How childhood trauma could be mistaken for ADHD

 

Acry

[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.

Continue reading

Patrick Kennedy delivers raw, revealing speech to mental health advocates

Just before former Rhode Island Congressman Patrick Kennedy delivered the closing speech to attendees of the National Council for Behavioral Health conference, my daughter and I had a warm, light-hearted conversation with him outside the hall about my daughter’s work in peer services in Texas, about her anticipated motherhood, his young children, and about a Texas ranch he visited once that is bigger than the entire state Rhode Island. We stuck around to hear him talk, even though we thought we could probably miss it since it was part of the send-off for attendees going on visits to Capitol Hill and we weren’t going. We were grateful we stayed; here’s why.Image

Kennedy gave a raw and revealing talk about his mental illness, addiction, and the “God-sized” hole in his soul before his recovery. He said his illness is “bio/psycho/social”, but added that it is also “spiritual.” After achieving successes in his political career—election to the Rhode Island state legislature at 21, Member of Congress at 27, master fundraiser for Democrats—you “would have thought that would have filled the hole in my soul but it didn’t.”

After being arrested “on the high seas, in airports, and by traffic cops,” and being in rehab over and over again, he felt that as long as he was re-elected, he was managing. He was, after all,  meeting the family’s definition of success by winning elective office and serving the public.

“Would I have freely chosen to bring such disregard, such disdain, and antipathy for me and bring shame on my family, like I woke up one day and said this is how I want to be perceived — as an alcoholic, drug addict who can’t get his life together? That’s not what I want for my life. And yet it was the inevitable result of me living in my illness and not knowing there was a solution. And of course I was given solutions and pointed to rehab over and over again. You would have thought I would have gotten it through my thick head that I had a problem. But my real problem was denial, thinking that if I could just continue to function and manage—continue to get re-elected­—then I must be okay.”

Then three years ago, after crashing into a barrier at the U.S. Capitol, he waited for the “final jackpot.” He woke up, not remembering what had happened the night before. Did he have a Chappaquiddick of his own (a referral to an accident that involved his father, Sen. Edward Kennedy)? Fortunately, the event took place at 3:00 a.m., when the streets and sidewalks, were empty and no one was hurt.

Continue reading

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

Image

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.)

Continue reading

Georgia juvenile court judge galvanizes statewide child trauma initiatives

Judge

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

____________________________

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

Continue reading

Models to curb domestic violence emerge from tragic murder in Massachusetts in 2002

nyorkerThe July 22 issue of the New Yorker contains a riveting account (“A Raised Hand: Can a new approach curb domestic homicide?” by Rachel Louise Snyder) of how the tragic 2002 murder of Dorothy Giunta-Cotter by her husband led to a fundamentally new approach to prevent domestic violence fatalities by advocates at the Jeanne Geiger Crisis Center where she sought help.

Continue reading