How childhood trauma could be mistaken for ADHD

 

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[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”

Considered a heritable brain disorder, one in nine U.S. children—or 6.4 million youth—currently have a diagnosis of ADHD. In recent years, parents and experts have questioned whether the growing prevalence of ADHD has to do with hasty medical evaluations, a flood of advertising for ADHD drugs, and increased pressure on teachers to cultivate high-performing students. Now Brown and other researchers are drawing attention to a compelling possibility: Inattentive, hyperactive, and impulsive behavior may in fact mirror the effects of adversity, and many pediatricians, psychiatrists, and psychologists don’t know how—or don’t have the time—to tell the difference.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children.

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Vermont first state to propose bill to screen for ACEs in health care

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Dr. George Till, Vermont state legislator and physician

When Vermont State Legislator and physician Dr. George Till heard Dr. Vincent Felitti present the findings of the CDC’s Adverse Childhood Experiences Study at a conference in Vermont last October, he had an epiphany that resulted in a seismic shift in how he saw the world. The result: H. 762, The Adverse Childhood Experience Questionnaire, the first bill in any state in the nation that calls for integrating screening for adverse childhood experiences in health services, and for integrating the science of adverse childhood experiences into medical and health school curricula and continuing education.

That Vermont would be the first in the nation to address adverse childhood experiences so specifically in health care at a legislative level isn’t unusual. More than most states, Vermont is a “laboratory of change” for health care. It has embraced universal health care coverage for all Vermonters, and it passed the nation’s first comprehensive mental health and substance abuse parity law. (Washington State passed a law in 2011 to identify and promote innovate strategies, and develop a public-private partnership to support effective strategies, but it was not funded as anticipated. The Washington State ACEs Public-Private Initiative is currently evaluating five communities’ ACE activities.)

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Arresting our way out of drug crisis is yesterday’s theory, says VT Gov. Shumlin; urges public health approach

AshumlinState of the state addresses—like the State of the Union—tend to cover a wide range of topics from the economy to health care to education.  Vermont Governor Peter Shumlin broke the mold when he devoted his entire 2014 State of the State address to the state’s drug addiction crisis.  The rising tide of drug addiction and drug-related crime spreading across Vermont is “more complicated, controversial, and difficult to talk about” than any other crisis the state confronts, he said.

“We have lost the war on drugs,” he said. ” The notion that we can arrest our way out of this problem is yesterday’s theory.”  Even though Vermont is the second smallest state in the union (pop. 626,600), more than $2 million of heroin and other opiates are being trafficked into the state every week. Shumlin expressed alarm over the increase in the deaths from heroin overdose that doubled in 2013 from the year before and the 770 percent increase in treatment for opiates.

Shumlin told emotional stories of young Vermonters becoming addicted to prescription opiates and heroin — one recovered, one died from an overdose. While stories of young and promising individuals dying from heroin overdoses may grab headlines, data from the Centers for Disease Control and Prevention (CDC) show that deaths from prescription opioid pain relievers — such as codeine, methadone, and oxycodone — between 1999-2008 now exceed deaths involving heroin and cocaine combined.

CDC reports that in 2008, 36,450 deaths were attributed to drug overdoses in the U.S.  Opioid pain relievers were involved in 14,800 deaths (73.8%) of the 20,044 prescription overdose deaths.  The drug overdose death rate of 11.9 per 100,000 (Vermont’s rate was 10.9 per 100,000) was roughly three times the rate in 1991. Prescription drugs accounted for most the increase.  An April 12, 2012 statement from the Office of National Drug Control Policy reported that death from unintentional drug overdoses is greater than car accidents, the leading cause of injury in the U.S.

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Georgia juvenile court judge galvanizes statewide child trauma initiatives

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Douglas County (GA) Juvenile Court Judge Peggy Walker and “Dalton”

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Douglas County Juvenile Court Judge Peggy Walker is an activist judge for the children of Georgia – the children she loves who do not get what they need for healthy, successful lives.  She’s seen how the children are failed when they come back to court again and again. Now she’s doing something about it.  When she takes over later this year as the president of the National Council of Juvenile and Family Court Judges, she’ll have a national platform to promote changes in polices and practices to prevent and treat childhood trauma.  For now, she is spreading the word around the state of Georgia through conferences in four different regions, with the first one held January 10 at the Carter Center in Atlanta.

Woven into Judge Walker’s Georgia Summit on Complex Trauma keynote address to more than 400 participants —  including judges, their staffs, child and family services professionals, and advocates — was a description of a painful case from her work as a judge.  She began her presentation on what science tells us to do for children who have experienced complex trauma with a photo of herself (shown above) holding “Dalton.” He was the first drug-free child in the court’s family drug treatment program; his mother “Tonya” was a participant (both names are pseudonyms).

During the 10 years that “Tonya” had been in and out of her court, Judge Walker did not know her story. When she found out, she learned that  “Tonya’s” mother was alcoholic, emotionally abusive, and manipulative.  At age seven, “Tonya” was raped by a 50-year-old neighbor who was later incarcerated but freed after three years.  She tried drug treatment in

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New federal guidance should help slow the flow in “school-to-prison pipeline”, but much work remains

AzeroAdvocates for fair and effective school discipline practices received a boost from the federal government with new guidance issued by the Departments of Education and Justice on January 8.  The guidance instructs schools on how to administer school discipline without discriminating on the basis of race, color, or national origin.  In addition to the guidance, the Administration issued a package of resources to assist in the improvement of school climates and discipline, including key principles and action steps based on best practices and emerging research.

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JFK legacy on mental health to be celebrated in Boston

kennedyFifty years ago this month, President John F. Kennedy signed the Community Mental Health Act, a largely unheralded piece of legislation that embodied a hopeful vision of what life should be like for people with mental illnesses, addiction and intellectual disabilities: living lives of dignity and sharing in the benefits of our society.

The President’s nephew and former Rhode Island congressman, Patrick J. Kennedy, is organizing the Kennedy Forum October 23 and 24 in Boston to commemorate the anniversary and start a new conversation among diverse leaders to assess what has been accomplished and what is now needed to improve care and achieve equality in all aspects of life. The forum is catalyzing a larger, national

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