Meeting the True Needs of Children Diagnosed as ‘ADHD’
By Dan Edmunds
How should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn’t fit into cultural norms.
In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person’s response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.
Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette’s Syndrome. Hedaya asks the question,”One might wonder-, why use methylphenidate at all?” Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.
However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children’s Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small.
Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents.
The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.
In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD.
Dr. Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic – the fact that many hyperactive children respond to Ritalin by becoming calmer doesn’t mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn’t mean they are suffering from a disease treated by cocaine. It is interesting to note Walker’s analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, EMP (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high similar to that of cocaine. Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette’s syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHDEhowever Walker feels that these issues are most often overlooked and the person is considered to be ADHD.
F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment. Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders. The Food and Drug Administration has noted (Walker, 1998, pg. 27) that ee acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.
There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate’s pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.
Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. Abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)
Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.
Valentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD itself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them.
Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don’t like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it’s better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illnessEin the schools.
Breggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.
Dr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving children. In this program, known as the Caregiver’s Skills program, Stein states it is necessary to treat your child as normal and not diseased. He states that the children should not be taking any medications, as they are risky for the child’s health and merely blunt behaviors. Stein argues, if the behaviors don’t occur, we can’t help (them) learn new habits.
The program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.
Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)
Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)
Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, ME, 1998)
Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)
DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).
Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)
Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)
Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)
National Institutes of Mental Health Consensus Conference Statement, 1998
Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)
Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)
Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6
Dan L. Edmunds, Ed.D.
Article Source: http://EzineArticles.com/?expert=Dan_Edmunds
COMMITMENTS : Cutting the Cord : Saying goodbye to your therapist can elicit bad feelings–unless it’s handled right. Then the parting can be a chance for growth.
That period of wrapping up therapy and saying goodbye is known as “termination,” a word that evokes images of being fired from a job or being stalked by Arnold Schwarzenegger. But mental-health experts consider termination a crucial stage in therapy.
If handled properly, it provides an opportunity to re-examine the issues that led the client to seek help in the first place, to evaluate the therapy itself and to deal with feelings that might bubble up in the face of bidding farewell.
A so-called natural termination, in which the two of you agree to end treatment because your goals have been met, is difficult enough. Who, after all, likes to say goodbye, especially to someone who has helped you so profoundly and so intimately? But a premature termination, where a dissatisfied client leaves without much notice or a therapist departs before the patient is ready, can be downright traumatic.
“It’s always best if people can have time to pay attention to the process of saying goodbye,” says Carl Shubs, a licensed clinical psychologist in private practice in Beverly Hills. “If people leave too abruptly, it interferes with the process–they’re not able to deal with the sadness or anger, the mourning that occurs.”
Adds Sylvia Martin, a licensed marriage, family and child therapist in private practice in Sherman Oaks: “Termination is a time when people start to deal with all their losses. It can trigger feelings about old issues, or issues about the relationship between the therapist and client.
“If there is an old loss they have not grieved, they will tap in and experience the same feelings,” she says. “Maybe they had a feeling of abandonment when they were young and did not understand it. Or maybe they have not had the luxury before now of dealing with a loss–for example, going through a divorce with two kids.”
If it is the patient who says so long, a good therapist will try to determine if he or she wants out because the topics being discussed are becoming too painful. In those cases, the therapist will encourage the patient to remain, so as to work through the discomfort and resolve those issues.
Many times, though, the client is willing to slog through the hard stuff, but feels this particular therapist is less than able. Such was the case last year for Laura, 41, who works in the travel industry in Orange County and sought counseling for marital problems.
“I was therapy illiterate,” she recalls. “I had no basis for comparison. But I never felt I was getting help. I would drive home and think, ‘Why did I just go there?’ I didn’t expect a magic cure, but I was just begging my therapist, ‘Give me some tools to help me.’
“All she said was, I had to divorce my husband, which I wasn’t ready to do. I felt her attitude was, ‘You won’t take my advice, so I don’t know what to tell you.’ ”
Laura–who is still married and on better terms with her husband–found another therapist to her liking. But she stuck with her first counselor longer than she preferred to because, she says, “The last thing I wanted was to look for someone new to spill my guts to, to start over again.”
Indeed, for some people, leaving the current therapist is the easy part; it’s finding a new one that poses problems. Says Studio City writer Catherine Johnson, author of the book “When to Say Goodbye to Your Therapist” (Simon and Schuster, 1988), “Finding a new therapist is not like finding a new dentist. It’s extremely difficult to find a match.
“It’s a bit like finding a lover, or best friend, or a parent. You don’t just go out and find a new best friend. You have to find a real emotional fit, on top of basic competence.”
Lisa Moore, 34, a West Los Angeles advertising account executive, discovered that last year when she left the marriage and family counselor she had been seeing for 15 months because she thought the therapist had crossed the professional line and was becoming too friendly. After six weeks with a new therapist recommended by her physician, she decided to return to her former counselor.
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Seven-year-old Gabriel Meyers didn’t want soup for lunch one Thursday in April, 2009. When his 23-year-old foster brother sent Gabriel to his room for dumping his soup in the trash, Gabriel threatened to kill himself. He kicked his toys around his room, then locked himself in the bathroom.
Police reports say Gabriel was home sick that day from his elementary school in Margate, Florida, under the care of Miguel Gould, his foster father’s son. Around 1 p.m., city police responded to Gould’s frantic 911 call and found Gabriel had hanged himself.
A troubled child who had previously suffered from neglect, sexual assault and abusive parenting, Gabriel spent the previous year shuttling among several foster parents while taking a constellation of anti-psychotic medicines, including Lexapro and Vyvanse, to control his depression and attention deficit hyperactivity disorder. Like most children in Florida foster care, Medicaid paid Gabriel’s medical expenses.
Just one month before his suicide, Gabriel’s doctor prescribed him Symbyax, an anti-depressant restricted for treatment of children. The medication’s FDA-required label features a warning that use of the drug by children or teenagers can lead to suicide.
Symbyax does not meet criteria established by Congress for Medicaid reimbursement, so it is illegal for Medicaid to pay for a prescription of the drug to a child. Sohail Punjwani, the doctor who prescribed Symbyax for Gabriel, received a stern letter from the FDA about his history of over-prescribing mental health drugs.
According to a number of foster care experts who spoke with Politics Daily, children in foster care, who are typically concurrently enrolled in Medicaid, are three or four more times as likely to be on psychotropic medications than other children on Medicaid. Alarmingly, many of these drugs are medically prohibited for minors and dangerous to the children taking them. Often young patients under state supervision are also prescribed three or four high-risk drugs at a time — all paid for by Medicaid.
State foster care programs and child protective services have had mixed success addressing the pervasiveness of dosing their clients with prescription psychotropic drugs. Using federal Medicaid money to purchase dangerous prohibited prescriptions for children, which cost the government up to $600 per dose, is technically a violation of the law.
Now, the Senate Subcommittee on Federal Financial Management, chaired by Sen. Tom Carper (D-Del.), has asked the Government Accountability Office to look into the drugging of foster care children. The investigators will attempt to account for estimates in the hundreds of millions of dollars of possible fraud arising from prescriptions for drugs explicitly barred from Medicaid coverage. The GAO is collecting data from Oregon, Massachusetts, Florida, Maryland, Minnesota and Texas, to search for patterns of abuse. This effort marks the first time suspicion of Medicaid fraud related to psychotropic drugs has been examined at the federal level. According to Senate staffers working on the investigation, the committee will likely hold hearings on the matter later this year.
Psychotropic medications act on the central nervous system and alter brain function, mood and consciousness. The GAO investigation is chiefly focused on anti-depressants, widely used in foster care in dangerous combinations, and for so-called “off-label” uses to treat symptoms for which they have not been medically approved. Anti-psychotic medications have been a factor in a number of children’s deaths.
Statistics on psychotropic drugs in foster care have until now come out in scattered reports, mostly from investigations of foster care failures by individual states. For example, in 2003 a Florida Statewide Advocacy Council study found that 55 percent of Florida’s foster children were being administered psychotropic medications. Forty percent of them had no record of a psychiatric evaluation. Another Florida report also indicated anti-psychotic medication use increased an astonishing 528 percent from 2000 to 2005.
A Texas state study in 2004 revealed that 34.7 percent of Texas foster children were prescribed at least one anti-psychotic drug — and 174 children aged 6-12 in the care of the state were taking five or more psychotropic medications at once.
Last April, an investigation by the Atlanta Journal-Constitution exposed several companies operating foster care homes in Georgia repeatedly used anti-psychotic medications to “subdue” children in their care. Despite being cited repeatedly, none of the agencies were fined more than $500.
According to child care experts and assessments by both advocacy groups and state government agencies, many states lack efficient records management and adequate oversight of foster care, contributing to a pervasive lack of medical continuity for the children. Social workers have oversized caseloads of foster children, who are often shunted between families and prescribed anti-psychotics from doctors unfamiliar with their medical histories. Without a case history, experts and foster care alumni say, doctors are more likely to add medications than take them away, resulting in record numbers of children dispensed several anti-psychotic medications at once. In many cases, the drugs are prescribed off-label to youngsters with behavior problems.
Julie Zito is a professor of pharmacology at the University of Maryland who conducted a 2008 study of the Texas foster care system that found 41 percent of the children prescribed psychotropic drugs received three or more different medications. She told Politics Daily what little research has been done suggests children in foster families are rarely assessed properly, a failure leading to serious effects. There has been no research on multiple-drug regimens, Professor Zito explained, and “blitzes” of medication have become a pervasive way of dealing with behavior problems in foster care. “We’ve expanded the medication practice in response to children not getting better,” she said, and children who fail to improve, “are getting more medication.”
Pharmaceutical companies manufacturing psychotropic drugs have played a major role in encouraging their increased use on foster care clients. Drug companies participate in aggressive marketing, conduct misleading research about efficacy and safety, and in some cases, “bribe” psychiatrists to prescribe their drugs, according to Zito and Jim Gottstein, an Alaska lawyer and founder of the Law Project for Psychiatric Rights, who has mounted several lawsuits against pharmaceutical corporations.
For example, last year the St. Petersburg Times reported that a psychiatrist in Jacksonville, Florida, was paid for speaking engagements to encourage her to prescribe Seroquel, a drug used to treat bipolar disorder and schizophrenia, and a neurologist in Tampa received free trips to Spain and Scotland from AstraZeneca, the drug’s British manufacturer, for her innumerable prescriptions of the drug for headaches. Seroquel is the top-selling anti-psychotic drug in the United States, with more than $4 billion per year in worldwide sales. AstraZeneca recently paid $520 million to settle lawsuits — some brought by doctors who had been offered swag in exchange for prescriptions — over its illegal promotion of off-label uses for Seroquel.
According to Jim Gottstein, the increase of anti-psychotic use in foster care amounts to “drug companies sacrificing children’s lives on the altar of corporate profits.” Gottstein recently filed a citizen’s suit on behalf of the state of Alaska against several doctors, drug companies and insurance companies, claiming that they knowingly promoted Medicaid fraud.
In response to the devastating study of the Texas system in 2004, that state’s top health agency introduced a new set of guidelines stressing specific treatment goals for medication and “informed consent” of parents and guardians. That effort led to decreased use of psychotropic drugs relative to the number of children enrolled in foster care from 2002 to 2009, according to data from the Texas Health and Human Services Commission.
In May 2005, Florida expanded foster parents’ rights to reject psychotropic treatment for the children in their care. Four years later, however, a review found that the new requirements were being flauted, and the panel that investigated Gabriel Meyers’ suicide concluded that every level of the Florida system had missed “warning signs” that Gabriel’s care was inadequate. Thirteen percent of Florida foster children were on one or more psychotropic drug, and 16 percent of those were not approved by parents or guardians.
In 2008, Rep. Jim McDermott (D-Wash.), the only psychiatrist in Congress, introduced a bill titled Invest in KIDS Act, which included stronger oversight for prescription medications in foster care. McDermott held a hearing on the use of psychotropic drugs in foster care, but the bill died in committee. Near the end of George W. Bush’s second term, Congress passed a law, co-sponsored by McDermott, that included increased oversight for “mental health” in foster care, but did not specifically mention psychotropic drugs.
“Some children in foster care may need and benefit from psychotropic medication,” McDermott told Politics Daily. “But these drugs should not be used as a shortcut to treat foster children when more effective treatments, including counseling, might provide long-term benefits.”
Federal and state agencies have pursued drug companies that illegally market their drugs for off-label uses, a practice that experts say heavily contributes to the overuse of psychotropic drugs in foster care.
Last year, a Justice Department action against Pfizer led to a $2.3 billion settlement, the largest in the department’s history. Companies convicted of major health fraud are barred from participating in Medicaid and Medicare. But worrying that a conviction would cause Pfizer to fail and cost its employees their jobs, the government allowed Pfizer’s shell company, which exists solely to plead guilty in lawsuits, to be charged instead, and the drug company paid a fine. Pfizer maintains that it did not break the law.
In 2006, The New York Times obtained a batch of internal documents that showed Eli Lilly, the maker of Zyprexa, a medication approved exclusively for treating the severe mental illnesses of schizophrenia and bi-polar disorder, was suppressing information on the drug’s harmful side effects and advertising it illegally. Lilly paid $62 million to settle lawsuits with 32 states and the District of Columbia, and agreed to ensure that its marketing complied with the law.
How to Fix It
The problems that lead to drug abuse in foster care are complex and deeply entrenched, but activists and advocates have proposed a number of solutions for limiting the overuse of anti-psychotics. Foster care experts, including a current task force of the American Academy of Pediatrics, believe that getting foster children a “medical home” — one physician who manages their care over the long term and has access to relevant records — would reduce the overprescription of psychotropic medications.
“Having a drug to take the edge off the pain and fear and sadness saved my life a time or two, but it’s not a lifestyle.” said Misty Stenslie, a former foster child who is currently the deputy director of Foster Care Alumni of America. Children under the protection of government agencies deserve the assurance of safe and decent health care. Especially, as Stenslie points out, “We can’t give kids what they really need, and that’s a family and love.”
- The Failure to Protect Foster Children and Children on Medicaid (madinamerica.com)
- 12. A HORRIBLE SECRET – What the US Government does to Foster Care Children (12160.info)
- Ending Misuse of Anti-Psychotic Medications in Long-Term Care (pattidudek.typepad.com)
- Making a Killing: The Untold Story of Psychotropic Drugging – Full Movie (Documentary) (newsworldwide.wordpress.com)
- Making a Killing: The Untold Story of Psychotropic Drugging (Full Version) (undergrounddocumentaries.com)
A new study published in the Journal of Pediatric Psychology found that children with symptoms of post-traumatic stress had poor function of the hippocampus, a part of the brain that stores and retrieves memories.
This is the first study to use functional magnetic resonance imaging, or fMRI, to look at the function of the hippocampus in youth with symptoms of post-traumatic stress, researchers said. The findings are in line with what has been previously found in adults.
The study was led by Dr. Victor Carrion, and the senior author was Dr. Allan Reiss, both at the Center for Interdisciplinary Brain Sciences Research at Stanford University School of Medicine.
Post-traumatic stress disorder is a condition that children and adults develop in response to a traumatic event. Intrusive memories, increased anxiety and emotional arousal are some of the symptoms, and typically they begin within three months of a traumatic event, according to the Mayo Clinic.
Of youths who have experienced a traumatic event, 3 percent to 15 percent of girls and 1 percent to 6 percent of boys could get a PTSD diagnosis, according to the U.S. Department of Veterans Affairs.
By contrast, an estimated 6.8 percent of the adult American population has had PTSD at some point, the department said.
The condition looks slightly different depending on age — young children may display “post-traumatic play” in which they repeat themes of the trauma, whereas adolescents may incorporate aspects of the trauma into their lives, carrying a weapon for instance. Also, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors, according to the Department of Veterans Affairs.
Although the study shows only an association — not a cause-and-effect relationship — between this brain damage and post-traumatic stress, the study authors believe the abnormal hippocampus findings are the consequence of post-traumatic stress, not a risk factor for it, said co-author Brian Haas.
That explanation makes sense, given what is known about post-trauma, said Dr. Sanjay Gupta, CNN’s chief medical correspondent and a neurosurgeon. He was not involved in the study. One of the reflexes that can come after a traumatic event is forgetting it, meaning perhaps “the hippocampus shrinks to fade away memories,” he said.
“The flip side of it is that you have trouble with memory overall,” he said. “You wish you could just forget the event.”
Animal studies have shown that brain damage in mice occurs after a trauma has been induced, Haas said.
Gupta said the study is important as researchers try to pinpoint what happens in the brain anatomically when a person has a trauma-related disorder.
The study looked at 27 people ages 10 to 17, which is a reasonable sample size for an imaging study of how the brain functions, said Lisa Shin, associate professor of psychology at Tufts University, who was not involved in the study. Participants were divided into 16 young people who had symptoms of post-traumatic stress disorder and 11 normal youths.
Scientists scanned the participants’ brains while they completed a verbal memory test. They read a list of words, then looked at a similar set with additional words and had to remember which words were on the original list.
Participants with PTSD symptoms did worse on the recall portion and showed less activity in the hippocampus during that time than the control group members.
The young people whose hippocampus functioning was the worst were more likely to experience avoidance and numbing symptoms of PTSD — having difficulty remembering the trauma, feeling isolated and not displaying emotion.
Previous research had found that adults with PTSD tended to have a smaller hippocampus volume.
Measuring neural functioning in the brain can indicate the extent of symptoms that a person is experiencing after a PTSD diagnosis, and reflect the effectiveness of therapy, Haas said. In other words, if the hippocampus is functioning better, that may mean the treatment is working.
If there is enough evidence that the hippocampus is involved in PTSD, a treatment could, in theory, be targeted to it, Shin said. There is some indication that treatment with serotonin reuptake inhibitors, or SSRIs, is associated with memory improvement and increased volume of the hippocampus in adults with PTSD.
Shin and colleagues are working on a twin study to explore whether brain abnormalities in people with PTSD were pre-existing risk factors or the result of PTSD.