inclusion (e.g., "I feel like a real part of my
school"), school involvement (e.g., "I am included in lots of activities at my school"), and
student-teacher relationship (e.g., "Most teachers at my school are interested in me")
(Goodenow, 1993). The PSSM has demonstrated high internal consistency (r = .77-.88) and
validity across samples (Goodenow, 1993; Hagborg, 1994,1998). For the purpose of this
study, the mean of each participant's responses were examined. This indicates, overall,
whether a student is feeling not at all attached to their school (scores around 1), somewhat
attached to their school (scores around 2), or very attached to their school (scores around
3).
Scholastic Competence (SC) subscale of the Self-Perception Profile for Children (SPC).
The SPC is a measure of children's self-perceptions (Harter, 1985). It includes six subscales:
19


scholastic competence, social acceptance, athletic competence, physical appearance,
behavioral conduct, and global self-worth. Items on this measure describe two types of
children (i.e., some kids like the kind of person they are, but other kids often wish they were
someone else), and the child being assessed is asked to choose which child s/he is most like
and then to decide whether the statement is "really true" or "sort of true" for them (Harter,
1985). Items are scored on a scale from one to four, with one indicating low self-perceptions
and four indicating high self-perceptions.
Only the scholastic competence (SC) scale was examined for this study. The SC
subscale measures children's perceptions of their own academic abilities and consists of six
items (Harter, 1985). These include, "some kids feel that they are very good at their school
work but other kids worry about whether they can do the school work assigned to them",
and "some kids feel like they are just as smart as other kids their age but other kids aren't so
sure and wonder if they are as smart" (Harter, 1985). This scale has been shown to have
high internal consistency (r= .80-.85) and validity across samples (Harter, 1985). The current
study examined the mean response for each participant, ranging from one (low perceived
scholastic competence) to four (high perceived scholastic competence).
Teacher Report Form (TRF). The TRF is the teacher report version of the Child
Behavior Checklist (CBCL). Items relating to academic functioning (e.g., teacher report of
current academic performance, teacher comparison to other pupils) were examined in
relation to dissociation symptoms in the current study. The items include, "how hard is
he/she working", "how appropriately is he/she behaving", "how much is he/she learning",
20


and "how happy is he/she". Teachers rated their pupils on a scale of one to seven compared
to typical pupils of the same age, where 1 = much less, 4 = about average, and 7 = much
more. Teacher responses for each of the four items were summed to create one overall
rating for each participant. The TRF has been shown to have good internal consistency (r =
.71-.96) and validity (Achenbach & Rescorla, 2001).
Wechsler Individual Achievement Test (WIAT) Screener. Academic functioning was
measured objectively using the WIAT Screener. This brief measure of academic achievement
is designed for use with children ages five to nineteen and consists of three subtests (basic
reading, mathematics reasoning, and spelling) (The Psychological Corporation, 1992). Each
subtest produces a raw score that is converted to a standard score according to age-specific
normative data. These standard scores have a mean of 100 and a standard deviation of 15.
The scores for each of the three subtests can also be combined into a composite score of
academic achievement. This measure has been shown to have excellent reliability (r = .88-
.97) and validity for the age range of the present sample (The Psychological Corporation,
1992).
Dissociation.
Dissociation (DIS) subscale of the Trauma Symptom Checklist for Children (TSCC). The
TSCC was developed for children ages eight to sixteen and is used to assess the effects of
childhood trauma (Briere, 1996). This measure is particularly relevant for maltreated youth
given their histories of trauma. The TSCC is a psychometrically sound tool that consists of six
21


scales (anxiety, depression, posttraumatic stress, dissociation, anger and sexual concerns)
and two validity scales (underresponse and hyperresponse). High intercorrelations have
been found between the TSCC and caregiver report on the Child Behavior Checklist (CBCL)
externalization (r = .13-.31) and internalization (r = .08-.23) scales (Briere, 1996). The TSCC
was separately normed for boys and girls in order to control for any discrepancies due to
gender (Lanktree et al., 2008).
The dissociation subscale (DIS) measures mild and moderate dissociative
symptomatology such as derealization, emotional numbing, and memory problems. This
scale consists of two subscales: Overt dissociation (DIS-O) and fantasy (DIS-F) (Briere, 1996).
Items from this scale include, "going away in my mind, trying not to think", "feeling like
things aren't real", "pretending I am somewhere else", and "my mind going empty or blank"
(Briere, 1996). Children with clinical elevations on the DIS subscale often appear
unresponsive and detached and may avoid negative affect (Briere, 1996). This scale has
been found to have good reliability (r = .80-.89) among clinical and non-clinical samples
(Briere, 1996).
Dissociation subscale of the Child Behavior Checklist (CBCL). The CBCL is a caregiver
report measure that assesses a variety of behavioral and emotional problems in children
and adolescents. Respondents rate items using a scale from zero to two (0 = not true, 1 =
somewhat or sometimes true, 2 = very true or often true). The CBCL has been shown to
have good reliability and validity (Achenbach & Rescorla, 2001). Dissociation subscales have
been created with items from the CBCL for use in other studies (e.g., Ogawa et al., 2001; Sim
22


et al., 2005). These subscales have consistently demonstrated good convergent validity with
other measures of dissociation, such as the Child Dissociative Checklist (CDC) (Hulette et al.,
2008).
For the purpose of this study, caregiver report of youth dissociation will be
measured using the subscale created by Sim et al. (2005). The items on this subscale include
"confused or seems to be in a fog", "daydreams or gets lost in his/her thoughts", and "stares
blankly". This subscale was found to correlate with the dissociation subscale of the TSCC
(r(45) = .31, p < .05) (Sim et al., 2005).
Dissociation subscale of the TRF. No known studies have created dissociation
subscales using the TRF, but most items on this measure are identical to those on the
caregiver version. Therefore, for the purpose of this study, the CBCL dissociation subscale
created and validated by Sim et al. (2005) will also be used to measure teacher report of
youth dissociation.
Control Variables.
Several variables were selected a priori to be included as control variables in
multivariate regression analyses, given their hypothesized relationships with the constructs
of dissociation and academic functioning in this sample. These variables include intellectual
functioning (IQ), community violence exposure (CVE), maximum maltreatment severity, the
total number of schools each youth had attended throughout their lifetime, the total
number of caregivers each youth had lived with over their lifetime, age, and gender.
23


The Kaufman Brief Intelligence Test (K-BIT). The K-BIT (Kaufman, 1990) is a screening
measure of intellectual functioning that yields verbal, nonverbal, and composite estimates
of IQ. The original version of the K-BIT includes two verbal subtests (expressive vocabulary
and definitions) and one nonverbal subtest (matrices). The Composite Score was used for
the current study. Split-half reliability coefficients for the K-BIT IQ composite range from .88-
.95 for the age range of the current study (Kaufman, 1990). Correlations with more
comprehensive measures of IQ are generally high (e.g., K-BIT IQ Composite r = .80 with
Wechsler Intelligence Scale for Children Full Scale IQ) (Kaufman, 1990). This measure was
only administered during the baseline interview.
The "Things I Have Seen and Heard" Scale. An adapted, twelve-item version of the
"Things I Have Seen and Heard" scale (Richters & Martinez, 1993) was administered to
youth as a measure of community violence exposure (CVE). Youth were asked to indicate
the number of times in the past year they had seen or heard acts such as, "guns being shot",
"someone being arrested" or "someone stealing something from a store or another person's
house." Responses were provided on a five-point scale, with 0 = never and 4 = four or more
times. The mean of the twelve items was computed to create an average score of
community violence exposure.
Maltreatment Classification System. Severity for various types of maltreatment was
assessed using the Maltreatment Classification System (Barnett et al., 1993) to code social
histories completed by caseworkers and legal petitions filed in the dependency and neglect
court proceedings. Two to three trained research assistants coded each petition and history
24


and final codes for each maltreatment type (i.e., yes/no and severity rating) were
determined by consensus or in consultation with senior investigators when necessary.
Coded maltreatment types included physical abuse, sexual abuse, failure to provide, lack of
supervision, emotional abuse, moral/legal maltreatment (e.g., exposing or involving children
in illegal activities), and educational neglect. Severity was rated for each type of
maltreatment on a scale from one to five, with five representing the greatest severity. The
developers of the rating system report an overall kappa of .60 and adequate estimates of
interrater agreement (.67-1.0) (Manly, 1994). For the purpose of the current study, the
maximum severity recorded across maltreatment types for each participant was the value
included in all analyses.
Age, gender, total number of schools, and total number of caregivers. The other
control variables included in this study were age, gender, total number of schools, and total
number of caregivers. These were all measured using youth report. Youth provided their
birthdates and gender at the beginning of the survey. Total number of schools and total
number of caregivers were calculated by adding together youth-reported school and
placement history during the baseline interview and again during the follow-up interview.
Data Analysis.
All data scoring and entry were rechecked prior to analyses in Statistical Package for
the Social Sciences (SPSS) version 17. Descriptive statistics and bivariate correlations were
calculated for all dependent, independent, and control variables and are presented in tables
25


below. Multiple regression models were utilized to examine the relationship between
dissociation and academic functioning, controlling for age, gender IQ, CVE, maximum
maltreatment severity, total number of schools, and total number of caregivers. Data
reduction techniques (e.g., principal components) were considered for measures of
dissociation, but multi-informant dissociation variables could not be combined to represent
a unitary construct. Therefore separate analyses were conducted for each academic
outcome (standardized test score, teacher report, and youth report) for each reporter of
dissociation. The same control variables were included in all analyses, regardless of whether
they were significantly correlated in bivariate analyses. This was done so that all analyses
would be consistent and so that interpretations could be made across reporters and
measures. The assumptions for multivariate regression, including independence,
homogeneity of variance, and multivariate normality, were examined visually through
histograms and P-P plots of standardized residuals. All residuals were independent and
approximated a normal distribution. No marked deviations were identified in terms of
homogeneity of variance. All regression weights are reported as standardized beta
coefficients. With a sample size of 149, power analyses utilizing GPOWER software (Faul et
al., 2007) suggest this study is sufficiently powered to detect small to medium effects (small
f = .02, medium f2 = .15, large f2 = .35 (Cohen, 1988)). Specifically, with an alpha set at .05,
assumed power of .80, and seven predicting variables, regression analyses should be able to
detect an effect size of f2 =.10.
26


Analyses were also conducted to examine the relationship between academic
functioning and dissociation by gender. Specifically, the association between each measure
of academic functioning and each report of dissociation was investigated for boys and girls
separately. With a sample size of 79 girls and 70 boys, power analyses utilizing GPOWER
software (Faul et al., 2007) suggest this study is sufficiently powered to detect medium to
large effects (small f2 = .02, medium f2 = .15, large f2 = .35 (Cohen, 1988)) for boys and girls
separately. Specifically, with an alpha set at .05, assumed power of .80, and seven predictor
variables, regression analyses should be able to detect an effect size off2 = .20 for girls
and f2 = .23 for boys.
27


CHAPTER 3
RESULTS
Descriptive Statistics and Bivariate Correlations.
Descriptive statistics for all study variables can be found in Table 1. On average,
students felt a strong sense of membership to their schools and displayed relatively positive
academic self-concepts. Teachers tended to rate students in the low-average to average
range relative to their peers. Mean scores on the WIAT Composite were within the average
range. As a group, youth reported dissociation symptoms in the average range. Nine youth
had dissociation scores within the clinical range (> 65), and four additional youth had scores
in the borderline range (60-64). The majority of variables approximated a normal
distribution. Number of schools attended had the highest kurtosis value and was positively
skewed. Community violence exposure also displayed a high kurtosis value and had a slightly
positive skew, indicating that the majority of youth in this sample reported exposure to
community violence exposure but a few had very little or no exposure to community
violence.
28


Table 1: Descriptive statistics of study variables
Variables N Min. Max. M SD Skewness Kurtosis
Mean School Attachment 143 1.39 2.94 2.49 0.33 -1.03 0.70
Mean Academic Self-Concept 145 1.00 4.00 3.02 0.74 -0.35 -0.75
Teacher Academic Ratings 138 4.00 28.00 14.48 5.59 0.11 -0.46
WIAT Composite Score 141 68.00 130.00 95.22 12.38 0.03 -0.19
Youth Reported Dissociation 147 35.00 77.00 45.82 9.27 1.22 1.14
Caregiver Reported Dissociation 145 0.00 6.00 1.40 1.46 1.18 1.17
Teacher Reported Dissociation 140 0.00 6.00 1.42 1.54 1.13 0.75
Mean CVE 145 0.00 3.50 0.39 0.52 2.54 9.44
Max. Maltreatment Severity 147 0.00 5.00 3.33 1.20 -0.65 0.31
IQ Score 149 57.00 121.00 97.60 12.25 -0.63 0.32
Age 146 9.50 13.00 11.33 0.88 0.02 -1.15
Number of Schools 144 2.00 25.00 5.85 2.89 3.41 19.08
Number of Caregivers 145 2.00 13.00 5.20 2.71 1.06 0.63
Bivariate correlations for all study variables can be found in Table 2. While all four
measures of academic functioning were positively correlated, rvalues (ranging from .26-.46;
all p values < .01) suggest measures are not redundant and each provides unique
information regarding youth's academic functioning. Youth and Caregiver reports of youth
dissociation were significantly correlated, but only shared 5% of variance. Teacher report of
youth dissociation was not significantly related to youth or caregiver reports. Given the
relatively low intercorrelations among reports of youth dissociation symptoms, data
reduction approaches (i.e., principal components analysis) were not utilized. Youth- and
teacher-reported dissociation symptoms were both negatively correlated with measures of
school membership and academic self-concept. Reports of more frequent dissociation
29


symptoms were related to lower school membership and academic self-concept. Youth
report of dissociation symptoms was also negatively correlated with academic achievement
scores (WIAT). Teacher reports of youth dissociation were negatively related to teacher
ratings of youths' academic functioning in the classroom. Caregiver report of youth
dissociation was not bivariately related to any of the four measures of academic functioning.
30


Table 2: Bivoriote correlations among study variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12
1. Mean School Attachment ..
2, Mean Academic Self-Concept .46" -
3. Teacher Academic Ratings .26" .33 -
4. WIAT Composite Score .29" .30** .40" --
5-Youth Reported Dissociation -.28" -.22" -.14 -.20* --
6, Caregiver Reported Dissociation -.09 -.15 .09 -.01 .22 -
7.Teacher Reported Dissociation -.22* -.21* -.52" -.16 .08 .14 --
8. Mean CVE -.44 -.32 -.35" -.15 .42 -.02 .12 -
9. Maximum Maltreatment Severity .09 .07 .13 .16 -.06 -.04 .01 -.11 -
10. K-BIT IQ Score .18* .25" .31** .60" -.11 -.08 -.10 -.20* .17* --
11. Gender -.02 .02 -.11 .10 -.07 -.13 .16 .02 .04 .01 -
12. Age -.06 -.08 .04 .02 .00 -.11 -.12 .12 -.05 .02 .08 -
13. Number of Schools -.08 -.02 .01 .01 .11 .04 .03 .09 .03 .07 .09 .27"
14, Number of Caregivers .18* -.02 -.22" -.07 .1! .03 .12 .13 .02 -.09 -.01 .09
* p < .05," p < ,01


Of the control variables included in this study, only community violence exposure
(CVE), intellectual functioning (IQ), and number of caregivers were related to independent
or dependent variables. CVE had relatively large negative correlations with school
membership, academic self-concept, and teacher ratings of academic functioning. These
patterns indicate that higher levels of CVE were related to lower subjective ratings of
academic functioning. CVE was also positively related with youth reports of dissociation
symptoms. Youth who reported higher levels of CVE, also reported more frequent
dissociative symptoms. IQ was positively related to all four measures of academic
functioning, indicating that youth with higher intellectual capacities displayed generally
higher academic functioning. IQ was also associated with CVE and maximum maltreatment
severity. Youth with higher IQ scores reported lower exposure to community violence and
more severe maltreatment. The number of caregivers youth had lived with throughout their
lifetime was negatively related to teacher reports of academic functioning and youths' sense
of membership to their schools. Youth who had a higher number of caregiver transitions
were rated as having poorer academic functioning by teachers. Among control variables,
older youth and those who had experienced more caregiver transitions were more likely to
have attended a greater number of schools.
32


Association between Dissociation and Academic Functioning.
Youth Report. Table 3 displays the results of the multiple regression analyses
examining the association between youth report of dissociation symptoms and measures of
academic functioning. Regression models including youth report of dissociation and all
control variables accounted for a significant amount of variance for each of the four
academic outcomes: School membership (R2 adj. = .25, F (8,125) = 6.64, p < .001), academic
self-concept (R2 adj. = .14, F (8,127) = 3.65, p = .001), teacher academic ratings {R2 adj. = .17,
F (8,119) = 4.30, p < .001), and WIAT composite score (R2 adj. = .33, F (8,123) = 9.14, p <
.001).
When predictors were examined separately for each model, results of these
analyses indicated that youth report of dissociation was only a significant predictor of school
membership after controlling for CVE, IQ, maltreatment severity, total number of schools,
total number of caregivers, age, and gender. Dissociation symptoms uniquely accounted for
3% of the variance in school membership. Youth report of dissociation approached
significance for the WIAT composite score, accounting for 2% of the variance in WIAT scores.
CVE was a significant predictor of school membership, academic self-concept, and teacher
academic ratings after controlling for other variables and uniquely accounted for 12%, 4%,
and 7% of the variance, respectively. IQ was a significant predictor of academic self-concept,
teacher academic ratings, and WIAT composite score after controlling for other variables.
Number of caregivers was also significant for teacher academic ratings, uniquely accounting
for 3% of the variance in this measure of academic functioning. Maltreatment severity, total
33


number of schools, age, and gender were not associated with academic functioning for any
of the four measures examined.
34


Table 3: Association between youth report of dissociation and academic functioning
Variables 6 t P sf Adj. R2
Mean School Membership (N = 134) * .25
Age -.05 -0.59 .555 .00
CVE -.39 -4.6l <.001 .12
Gender -.01 -0.11 .909 .00
IQ .06 0.77 .441 .00
Maltreatment Severity .05 0.70 .486 .00
Number of Schools .03 0.37 .714 .00
Number of Caregivers -.11 -1.31 .193 .01
Youth Dissociation -.18 -2.18* .031 .03
Mean Academic Self-Concept (N = 136) .14
Age -.10 -1.15 .252 .01
CVE -.24 -2.63* .010 .04
Gender .03 0.35 .725 .00
IQ .22 ** 2.64 .009 .04
Maltreatment Severity .01 0.07 .947 .00
Number of Schools .02 0.16 .872 .00
Number of Caregivers .07 0.85 .400 .01
Youth Dissociation -.15 -1.67 .098 .02
Teacher Academic Ratings (N = 127) .17
Age .10 1.22 .226 .01
CVE -.29 -3.21 .002 .07
Gender -.12 -1.46 .148 .01
IQ .21 * 2.54 .012 .04
Maltreatment Severity .06 0.76 .450 .00
Number of Schools .06 0.62 .539 .00
Number of Caregivers -.20 -2.26* .026 .03
Youth Dissociation .05 0.58 .564 .00
WIAT Composite Score (N = 132) .33
Age -.04 -0.55 .582 .00
CVE .05 0.63 .529 .00
Gender .09 1.29 .199 .01
IQ .57 7.60** <.001 .29
Maltreatment Severity .07 0.97 .333 .01
Number of Schools -.03 -0.36 .722 .00
Number of Caregivers .01 0.15 .878 .00
Youth Dissociation -.16 -1.94t .055 .02
+ p = .055; p < .05; ** p < .01
35


Teacher Report. Results of the multiple regression analyses examining the
association between teacher report of dissociation symptoms and measures of academic
functioning can be found in Table 4. Regression models including teacher report of
dissociation and all control variables accounted for a significant amount of variance for each
of the four academic outcomes: School membership (R2 adj. = .26, F (8,118) = 6.47, p <
.001), academic self-concept (R2 adj. = .15, F (8,119) = 3.76, p = .001), teacher academic
ratings (R2 adj. = .36, F (8,119) = 9.81, p < .001), and WIAT composite score (R2 adj. = .34, F
(8,115) = 8.85, p < .001). The TRF dissociation scale was a robust predictor of academic
functioning, even after controlling for CVE, IQ, maltreatment severity, total number of
schools, total number of caregivers, age, and gender. Teacher report of dissociation was a
significant predictor of school membership, academic self-concept, and teacher report of
academic functioning on the TRF and uniquely accounted for 4%, 3%, and 18% of the
variance, respectively. Teacher-reported dissociation approached significance for the WIAT,
accounting for 2% of the variance in standardized scores.
Youth whose teachers reported higher levels of dissociation on the TRF had
significantly lower scores on measures of academic functioning. The pattern seen in youth
report of dissociation for CVE and IQ was also seen for teacher report of dissociation. CVE
was a significant predictor of school membership, academic self-concept, and teacher
academic ratings after controlling for other variables. CVE uniquely accounted for 17% of
the variance in school membership, 7% of the variance in academic self-concept, and 5% of
the variance in teacher academic ratings. IQ was a significant predictor of academic self-
36


concept, teacher academic ratings, and WIAT composite score after controlling for other
variables, uniquely accounting for 5%, 3%, and 29% of the variance, respectively. Number of
caregivers approached significance, accounting for 2% of the variance in teacher academic
ratings. Maltreatment severity, total number of schools, total number of caregivers, age,
and gender were not associated with academic functioning in this model.
37


Table 4: Association between teacher report of dissociation and academic functioning
Variables 8 t P sr2 Adj. R2
Mean School Membership (N = 127) ** .26
Age -.09 -1.05 .289 .04
CVE -.43 ** -5.39 <.001 .17
Gender .04 0.50 .621 .00
IQ .04 0.45 .655 .00
Maltreatment Severity .06 0.77 .444 .00
Number of Schools .04 0.40 .688 .00
Number of Caregivers -.11 -1.31 .193 .01
Teacher Dissociation -.21 -2.60* .010 .04
Mean Academic Self-Concept (N = 128) ** .15
Age -.11 -1.31 .192 .01
CVE -.27 * -3.19 .002 .07
Gender .02 0.18 .856 .00
IQ .22 2.64* .010 .05
Maltreatment Severity -.02 -0.26 .797 .00
Number of Schools .04 0.40 .687 .00
Number of Caregivers .06 0.67 .506 .00
Teacher Dissociation -.18 -2.15* .034 .03
Teacher Academic Ratings (N = 128) ** .36
Age .02 0.29 .775 .00
CVE -.24 ** -3.17 .002 .05
Gender -.04 -0.58 .565 .00
IQ .18 2.47* .015 .03
Maltreatment Severity .07 0.95 .342 .01
Number of Schools .07 0.92 .360 .01
Number of Caregivers -.14 -1.84 .068 .02
Teacher Dissociation -.44 -5.89** <.001 .18
WIAT Composite Score (N = 124) ** .34
Age -.04 -0.56 .577 .00
CVE -.01 -0.07 .946 .00
Gender .15 1.92 .057 .02
IQ .56 ** 7.31 <.001 .29
Maltreatment Severity .08 1.08 .281 .01
Number of Schools -.05 -0.64 .526 .00
Number of Caregivers .01 0.14 .889 .00
Teacher Dissociation -.15 -1.91 .059 .02
p < .05; p < .01
38


Caregiver Report. Table 6 presents the results of multiple regression analyses
examining the association between caregiver report of dissociation symptoms and academic
functioning. Regression models including caregiver report of dissociation and all control
variables accounted for a significant amount of variance for each of the four academic
outcomes: School membership {R2 adj. = .23, F (8,122) = 5.79, p < .001), academic self-
concept (R2 adj. = .15, F (8,124) = 3.92, p < .001), teacher academic ratings (R2 adj. = .18, F
(8,116) = 4.39, p < .001), and WIAT composite score (R2 adj. = .32, F (8,120) = 8.60, p <
.001). Higher levels of dissociation as reported by caregivers on the CBCL dissociation scale
were associated with significantly lower academic self-concept, uniquely accounting for 3%
of the variance. However, caregiver report of dissociation was not associated with any of the
other measures of academic functioning. Following the pattern of the youth and teacher
models, CVE and IQ remained significant predictors of academic functioning even after
controlling for other variables. Higher CVE was associated with lower school membership,
academic self-concept, and teacher academic ratings, uniquely accounting for 20%, 8%, and
7% of the variance, respectively. Higher IQ was associated with higher academic self-
concept, teacher academic ratings, and WIAT composite score. IQ uniquely accounted for
4% of the variance in academic self-concept, 4% of the variance in teacher academic ratings,
and 30% of the variance in WIAT composite scores. Similar to youth report, number of
caregivers significantly accounted for 3% of the variance in teacher academic ratings.
39


Table 5: Association between caregiver report of dissociation and academic functioning
Variables 6 t P sr2 Adj. R2
Mean School Membership (N = 131) * .23
Age -.04 -0.50 .621 .00
CVE -.47 -5.81 <.001 .20
Gender .00 0.02 .987 .00
IQ .05 0.66 .509 .00
Maltreatment Severity .04 0.49 .622 .00
Number of Schools .03 0.35 .724 .00
Number of Caregivers -.11 -1.36 .175 .01
Caregiver Dissociation -.10 -1.21 .227 .01
Mean Academic Self-Concept (N = 133) ** .15
Age -.12 -1.43 .154 .01
CVE -.29 -3.52 .001 .08
Gender .04 0.47 .641 .00
IQ .21 2.46* .015 .04
Maltreatment Severity .00 0.03 .979 .00
Number of Schools .02 0.19 .851 .00
Number of Caregivers .09 1.03 .305 .01
Caregiver Dissociation -.18 -2.18* .031 .03
Teacher Academic Ratings (N = 125) * .18
Age .12 1.38 .172 .01
CVE -.27 * -3.24 .002 .07
Gender -.13 -1.51 .133 .01
IQ .22 2.62* .010 .04
Maltreatment Severity .06 0.75 .454 .00
Number of Schools .05 0.52 .603 .00
Number of Caregivers -.20 -2.25* .026 .03
Caregiver Dissociation .09 1.12 .265 .01
WIAT Composite Score (N = 129) ** .32
Age -.02 -0.25 .801 .00
CVE -.02 -0.22 .830 .00
Gender .10 1.39 .167 .01
IQ .58 7.59 <.001 .30
Maltreatment Severity .08 1.11 .268 .01
Number of Schools -.07 -0.84 .405 .00
Number of Caregivers .02 0.21 .834 .00
Caregiver Dissociation .05 0.73 .467 .00
p < .05; ** p < .01
40


Summary. For both youth report measures of academic functioning (i.e., school
membership and academic self-concept), reports of dissociation from at least two
informants were consistently and significantly related to academic functioning, even after
accounting for relevant control variables such as IQ, CVE, and number of caregivers. Both
youth and teacher report of dissociation approached significance in predicting WIAT scores.
Only teacher-reported dissociation symptoms significantly predicted teacher ratings of
academic functioning. Several control variables accounted for significant variance across
measures. Specifically, CVE was especially important for subjective measures of academic
functioning (school membership, academic self-concept, and teacher academic ratings). In
several cases, the inclusion of CVE in models resulted in bivariate relationships between
dissociation and academic functioning to no longer meet significance criteria. IQ was also a
significant predictor for academic self-concept, teacher academic ratings, and WIAT
composite score for all reporters. Finally, the number of caregivers that youth had lived with
throughout their lifetime was related to teacher ratings of academic functioning.
Gender Analyses.
Correlations by Gender. While gender was not a significant predictor in any of the
above analyses with the entire sample, some studies have found that dissociation is more
common in females than in males (Hulette et al, 2011; Saxe et al., 1993). For this reason,
analyses were repeated for girls and boys separately. It is important to note that due to
41


smaller sample sizes, these analyses have less power to detect effects than those conducted
with the full sample.
First, independent sample t-tests were conducted to determine if dependent and
independent variables differed by gender. Girls and boys scored similarly on measures of
academic functioning. Specifically, girls (M = 2.50, SD = .34) and boys (M = 2.50, SD = .33)
reported similar levels of school membership, t (141) = .28, p = .881. Academic self-concept
also did not differ for girls (M = 3.01, SD = .71) and boys (M = 3.04, SD = .77), t (143) = -.23, p
= .82, and neither did teacher academic ratings of girls (M = 15.07, SD = 5.80) and boys (M =
13.85, SD = 5.33), t (136) = 1.28, p = .201. WIAT composite scores were also similar for girls
{M = 94.04, SD = 12.50) and boys (M = 96.60, SD = 12.18), t (139) = -1.23, p = .222. The
current study also did not find differences in levels of dissociation for girls and boys.
Specifically, youth-reported dissociation was similar for girls (M = 46.44, SD = 8.93) and boys
(M = 45.13, SD = 9.65), t (145) = .852, p = .396. Teacher-reported dissociation also did not
significantly differ for girls {M = 1.18, SD = 1.38) and boys (M = 1.67, SD = 1.66), t (138) =
-1.88, p = .062, and no differences were found for caregiver report for girls (M = 1.57, SD =
1.43) and boys (M = 1.21, SD = 1.48), t (143) = 1.51, p = .133.
Table 6 presents bivariate correlations between variables for boys and girls
separately (girls above the diagonal, boys below). For girls, youth report of dissociation was
significantly correlated with caregiver and teacher reports dissociation, but only shared 6%
and 7% of variance, respectively. None of the reports of dissociation for boys were
correlated with each other. Youth reports of more frequent dissociation symptoms were
42


related to lower school membership, academic self-concept, and teacher academic ratings
for girls, but were not correlated with any measures of academic functioning for boys.
Teacher report of dissociation was related with academic self-concept, teacher academic
ratings and WIAT composite score for girls and was correlated with school membership and
teacher academic ratings for boys. Caregiver reports of more frequent dissociation
symptoms were not related to any measures of academic functioning for girls or boys. These
patterns suggest that dissociation may have a stronger relationship with girls' academic
functioning than it does on boys' academic functioning. For girls, CVE significantly correlated
with school membership, academic self-concept, teacher academic ratings and youth report
of dissociation. CVE was only related to school membership and academic self-concept for
boys. Maximum maltreatment severity was correlated with teacher academic ratings and
WIAT composite score for girls but was not significantly correlated with any variables for
boys. IQ was associated with academic self-concept, teacher academic ratings, WIAT
composite score, and teacher report of dissociation for girls and with academic self-concept
and WIAT composite score for boys. Number of schools was correlated with youth report of
dissociation and age for girls and only with age for boys. Number of caregivers was
associated with number of schools for girls and with teacher academic ratings for boys.
43


Table 6: Bivariate correlations among study variables by gender
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13
1. Mean School Attachment - .49 .16 .27 -.42 -.11 -.14 -.44" .01 .17 -.04 -.08 -.19
2. Mean Academic Self-Concept .44 .. .36 .31 -.40" -.10 -.33" -.46" .16 .23' -.13 -.13 -.01
3. Teacher AcademicRatmgs .38" .29' - .51" -.25' .13 -.44" -.35" .29' .46" .05 -.03 -.16
4. WiAT Composite Score .31" .30' .29* - -.18 .12 -.32" -.21 .25' .67 .07 .07 -.15
5. Youth Reported Dissociation -.14 -.05 -.04 -.20 ~ .24' .26' .53" .00 -.10 .00 .24' .12
6. CaregiverReported Dissociation -.07 -.19 .03 -.14 .18 - .18 .01 .04 .00 -.09 .19 .14
7. Teacher Reported Dissociation -.29' -.12 -.58 -.07 -.04 .13 -- .19 .07 -.24' -.08 .00 .10
8. Mean Community Violence Exposure -.44 -.17 -.35" -.05 .23 -.06 .05 - -.11 -.20 .11 .18 .09
9. Maximum Maltreatment Severity .19 -.04 -.05 .04 -.11 -.12 -.07 -.12 - .13 .02 .11 .03
10. K-BlTlQScore .18 .28' .12 .52" -.11 -.16 .02 -.20 .22 - .04 .11 -.15
11. Age -.08 -.03 .04 -.07 -.00 -.12 -.16 .12 -.13 -.01 - .27 .21
12. NumberofSchools -.08 .11 .07 -.08 -.02 -.10 .04 -.04 -.07 .02 .25' - ,48"
13. Numberof Caregivers -.18 -.03 -.30' ,04 .09 -.10 .14 .19 .00 -.01 -.06 .18 -
iVofe: Males' correlation coeff iaentsare below the diagonal (N = 70), and females' correlation coefficients are above the
diagonalfN* 79).
'p<.05, "pc.Ol


Girls' Reports of Dissociation. Table 7 displays the results of the multiple regression
analyses examining the association between girls' reports of dissociation symptoms and
measures of academic functioning. Regression models including youth report of dissociation
and ail control variables accounted for a significant amount of variance for each of the four
academic outcomes: School membership (R2 adj. = .34, F (7, 63) = 6.10, p < .001), academic
self-concept (R2 adj. = .24, F (7,66) = 4.33, p = .001), teacher academic ratings (R2 adj. = .22,
F (7, 59) = 3.71, p = .002), and WIAT composite score (R2 adj. = .41, F (7, 64) = 8.04, p < .001).
Girls' report of dissociation symptoms on the TSCC was a significant predictor of school
membership and academic self-concept after controlling for age, CVE, IQ, maltreatment
severity, total number of schools, and total number of caregivers, accounting for 8% and 5%
of variance, respectively. CVE was also a significant predictor of school membership and
academic self-concept after controlling for other study variables. CVE accounted for 7% of
the variance in school membership and 4% of the variance in academic self-concept for girls.
IQ was a significant predictor for teacher academic ratings and WIAT composite score,
accounting for 12% and 31% of variance, respectively. Finally, maximum maltreatment
severity approached significance for WIAT composite score, accounting for 3% of the
variance.
45


Table 7: Association between girls' report of dissociation and academic functioning
Variables 6 t P Adi. R2
Mean School Membership (N = 71) ** .34
Age .03 0.28 .783 .00
CVE -.34 * -2.70 .009 .07
IQ .08 0.74 .465 .01
Maltreatment Severity -.06 -0.61 .543 .00
Number of Schools .20 1.60 .115 .03
Number of Caregivers -.20 -1.76 .083 .03
Youth Dissociation -.36 * -2.95 .004 .08
Mean Academic Self-Concept (N = 74) * .24
Age -.07 -0.68 .498 .01
CVE -.26 -2.05* .044 .04
IQ .20 1.82 .074 .04
Maltreatment Severity .11 1.01 .316 .01
Number of Schools -.07 -0.55 .582 .00
Number of Caregivers .13 1.05 .298 .01
Youth Dissociation -.27 -2.15* .036 .05
Teacher Academic Ratings (N = 67) .22**
Age .11 1.00 .320 .01
CVE -.17 -1.25 .215 .02
IQ .37 3.22 .002 .12
Maltreatment Severity .19 1.72 .091 .04
Number of Schools -.04 -0.27 .785 .00
Number of Caregivers -.08 -0.58 .566 .00
Youth Dissociation -.08 -0.59 .558 .00
WIAT Composite Score (N = 72) .41**
Age .07 0.70 .487 .00
CVE -.05 -0.42 .676 .00
IQ .60 6.18** <.001 .31
Maltreatment Severity .18 1.96+ .054 .03
Number of Schools .00 0.01 .993 .00
Number of Caregivers -.07 -0.64 .522 .00
Youth Dissociation -.05 -0.44 .664 .00
*p = .05; p < .05; p < .01
46


Teacher Report for Girls. Results of the multiple regression analyses examining the
association between teacher report of dissociation symptoms and measures of academic
functioning for girls can be found in Table 8. Regression models including teacher report of
dissociation and all control variables accounted for a significant amount of variance for each
of the four academic outcomes: School membership (R2 adj. = .24, F (7, 57) = 3.94, p = .001),
academic self-concept {R2 adj. = .25, F (7, 59) = 4.09, p = .001), teacher academic ratings (R2
adj. = .32, F (7, 59) = 5.34, p < .001), and WIAT composite score (R2 adj. = .26, F (7, 57) = 7.81,
p < .001). Teacher report of dissociation significantly accounted for 5% of the variance in
academic self-concept and 8% of the variance in teacher academic ratings. CVE was a
significant predictor for school membership and academic self-concept, accounting for 23%
and 14% of the variance in these measures, respectively. IQ was a significant predictor for
teacher academic ratings, accounting for 8% of the variance. IQ was also a significant
predictor for WIAT composite score, accounting for 26% of the variance. Number of
caregivers uniquely accounted for 5% of the variance in school membership, and
maltreatment severity accounted for 4% of the variance in WIAT composite scores and 5%
of the variance in teacher academic ratings.
47


Table 8: Association between teacher report of dissociation and academic functioning for girls
Variables 6 t P sf Adj. R2
Mean School Membership (N = 65) .24
Age .01 0.09 .929 .00
CVE -.52 * -4.42 <.001 .23
IQ .00 0.03 .974 .00
Maltreatment Severity -.06 -0.57 .573 .00
Number of Schools .19 1.39 .170 .02
Number of Caregivers -.27 -2.06* .044 .05
Teacher Dissociation -.07 -0.60 .551 .01
Mean Academic Self-Concept (N = 67) * .25
Age -.05 -0.48 .630 .00
CVE -.41 ** -3.53 .001 .14
IQ .15 1.29 .202 .02
Maltreatment Severity .09 0.82 .417 .01
Number of Schools -.05 -0.38 .705 .00
Number of Caregivers .05 0.42 .677 .00
Teacher Dissociation -.23 -2.02* .048 .05
Teacher Academic Ratings (N = 67) .32
Age .07 0.66 .512 .01
CVE -.17 -1.56 .124 .03
IQ .30 2.74 .008 .08
Maltreatment Severity .23 2.19* .032 .05
Number of Schools -.05 -0.38 .708 .00
Number of Caregivers -.06 -0.52 .603 .00
Teacher Dissociation -.31 -2.89** .005 .08
WIAT Composite Score (N = 65) * .43
Age .04 0.37 .712 .00
CVE -.05 -0.47 .641 .00
IQ .56 5.41*" <.001 .26
Maltreatment Severity .20 2.06* .044 .04
Number of Schools -.01 -0.08 .939 .00
Number of Caregivers -.08 -0.70 .487 .01
Teacher Dissociation -.15 -1.52 .135 .02
* p < .05; ** p < .01
48


Caregiver Report for Girls. Table 9 presents the results of the multiple regression
analyses examining the association between caregiver report of dissociation symptoms and
academic functioning for girls. Regression models including caregiver report of dissociation
and all control variables accounted for a significant amount of variance for each of the four
academic outcomes: School membership (R2 adj. = 25., F (7, 61) = 4.21, p = .001), academic
self-concept (R2 adj. = .19, F (7, 64) = 3.43, p = .004), teacher academic ratings (R2 adj. = .25,
F (7, 57) = 4.09, p = .001), and WIAT composite score (R2 adj. = .46., F (7, 62) = 9.29, p <
.001). Caregiver report of dissociation was not a significant predictor of any measures of
academic functioning. CVE was a significant predictor for school membership and academic
self-concept, and approached significance for teacher academic ratings, accounting for 26%,
14%, and 8% of variance, respectively. IQ significantly predicted teacher academic ratings
and WIAT composite score, accounting for 12% and 34% of the variance in these measures,
respectively. Maximum maltreatment severity significantly accounted for 4% of the variance
in WIAT composite score.
49


Table 9: Association between caregiver report of dissociation and academic functioning for girls
Variables 6 t P sr* Adj. R2
Mean School Membership (N = 69) .25
Age .02 0.18 .855 .00
CVE -.54 -4.82 <.001 .26
IQ .04 0.32 .748 .00
Maltreatment Severity -.09 -0.80 .425 .01
Number of Schools .19 1.44 .156 .02
Number of Caregivers -.23 -1.80 .076 .04
Caregiver Dissociation -.08 -0.69 .492 .01
Mean Academic Self-Concept (N = 72) * .19
Age -.10 -0.86 .392 .01
CVE -.40 * -3.53 .001 .14
IQ .18 1.58 .119 .03
Maltreatment Severity .08 0.75 .455 .01
Number of Schools -.07 -0.55 .585 .00
Number of Caregivers .14 1.12 .267 .01
Caregiver Dissociation -.13 -1.17 .245 .02
Teacher Academic Ratings (N = 65) ** .25
Age .16 1.36 .179 .02
CVE -.23 -1.98+ .053 .04
IQ .37 ** 3.26 .002 .12
Maltreatment Severity .20 1.76 .084 .04
Number of Schools -.10 -0.76 .449 .01
Number of Caregivers -.09 -0.72 .472 .01
Caregiver Dissociation .16 1.43 .157 .03
WIAT Composite Score (N = 70) .46
Age .10 1.08 .286 .01
CVE -.08 -0.80 .426 .01
IQ .62 6.56 <.001 .34
Maltreatment Severity .20 2.24 .028 .04
Number of Schools -.09 -0.78 .438 .01
Number of Caregivers -.07 -0.63 .534 .00
Caregiver Dissociation .16 1.74 .087 .02
fp = .05;' p < .05; * p < .01
50


Boys' Reports of Dissociation. Table 10 displays the results of the multiple regression
analyses examining the association between boys' reports of dissociation symptoms and
measures of academic functioning. Regression models including boys' reports of dissociation
and all control variables accounted for a significant amount of variance for school
membership and WIAT composite score: School membership (R2 adj. = .20, F (7, 55) = 3.16,
p = .007), WIAT composite score (R2 adj. = .26, F (7, 52) = 4.00, p = .001). Models including
boys' reports of dissociation were not significant predictors of academic self-concept or
teacher academic ratings: academic self-concept (R2 adj. = .04, F (7, 54) = 1.32, p = .261),
teacher academic ratings (R2 adj. = .11, F (7, 53) = 2.00, p = .072). When predictors were
examined separately for each model, results of these analyses indicated that boys' report of
dissociation was only a significant predictor of WIAT composite score after controlling for
age, CVE, IQ, maximum maltreatment severity, total number of schools, and total number of
schools. Boys' dissociation symptoms uniquely accounted for 7% of the variance in their
WIAT scores. Though regression models were not significant for academic self-concept or
teacher academic ratings, independent variables were significant within these models. IQ
was a significant predictor of academic self-concept, accounting for 9% of the variance.
Following the pattern of all other analyses, IQ was also a significant predictor of WIAT
composite score, accounting for 24% of the variance in this measure. CVE was a significant
predictor of school membership, teacher academic ratings, and total number of caregivers
approached significance for this measure of academic functioning. These variables
accounted for 8% and 6% of variance, respectively.
51


Table 10: Association between boys' report of dissociation and academic functioning
Variables 6 t P sr2 Adj. R2
Mean School Membership (N = 63) .20
Age -.09 -0.77 .444 .01
CVE -.41 * -3.31 .002 .14
IQ .01 0.10 .919 .00
Maltreatment Severity .19 1.61 .112 .03
Number of Schools -.06 -0.48 .635 .00
Number of Caregivers -.05 -0.45 .654 .00
Youth Dissociation -.07 -0.55 .587 .00
Mean Academic Self-Concept (N = 62) .04
Age -.14 -1.07 .292 .02
CVE -.12 -0.85 .397 .01
IQ .30 2.29* .026 .08
Maltreatment Severity -.10 -0.73 .470 .01
Number of Schools .13 0.99 .329 .01
Number of Caregivers .00 0.02 .982 .00
Youth Dissociation -.03 -0.21 .832 .00
Teacher Academic Ratings (N = 61) .11
Age .06 0.48 .630 .00
CVE -.32 -2.40* .020 .08
IQ .09 0.74 .465 .01
Maltreatment Severity -.06 -0.48 .631 .00
Number of Schools .08 0.61 .547 .01
Number of Caregivers -.25 -1.97* .054 .06
Youth Dissociation .10 0.75 .455 .01
WIAT Composite Score (N = 60) .26
Age -.18 -1.51 .137 .03
CVE .11 0.92 .362 .01
IQ .52 4.41 <.001 .24
Maltreatment Severity -.11 -0.92 .364 .01
Number of Schools -.06 -0.49 .630 .00
Number of Caregivers .07 0.55 .588 .00
Youth Dissociation -.28 -2.33 .024 .07
+p = .05; p < .05; ** p < .01
52


Teacher Report for Boys. Results of the multiple regression analyses examining the
association between teacher report of dissociation symptoms and measures of academic
functioning for boys can be found in Table 11. Regression models including teacher report of
dissociation and all control variables accounted for a significant amount of variance for
three of the four academic outcomes: School membership {R2 adj. = .20, F (7, 54) = 4.54, p <
.001), teacher academic ratings (R2 adj. = .44, F (7,53) = 7.68, p < .001), and WIAT composite
score (R2 adj. = .22, F (7, 51) = 3.32, p = .005). The model for academic self-concept was not
significant (R2 adj. = .08, F (7, 53) = 1.73, p = .121). Teacher report of dissociation was a
significant predictor of school membership and teacher academic ratings, accounting for 9%
and 30% of the variance, respectively. CVE uniquely accounted for 15% of variance in school
membership and 7% of variance in teacher academic ratings. Although the model for
academic self-concept was not significant, IQ was a significant predictor of this measure of
academic functioning, accounting for 9% of the variance. IQ was also a significant predictor
of WIAT composite score, accounting for 27% of the variance on this measure.
53


Table 11: Association between teacher report of dissociation and academic functioning for boys
Variables 6 t P s/ Adj. K2
Mean School Membership (N = 62) * .29
Age -.15 -1.32 .193 .02
CVE -.41 -3.59** .001 .15
IQ .04 0.34 .739 .00
Maltreatment Severity .15 1.36 .180 .02
Number of Schools -.04 -0.31 .759 .00
Number of Caregivers -.01 -0.06 .956 .00
Teacher Dissociation -.32 -2.82*" .007 .09
Mean Academic Self-Concept (N = 61) .08
Age -.21 -1.54 .131 .04
CVE -.11 -0.80 .426 .01
IQ .31 2.42* .019 .09
Maltreatment Severity -.14 -1.07 .288 .02
Number of Schools .16 1.16 .250 .02
Number of Caregivers .05 0.35 .729 .00
Teacher Dissociation -.19 -1.47 .147 .03
Teacher Academic Ratings (N = 61) .44
Age -.07 -0.67 .506 .01
CVE -.28 -2.70 .009 .07
IQ .12 1.15 .256 .01
Maltreatment Severity -.13 -1.32 .194 .02
Number of Schools .11 1.08 .284 .01
Number of Caregivers -.16 -1.50 .140 .02
Teacher Dissociation -.57 -5.69 <.001 .30
WIAT Composite Score (N = 59) * .22
Age -.17 -1.29 .205 .02
CVE .03 0.27 .787 .00
IQ .55 4.49** <.001 .27
Maltreatment Severity -.10 -0.78 .437 .01
Number of Schools -.06 -0.48 .633 .00
Number of Caregivers .09 0.71 .482 .01
Teacher Dissociation -.18 -1.48 .146 .03
* p < .05; * p < .01
54


Caregiver Report for Boys. Table 12 presents the results of the multiple regression
analyses examining the association between caregiver report of dissociation symptoms and
academic functioning for boys. Regression models including caregiver report of dissociation
and all control variables accounted for a significant amount of variance for school
membership and WIAT composite score: school membership (R2 adj. = .20., F (7,54) = 3.20,
p = .007) and WIAT composite score (R2 adj. = .19, F (7, 51) = 2.95, p = .011). The models for
academic self-concept and teacher academic ratings were not significant: academic self-
concept (R2 adj. = .08, F (7,53) = 1.71, p = .126), teacher academic ratings (Z?2 adj. = .10, F (7,
52) = 1.92, p = .084). Caregiver report of dissociation was not a significant predictor of any of
the four measures of academic functioning for boys. CVE accounted for 17% of the variance
in school membership and 8% of the variance in teacher academic ratings. IQ was a
significant predictor of academic self-concept and WIAT composite score, accounting for 6%
and 23% of the variance, respectively. Total number of caregivers approached significance
for teacher academic ratings, uniquely accounting for 6% of the variance in this measure of
academic functioning.
55


Table 12: Association between caregiver report of dissociation and academic functioning for boys
Variables 6 t P sr* Adj. R2
Mean School Membership (N = 62) .20
Age -.10 -0.79 .433 .01
CVE -.44 -3.56 .001 .17
IQ .00 0.02 .981 .00
Maltreatment Severity .17 1.46 .151 .03
Number of Schools -.07 -0.55 .584 .00
Number of Caregivers -.07 -0.56 .577 .00
Caregiver Dissociation -.13 -1.06 .292 .01
Mean Academic Self-Concept (N = 61) .08
Age -.16 -1.23 .223 .02
CVE -.14 -1.04 .302 .02
IQ .27 2.04* .047 .06
Maltreatment Severity -.09 -0.69 .492 .01
Number of Schools .10 0.75 .456 .01
Number of Caregivers .01 0.07 .948 .00
Caregiver Dissociation -.20 -1.59 .119 .04
Teacher Academic Ratings (N = 60) .10
Age .06 0.42 .675 .00
CVE -.30 -2.21 .027 .08
IQ .09 0.69 .493 .01
Maltreatment Severity -.08 -0.64 .527 .01
Number of Schools .08 0.61 .544 .01
Number of Caregivers -.26 -1.96* .055 .06
Caregiver Dissociation -.02 -0.17 .866 .00
WIAT Composite Score (N = 59) .19**
Age -.14 -1.15 .255 .02
CVE .04 0.29 .775 .00
IQ .52 4.09** <.001 .23
Maltreatment Severity -.09 -0.72 .474 .01
Number of Schools -.08 -0.60 .554 .01
Number of Caregivers .06 0.46 .647 .00
Caregiver Dissociation -.08 -0.68 .498 .01
+p = .05; p < .05; ** p < .01
56


Summary of Gender Differences. Results of analyses by gender indicated some
notable differences for girls and boys. Across measures, dissociation was more consistently
predictive of academic functioning for girls than it was for boys. This was especially true for
girls' report of dissociation on the TSCC. Girls' self-reported dissociation significantly
predicted school membership, academic self-concept, and teacher academic ratings. Boys'
report of dissociation on the TSCC was only a significant predictor for WIAT composite score.
Teacher report of dissociation was associated with teacher academic ratings for both boys
and girls. It was also predictive of girls' academic self-concept and boys' school membership.
Caregiver report of dissociation was not a significant predictor of academic functioning in
girls or boys after controlling for other variables. Differences also existed between boys and
girls for various control variables. Academic self-concept was related to CVE for girls and to
IQ for boys. Girls' IQ scores were related to teacher academic ratings, while teachers'
academic rating of boys was associated with CVE and number of caregivers. Finally,
maltreatment severity was especially important for girls, predicting both teacher academic
ratings and WIAT composite score. This control variable was not a significant predictor of
any of the measures of academic functioning for boys. There were also some similarities
between boys and girls. Following patterns seen in analyses for the entire sample, IQ was a
significant predictor of WIAT composite score for both boys and girls. Additionally, CVE
significantly predicted school membership for both genders.
57


CHAPTER 4
DISCUSSION
The purpose of the current study was to investigate the association between
dissociation and academic functioning in children with a history of maltreatment and out-of-
home placement. This study used a multi-reporter, multi-method design that controlled for
age, community violence exposure, gender, IQ, maltreatment severity, total number of
caregivers, and total number of schools. While there was some variation across reporters
and measures of academic functioning, results suggest dissociation is associated with
academic functioning in maltreated children with a history of out-of-home placement.
Children with more frequent dissociation symptoms tended to have lower academic
functioning across measures. This is the first known study that has investigated the
relationship between dissociation and academic functioning, but other studies that have
examined the association between dissociation and cognitive functioning in high-risk
samples have found similar patterns (e.g., Narang & Contreras, 2003; Yehuda, 2005).
Research on dissociation has identified numerous negative factors that are
associated with dissociative symptoms, including impaired memory and a higher rate of
other mental health problems, such as posttraumatic stress disorder and obsessive
compulsive disorder (e.g., DePrince et al., 2008; ISSD, 2004; Putnam, 1993; Yehuda, 2005).
58


In the current study, dissociation appears to be more highly associated with
subjective measures of academic functioning such as school membership and academic self-
concept than with academic performance on standardized measures such as the WIAT,
although the pattern of association is in the same direction. Perhaps this is because reports
of dissociation are also subjective, regardless of reporter. Also, the context in which
standardized tests are administered varies substantially from the context that leads to
teacher or caregiver observations or youth self-perceptions. The WIAT is administered in a
short time period with very specific guidelines, and the only individuals involved are the
tester and the child being tested. Finally, children who suffer from dissociative symptoms
may have trouble engaging in their school environment and getting involved in scholastic or
extracurricular activities, and therefore may have trouble forming a bond with their school.
This could contribute to lower self-perceptions in relation to school. Dissociation also
appears to be related to teachers' perceptions of their students. Children with higher levels
of teacher-reported dissociation were rated as having more academic difficulties by their
teachers than children who did not suffer from dissociative symptoms. Perhaps teachers are
observing what they interpret to be poor attention or minimal classroom engagement that
is actually the observable result of a child dissociating. This could also be partially due to the
fact that for this finding, teachers reported academic functioning as well as dissociation.
The relationship between dissociation and academic functioning varied somewhat
by reporter and by academic measure. Specifically, youth report of dissociation was
predictive of youths' membership to school and approached significance for WIAT
59


composite scores. Teacher report of dissociation was associated with school membership,
youths' academic self-concept, and teacher academic ratings, and approached significance
for WIAT composite score. Finally, caregiver report of dissociation was predictive of
academic self-concept. These differences could be the result of a number of factors. In
terms of differences across reporters, dissociation is largely a subjective experience that
may be more noticeable to the individual experiencing symptoms than outside observers.
Reporters may also perceive and interpret the same behavior differently. Specifically, youth
may be more aware of internal manifestations of dissociation whereas caregivers and
teachers notice external representations of dissociation such as confusion, daydreaming,
and staring blankly. There may also be differences in what each reporter observes and is
willing to report. For example, youth may be reluctant to admit to dissociative symptoms for
fear of negative consequences, such as being judged by others or being treated differently
by their peers. Teacher and caregiver reports may also differ based on the environment in
which each reporter interacts with the child. Specifically, teachers largely interact with
students in a classroom setting where children are required to maintain focus for long
periods of time and apply knowledge and critical thinking in a structured way. Caregivers are
more likely to observe children in less structured environments, such as in the home where
children may feel more comfortable and have greater control over their activities.
Dissociation may be more noticeable in a structured classroom setting where a child is
expected to encode information and demonstrate understanding of concepts than it is in
the less structured environment of a child's home. Despite differences across measures and
60


across reporters, concordance across at least two reporters provides greater confidence in
the relationship between dissociation and several of the measures of academic functioning.
As previously mentioned, dissociation symptoms tended to have stronger
association with subjective measures of academic functioning. Because dissociation
interferes with an individual's ability to encode information and identify with the world
around them, youth may have difficulty forming connections with peers and teachers at
school, encoding new academic material presented in the classroom, and may feel
negatively about their own academic abilities. WIAT scores may have been less related to
dissociation because there are fewer requirements or demands for children to identify with
the world around them or relate to other individuals in the short period of time during
which they complete the test. There may also be fewer environmental triggers leading to
dissociation during the administration of the WIAT. Specifically, at school children may have
greater exposure to certain words, activities, or individuals that remind them of the trauma
they have endured than they may experience while taking a standardized test.
Although gender was not a significant predictor in any models with the full sample,
the relationship between dissociation and academic functioning was examined within each
gender because previous research has suggested that males and females may differ in their
experience and expression of dissociative symptoms (e.g., Hulette et al, 2011). When the
relationship between dissociation and academic functioning was examined for each gender
separately, some differences were found for girls and boys. Girls' report of dissociation was
related to subjective, self-report measures (i.e., school membership, academic self-concept),
61


whereas boys' report of dissociation was related to an objective measure of academic
functioning (i.e., WIAT composite score). Dissociation symptoms seem to be more related to
girls' ability to engage in their environment and may lead to stronger feelings of loneliness
and isolation at school for girls than for boys. These feelings may present in low school
membership and academic self-concept. Dissociation was not related to subjective
measures of academic functioning for boys, but did seem to be related to WIAT scores.
Perhaps boys are more likely to dissociate during structured activities, which could lead to
this pattern.
Teacher report of dissociation was associated with teacher academic ratings for
both boys and girls, possibly due in part to the fact that these measures used the same
reporter. Teacher report of dissociation was also related to academic self-concept for girls
and to school membership for boys. For girls, the dissociation symptoms observed by
teachers may be more related to girls' self-perceptions whereas for boys these symptoms
may be more associated with school membership. Caregiver report of dissociation was not a
significant predictor of academic functioning for boys or girls when the genders were
examined separately. It is also important to note that due to smaller sample sizes, these
subgroup analyses have less power to detect effects. These findings fit well with current
literature on differences in dissociative experiences for males and females (e.g., Hulette et
al., 2011; Saxe et al., 1993). Although the current study did not find a difference in the level
of dissociation experienced by boys and girls, dissociation did seem to play a larger role in
girls' academic functioning than it did for boys' academic functioning.
62


Results indicated that a number of control variables also accounted for significant
variance in academic functioning. IQ was predictive of the WIAT composite score for every
model regardless of reporter, which is consistent with research on the relationship between
intelligence and academic achievement (e.g., Frey & Detterman, 2004; Rohde & Thompson,
2007). It is not surprising that standardized measures such as the WIAT would be associated
with IQ, as a child's intellectual prowess plays an integral role in their attainment and
application of knowledge. IQ was also related to academic self-concept and teacher
academic ratings across reporters. Children's intellectual capacity likely influences their own
perceptions of their academic abilities. In addition, children with higher IQ scores probably
get more positive feedback in the classroom, which may lead to a more positive sense of
self. In contrast, IQ was not significantly related with youth's sense of membership to their
school. Factors other than IQ may play a larger role in children's school membership. For
example, social support from teachers or peers and involvement in extracurricular activities
might be more strongly associated with youths' sense of school membership than academic
ability as measured by IQ.
Community violence exposure (CVE) consistently predicted subjective ratings of
academic functioning (i.e., school membership, academic self-concept, and teacher
academic ratings) for all models. In many cases, CVE was a more significant predictor of
academic functioning than dissociation. Past research has shown that CVE has a direct
negative impact on academic functioning (Mathews et al., 2009). This relationship could be
a result of violence exposure in more than one setting. Specifically, youth who report high
63


levels of CVE may also be witnessing or experiencing violence in their school community.
This could result in fear and uncertainty at school, distracting children from their
schoolwork. Finally, there may be a relationship between family values and communities
high in violence. Youth from highly violent communities may also come from families who
do not value education as highly as families in less violent communities.
Finally, the total number of caregivers that youth had lived with throughout their
lifetime was a significant predictor of teacher academic ratings in youth report and caregiver
report models. Previous research has indicated that a higher number of placement
transitions can have negative consequences. For example, Newton et al. (2000) found that
increased placement changes contributed to internalizing and externalizing behavior
problems. Youth with a history of more caregivers are also more likely to suffer from
dissociation than youth with fewer caregivers (Hulette et al., 2011). Perhaps the trauma of
frequent moves and upset relationships leads children to suffer from mental health
symptoms such as dissociation, which then negatively impacts their performance in school.
Teachers may also rate students more negatively if the teacher doesn't sense a collaborative
relationship with the child's caregiver, which may happen more when a child changes
caregivers frequently. More caregiver transitions may also be indicative of a child with more
behavior problems, as caregivers may have trouble with these children, resulting in frequent
moves.
In addition, for girls, maltreatment severity was related to WIAT scores as well as
teacher academic ratings for the teacher report model. Maltreatment was not a significant
64


predictor of academic functioning for boys or for the sample as a whole. Previous studies
have found that maltreated youth have poorer academic functioning (e.g., Crozier & Barth,
2005; Eckenrode et al., 1993; Leiter and Johnsen, 1997), but no known studies have
investigated whether this relationship is influenced by the severity of the maltreatment
experienced. There are also no known studies that have looked at maltreatment severity
and academic functioning for girls and boys separately. Perhaps maltreatment severity is
more influential on girls' academic outcomes than it is for boys. This relationship seems to
be especially true for standardized test scores, as current results indicated that girls with
more extreme maltreatment experiences had consistently lower WIAT scores across
reporters.
There were a number of control variables that were not associated with academic
functioning in any of the models examined for the entire sample. These included age,
gender, and total number of schools attended. Perhaps these variables were not significant
because they were examined in models alongside other especially meaningful variables,
including IQ, dissociation, and CVE. Age was likely not a significant predictor because the age
range examined in the current study was very narrow.
The current findings have several implications. Primarily, this study indicates that
dissociation may be one of the reasons that children with a history of maltreatment and
out-of-home care struggle in school. Dissociation symptoms could be related to their
maltreatment histories and exposure to community violence. Dissociation and poor
academic functioning may also impact children in other aspects of their lives. For example,
65


children who struggle in school at an early age may be at greater risk for other adverse
outcomes, such as delinquency, substance use, and quality of life. Previous research has
supported this theory. For example, Hirschfield & Gasper (2011) showed that
disengagement in school has a direct effect on delinquent behavior; however, delinquent
behavior does not seem to lead to disengagement in the classroom. Additionally, teenage
girls who get higher grades have been shown to be less likely to use illegal substances and
less likely to initiate sexual relationships (Wheeler, 2010).
A child's poor academic performance could also negatively impact their peers. For
example, a child who is struggling with schoolwork may demand extra attention from the
teacher, which could take attention away from other students. This dispersion of attention
could also affect teachers. Teachers may misinterpret symptoms as willful and become
frustrated with students who experience dissociation and punish them for not paying
attention or not participating, which could further estrange a child from their school
environment, leading to even lower school membership and academic self-concept.
The numerous negative consequences of childhood dissociation and their affect on
academic functioning can be minimized, if not avoided altogether. Children with a known
history of maltreatment should be assessed for trauma symptoms, and interventions should
be offered for children whose mental health has been impacted by trauma. These children
could then be referred for evidence-based trauma treatments, such as trauma-focused
cognitive behavioral therapy (TF-CBT) (see Feather & Ronan, 2009). Additionally, children
who demonstrate dissociative symptoms should be provided with academic services such as
66


tutoring or possibly a therapeutic classroom setting. These steps would give maltreated
children the skills and services they need to succeed in school. Finally, teachers should be
educated on the affects of maltreatment on children and how to recognize symptoms such
as dissociation. If teachers were more informed about these symptoms and how to help
students who struggle with them, these students may be less likely to have poor academic
self-concept and low school membership.
Limitations and Future Directions.
The present study had a number of strengths that support the current findings. For
instance, multiple reporters and multiple measures were included to measure both
dissociation and academic functioning. This eliminates a common limitation of many studies
that only examine youth report and only use one measure for each study variable. In
addition, this study consisted of a very high-risk sample that is known to suffer from a
variety of problems, such as poor school performance and high instances of mental and
physical illness. Despite these strengths, there are a few notable limitations of this study.
First, the measures used to assess caregiver and teacher report of dissociation are limited in
scope and their psychometric properties have only been examined in a few studies. Second,
the level of dissociation symptoms in this sample was relatively low, with only thirteen
youth reporting dissociation in the borderline or clinical ranges. Although dissociation
measures displayed good variability and the distributions were relatively normal, this level
of severity may limit generalizability to other samples. Future studies with samples
67


displaying more severe levels of dissociation are needed to replicate the current findings. In
addition, the measure used to assess CVE may not be specific to community violence but
rather may measure violence exposure across environments, including family, school, and
peer group. Research has also indicated that youth tend to underreport trauma symptoms
(Elliott & Briere, 1994), which could be one reason that dissociation seemed to be less
significant than CVE in the present sample. Future studies should take this into
consideration when examining the relationship between dissociation and other adverse
outcomes. Notably, this study did not examine academic functioning through student grades
or attendance records. These measures of school performance should be included in future
studies that investigate factors that may influence poor academic functioning in maltreated
children in out-of-home care. Finally, though this study did use a sizeable sample that was
sufficiently powered to detect a medium effect, a larger sample may have been needed to
detect more subtle effects and could also have been beneficial when examining dissociation
by gender.
Summary.
The findings from the current study suggest that dissociative symptoms are related
to poorer academic functioning in maltreated children with a history of out-of-home
placement. Additionally, subjective academic functioning such as school membership and
academic self-concept are more influenced by dissociation in girls than boys. Support for a
relationship between dissociation and academic functioning was found across youth,
68


teacher, and caregiver report of dissociation, although there was some variability by
reporter and measure of academic functioning. It is important for teachers, caregivers, and
other adults to be aware of this relationship in order to minimize the harmful results of
dissociation in maltreated children.
69


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