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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
ADHD and Trauma
Title: Children's Solution Work. Author(s): Woodhouse, Anne , Clinical Psychology Service for Children & Young People in Highland, United Kingdom Source: Clinical Child Psychology & Psychiatry , Vol 9(2), Apr 2004. pp. 317. Publisher: US: Sage Publications
Publisher URL: http://www.sagepublications.com/ Reviewed Item: Children's Solution Work. Insoo Kim Berg and Therese Steiner; New York: Norton, 2003. 258 pp. ISBN 0-393-70387-8.2003. ISSN: 1359-1045 (Print) Language: English Abstract: Reviews the book "Children's Solution Work," by Insoo Kim Berg and Therese Steiner. The authors have an entrancing way of leading you into their world of solution focused brief therapy (SFBT) with children, adolescents and parents. The authors start with introductions to SFBT practice and to working with children. They progress to a creative and diverse range of techniques for engaging children. This chapter began to elicit new solutions for working with many of my cases. Then they tackle the more complex cases, covering examples of working in a solution focused way with ADHD, autism, enuresis, violence, trauma, physical and sexual abuse, lying, stealing, self-harm, eating disorders, and more. Authors beautifully illustrate their ideas and concepts with case examples that are so familiar. There's nothing 'textbook' about these children. They are simultaneously completely individual and completely recognizable; they bring the book to life. (PsycINFO Database Record (c) 2004 APA, all rights reserved) Subjects: *Brief Psychotherapy; *Child Psychotherapy Classification: Psychotherapy & Psychotherapeutic Counseling (3310) Population: Human (10) Form/Content Type: Journal Review-Book (5900) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20040531 Accession Number: 2004-14078-017
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Record: 2
Title: Adolescent Psychiatry: The Annals of the American Society for Adolescent Psychiatry. Author(s): Nguyen, Nga A. , Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, US Source: Journal of Nervous & Mental Disease , Vol 191(10), Oct 2003. pp. 696-697.
Journal URL: http://www.jonmd.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com Reviewed Item: Adolescent Psychiatry: The Annals of the American Society for Adolescent Psychiatry. Lois T. Flaherty (Ed); Hillsdale, NJ: The Analytic Press, 2002, viii + 332 pp.2002. ISSN: 0022-3018 (Print) Digital Object Identifier: 10.1097/01.nmd.0000092181.55026.26 Language: English Key Concepts: adolescent psychiatry; clinical studies; trauma; violence; suicide; ADHD; conduct disorders Abstract: With the overarching theme of "Keeping our balance: The challenge of maintaining human connection in a biological century" (p. vii), this volume is a collection of 17 chapters organized in 5 parts: 1) Schonfeld and keynote addresses, 2) Developmental issues, 3) Trauma, violence, and suicide, 4) ADHD and conduct disorders, and 5) The American Society for Adolescent Psychiatry (ASAP) position papers. The reviewer states that is is an outstanding volume, best characterized by the editor's own words, 'a...thoughtful compendium that, in drawing attention to the pressing issues before those who work with adolescents, highlights both the field's achievements to date and the work that lies before it" (cover page). In her debut as Editor, she magnificently upholds the tradition of excellence of the series. Informative and insightful, the volume is most of all stimulating: Readers will not always agree about what is written in the volume, but hardly anyone, I suspect, can walk away without pondering the many thought-provoking ideas and compelling issues put forth before them. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Psychiatry; Attention Deficit Disorder with Hyperactivity; Conduct Disorder; Emotional Trauma; Suicide; Violence Classification: Health & Mental Health Services (3370) Population: Human (10) Form/Content Type: Journal Review-Book (5900) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20031117 Accession Number: 2003-09492-013
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Title: Development and validation of a web-based screening tool for monitoring cognitive status. Author(s): Erlanger, David M. , HeadMinder, Inc., New York, NY, US, david@headminder.com
Kaushik, Tanya , HeadMinder, Inc., New York, NY, US
Broshek, Donna , U Virginia, Charlottesville, VA, US
Freeman, Jason , U Virginia, Charlottesville, VA, US
Feldman, Daniel , HeadMinder, Inc., New York, NY, US
Festa, Joanne , HeadMinder, Inc., New York, NY, US Address: Erlanger, David M., 3 East 65th Street, Suite 5B, New York, NY, US, david@headminder.com Source: Journal of Head Trauma Rehabilitation , Vol 17(5), Oct 2002. Special issue: Neuropsychological Technologies. pp. 458-476. Publisher: US: Aspen Publishers
Publisher URL: http://www.aspenpublishers.com ISSN: 0885-9701 (Print) Language: English Key Concepts: Cognitive Stability Index; Internet neurocognitive tool; normative data; validity; traumatic brain injury; ADHD; Alzheimer's disease; screening; monitoring change Abstract: We acquired normative data for an Internet neurocognitive screening tool, the Cognitive Stability Index (CSI), and investigated its validity for initial assessment and for detecting significant change. Normative data were obtained on a nationally representative sample of 284 individuals aged 18-87 yrs. Validity data were obtained for outpatient groups with mild-to-moderate traumatic brain injury, attention deficit/hyperactivity disorder, and Alzheimer's disease. The CSI subtests resolve to 4 factors: attention, processing speed, motor speed, and memory with acceptable psychometric properties. Patterns of scores obtained by 3 groups of patient-participants provide reasonable evidence of clinical validity for screening and monitoring change. It is concluded that an Internet-based system holds promise for applying complex statistical models for routine monitoring of cognitive function. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Cognitive Assessment; *Internet; *Neuropsychological Assessment; *Screening Tests; *Test Validity; Alzheimers Disease; Attention Deficit Disorder with Hyperactivity; Cognitive Ability; Computer Assisted Diagnosis; Monitoring; Traumatic Brain Injury Classification: Neuropsychological Assessment (2225)
Psychological & Physical Disorders (3200) Population: Human (10)
Male (30)
Female (40)
Outpatient (60) Location: US Age Group: Adulthood (18 yrs & older) (300)
Young Adulthood (18-29 yrs) (320)
Thirties (30-39 yrs) (340)
Middle Age (40-64 yrs) (360)
Aged (65 yrs & older) (380)
Very Old (85 yrs & older) (390) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print Release Date: 20030421 Accession Number: 2002-06501-006 Number of Citations in Source: 27
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Record: 4
Title: Healing traumatized children: Creating illustrated storybooks in family therapy. Author(s): Hanney, Lesley
Kozlowska, Kasia , Children's Hosp at Westmead, Westmead, NSW, Australia, kasiak@chw.edu.au Address: Kozlowska, Kasia, Children's Hosp at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145, kasiak@chw.edu.au Source: Family Process , Vol 41(1), Spr 2002. pp. 37-65. Publisher: US: Family Process
Publisher URL: http://www.familyprocess.org ISSN: 0014-7370 (Print) Language: English Key Concepts: illustrated storybook creation; family therapy; traumatized children; aggressive behavior; ADHD Abstract: Discusses the therapeutic practice of creating illustrated storybooks in family therapy with traumatized children. Three vignettes are provided of storybook use in therapy: a 4.5-yr-old boy referred for uncontrollable tantrums, aggressive behaviors, and inability to socialize; a 6-yr-old boy referred for aggressive episodes and inability to concentrate; and an 11-yr-old boy with ADHD. The therapeutic emphasis of storybooks can be adjusted to take into account a child's life story, verbal capacity, level of anxiety, and traumatic hyperarousal. Storybook creation is an active process that embraces important aspects of trauma-specific interventions, including expression of trauma-related feelings; clarification of erroneous beliefs about the self, others, or the trauma event; and externalization of trauma stimuli into artwork, allowing for exposure and habituation of the arousal response. A focus on visual images together with narrative takes advantage of children's developmental capacities and spontaneous pleasure in the creation of art, thus minimizing anxiety and enhancing feelings of mastery, competence, and hope. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Aggressive Behavior; *Attention Deficit Disorder with Hyperactivity; *Drawing; *Emotional Trauma; *Family Therapy Classification: Group & Family Therapy (3313) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
Preschool Age (2-5 yrs) (160)
School Age (6-12 yrs) (180) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print Release Date: 20020522 Accession Number: 2002-12438-001 Number of Citations in Source: 129
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Database: PsycINFO _____
Record: 5
Title: Attention and traumatic stress in children. Author(s): Becker, Kathryn Anne , U Oregon, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(6-B), Jan 2002. pp. 3038. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAI3055667 Language: English Key Concepts: attention; hyperactivity; traumatic stress; ADHD; children Abstract: Reports of increasing rates of Attention Deficit Hyperactivity Disorder (ADHD) diagnosis and stimulant treatment have alarmed clinicians, researchers and parents. Clinicians who treat abused children have been particularly concerned about misdiagnosis of ADHD. Dissociation is one response to trauma. Dissociative children have difficulty integrating aspects of their experience and may become distracted by internal thoughts, feelings or memories. Children with post-traumatic stress reactions may have similar experiences and may also experience hypervigilance, making it difficult for them to sit still and concentrate. Study 1 investigates relations between trauma reactions and attention/hyperactivity problems in a community sample of 80 preschool children who varied in their experiences with stressful life events. Trauma symptoms were related to ADHD symptoms. Study 1 also investigates differences in memory for threat-related and neutral stimuli presented to children under selective and divided attention. Similar to previous results for dissociative adults (A. DePrince and J. Freyd, 1999), traumatized preschoolers did not differ from non-traumatized preschoolers in memory under selective attention, but had poorer memory for threat-related stimuli under divided attention when compared to non-traumatized children in the same condition. Study 2 investigates relations between trauma reactions and attention/hyperactivity problems in a community sample of 29 8- to 11-year-olds whose parents reported ADHD symptoms and who varied in their experiences with stressful life events. In contrast to studies that have not included abused children, there were no sex differences in symptoms of inattention and hyperactivity. Parents reported non-abused boys' ADHD symptoms began much younger than non-abused girls' symptoms (10.3 months vs. 6.0 yrs.). Trauma symptoms were related to ADHD symptoms. More parents reported that their children's ADHD symptoms were due to chronic stress, as compared to beginning or worsening after a particular stressful event. Abused children were more likely than non-abused children to have a relative with ADHD symptoms. Abuse predicted ADHD symptoms. Abuse and ADHD symptoms independently predicted school performance. Results suggest that trauma plays a significant role in children's inattention and hyperactivity. Understanding how trauma affects children's attention, activity level and school functioning will improve the treatment and education of traumatized children. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention; *Attention Deficit Disorder with Hyperactivity; *Emotional Trauma; *Hyperkinesis Classification: Developmental Psychology (2800) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print
Format(s) Available: Print Release Date: 20030728 Accession Number: 2002-95024-138
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Record: 6
Title: Reliability and validity of the Turkish Version of the Child Dissociative Checklist. Author(s): Zoroglu, Salig S. , Sisili Children State Hosp, Istanbul, Turkey, zoroglus@hotmail.com
Tuzun, Umran , Istanbul U, Istanbul Medical Faculty, Dept of Child & Adolescent Psychiatry, Istanbul, Turkey
Ozturk, Mucahit , Vakif Gureba Hosp, Dept of Child & Adolescent Psychiatry, Istanbul, Turkey
Sar, Vedat , Istanbul U, Dept of Psychiatry, Istanbul, Turkey Address: Zoroglu, Salig S., Gaziantep U, Tip Fakultesi, Psikiyatri Anabilim Dali, Cocuk ve Genclik Psikiyatrisi Bilim Dali, Gaziantep, Turkey, zoroglus@hotmail.com Source: Journal of Trauma & Dissociation , Vol 3(1), 2002. pp. 37-49.
Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J229 Publisher: US: Haworth Press
Publisher URL: http://www.haworthpressinc.com ISSN: 1529-9732 (Print) Language: English Key Concepts: Turkish Version of the Child Dissociative Checklist; psychometric characteristics; dissociation; reliability; validity Abstract: Investigated the psychometric characteristics of the Turkish Version of the Child Dissociative Checklist (CDC). The CDC was translated by the authors and discrepancies were resolved by consensus. It was administered to a sample consisting of 9 disociative identity disorder (DID), 28 dissociative disorder nototherwise specified (DDNOS), 35 anxiety disorder, 22 mood disorder, 22 attention deficit hyperactivity disorder (ADHD), and 88 non-psychiatric comparison children and adolescents (N = 204, aged 6-17 yrs). Parents or caretakers completed the measure at the hospital for patient groups. Controls were recruited through school. A 5-motest-retest was performed on a mixed patient and control group. Results show that the test-retest coefficient was 0.59. The split-half was 0.85. For the whole sample, Cronbach's alpha coefficient was 0.89. Spearman rank-order correlations were calculated between each item and item-corrected score totals and were all significant at p < 0.001 except for item 17. A Kruskal-Wallis comparison across the different groups with pair-wise comparisons was highly significant. The median score of CDC was 25.0 in DID, 16.5 in DDNOS, 4.0 in anxiety disorder, 5.0 in mood disorder, 5.5 in ADHD groups and 2.0 in non-clinical controls. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Dissociative Disorders; *Measurement; *Statistical Reliability; *Statistical Validity Classification: Clinical Psychological Testing (2224)
Schizophrenia & Psychotic States (3213) Population: Human (10) Location: Turkey Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Conference Proceedings/Symposia (0600)
Empirical Study (0800) Conference: International Fall Conference of the International Society for the Study of Dissociation, 15, Nov, 1998, Seattle, WA, US Conference Notes: This paper was presented at the aforementioned conference. Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20020417 Accession Number: 2002-12656-003 Number of Citations in Source: 28
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Record: 7
Title: Cultivating resiliency in youth. Author(s): Bell, Carl C. , U Illinois, Dept of Public & Community Psychiatry, Chicago, IL, US Address: Bell, Carl C., Community Mental Health Council, 8704 S. Constance, Chicago, IL, US Source: Journal of Adolescent Health , Vol 29(5), Nov 2001. pp. 375-381.
Journal URL: http://www.elsevier.com/inca/publications/store/5/0/5/7/6/5/ Publisher: United Kingdom: Elsevier Science
Publisher URL: http://www.elsevier.com ISSN: 1054-139X (Print) Digital Object Identifier: 10.1016/S1054-139X(01)00306-8 Language: English Key Concepts: resilience; adolescents; youth; neuropsychiatry; traumatic stress; resiliency building; psychological resiliency Abstract: Discusses characteristics of resiliency in adolescents and young people, and the importance of strengthening resiliency and how to build it. The neuropsychiatry of traumatic stress is discussed, including effects on the catecholamine system, the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-gonadal axis, and the relationship with posttraumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD). Esoteric resiliency-building activities are discussed, including cultivating a sense of "Atman" (a true or real self), the meditative practice of attending, developing a fighting spirit ("building heart"), building physiologic resiliency (exercise and adrenocorticotrophic hormone (ACTH) building), and building psychological resiliency through Chi Kung exercises. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Psychological Endurance; *Psychological Stress; *Resilience (Psychological); Adolescent Psychiatry; Emotional Trauma; Human Potential Movement; Neuropsychiatry; Posttraumatic Stress Disorder
Classification: Psychosocial & Personality Development (2840)
Promotion & Maintenance of Health & Wellness (3365) Population: Human (10) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Conference Proceedings/Symposia (0600) Conference: Society for Adolescent Medicine annual meeting, Mar, 2001, San Diego, CA, US Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20020109 Accession Number: 2001-09202-008 Number of Citations in Source: 63
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Database: PsycINFO _____
Record: 8
Title: Pre-, Peri-, and Postnatal Trauma in Subjects With Attention-Deficit Hyperactivity Disorder. Author(s): Zappitelli, Michael , Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
Pinto, Teresa , McGill University, Montreal, PQ, Canada
Grizenko, Natalie , Department of Psychiatry, McGill University, Montreal, PQ, Canada Address: Grizenko, Natalie, Lyall Pavilion, Douglas Hospital, 6875 Lasalle Blvd., Verdun, PQ, Canada, H4H 1R3 Source: Canadian Journal of Psychiatry , Vol 46(6), Aug 2001. pp. 542-548.
Journal URL: http://www.cpa-apc.org/Publications/cjpHome.asp Publisher: Canada: Canadian Psychiatric Assn
Publisher URL: http://www.cpa-apc.org/ ISSN: 0706-7437 (Print) Language: English Key Concepts: prenatal stress; perinatal stress; postnatal stress; stress; attention-deficit hyper-activity disorder; environmental factors
Abstract: Objective: To review research on pre-, peri-, and postnatal stress and their potential relation to attention-deficit hyperactivity disorder (ADHD). Method: We selected and critically reviewed 51 research reports from the medical and psychology literature, between January 1, 1976 and May 1, 2001, based on the subjects of pre-, peri-, or postnatal stress and ADHD. Results: Children with ADHD show higher percentages of pre-, peri-, or postnatal insult, compared with unaffected children; however, the relative influence of various factors is still controversial. Conclusions: The etiology of ADHD encompasses genetic and environmental factors. Pre-, peri-, and postnatal stressors are environmental factors that may play a role in its etiology. Future research should carefully examine interactions between genetic predisposition and environmental factors as etiologies of ADHD. (PsycINFO Database Record (c) 2003 APA, all rights reserved)(journal abstract) Subjects: *Attention Deficit Disorder with Hyperactivity; *Birth Trauma; Stress Classification: Developmental Psychology (2800) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Form/Content Type: Literature Review (1300)
Journal Article (2400) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20030728 Accession Number: 2003-05532-009 Number of Citations in Source: 51
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Database: PsycINFO _____
Record: 9
Title: Attachment status, affect regulation, and behavioral control in young adults. Author(s): Allen, Sarah Turrentine , U Connecticut, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 61(8-B), Mar 2001. pp. 4386. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAI9984056 Language: English Key Concepts: attachment status; affect regulation; behavioral control; self destructive behaviors Abstract: The present study evaluates predictions based on the model of development of behavioral self-control proposed by Schore (1994), which suggests that children develop the abilities to regulate affect and control self-destructive behaviors in the context of primary attachment relationships. The model proposes that insecurely attached children do not fully develop the experience-dependent neuronal control pathways necessary for behavioral inhibition, which leaves them vulnerable to potentially lifelong difficulties with impulse control. To test these predictions, 198 college students were administered measures of sensory regulation, attachment status, and child abuse and trauma, as well as measures of hypothesized outcomes related to poor impulse control, including substance use, risky sexual behavior, bulimia, verbal aggressiveness, and Attention Deficit Hyperactivity Disorder (ADHD) symptoms, as well as a measure of general psychological distress. Multiple regression was used to predict each hypothesized outcome as a function of sensory regulation and attachment status. The combination of attachment status and sensory regulation was significantly predictive of cigarette, alcohol, and marijuana use, bulimic symptomatology, and ADHD symptoms, but not other drug use, risky sexual behavior, or verbal aggressiveness. Sensory regulation was a more significant contributor to prediction than was attachment status, possibly due to psychometric limitations of the measure of attachment. Additionally, attachment status and sensory regulation appear to be equally predictive of general psychopathology, rather than specific to problems of poor impulse control. The second phase of the study compared the normative sample with a clinical sample of college students (n = 21) in treatment for substance abuse disorders. The clinical substance-abusing group did not differ from the normative sample in rate of insecure attachment classification or sensory regulatory capacity. The results suggest a more general model for the role of insecure attachment and poor sensory regulation in the development of general psychological symptoms, rather than being specific to the development of impulse control problems, and a direct impact of poor regulatory capacity as well as an indirect contribution mediated by attachment status is proposed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attachment Behavior; *Emotional Control; *Self Destructive Behavior Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Adulthood (18 yrs & older) (300) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print
Format(s) Available: Print Release Date: 20010718 Accession Number: 2001-95004-262
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2001-95004-262&db=psyh">Atta chment status, affect regulation, and behavioral control in young adults.</A>
Database: PsycINFO _____
Record: 10
Title: Adult attention deficit hyperactivity disorder, the family, and child maltreatment. Author(s): Mulsow, Miriam H. , Texas Tech U, Dept of Human Development & Family Studies, Lubbock, TX, US
O'Neal, Keri K.
Murry, Velma McBride Source: Trauma Violence & Abuse , Vol 2(1), Jan 2001. pp. 36-50. Publisher: US: Sage Publications
Publisher URL: http://www.sagepub.com ISSN: 1524-8380 (Print) Language: English Key Concepts: family stress & parental ADHD as risk factor for child maltreatment Abstract: attention deficit hyperactivity disorder (ADHD) is common in children (3%-7% of the population) and adults (1%-5%). When one member of a family has ADHD, it will usually be present in other members. Thus, many adults with ADHD are parents of ADHD children. ADHD in families is associated with increased stress, fewer resources, limited coping methods, and more negative perceptions. ADHD has been shown to contribute to substance abuse, depression, impulsivity, isolation, unemployment, low educational attainment, unintended pregnancy, and relationship disruption. Each of these factors has been linked to child maltreatment. Although the presence of ADHD in families is only one risk factor and does not by itself mean that a family will experience violence, it is a risk factor for which screening measures are available. In addition, most people with ADHD are responsive to treatment, and parent-training methods specifically tailored to parents of ADHD children are widely available. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder with Hyperactivity; *Child Abuse; *Family Relations; *Parental Characteristics; *Stress; Risk Factors Classification: Developmental Disorders & Autism (3250) Population: Human (10) Form/Content Type: Literature Review (1300) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print; Electronic Release Date: 20010321 Accession Number: 2001-14856-002 Number of Citations in Source: 98
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2001-14856-002&db=psyh">Adul t attention deficit hyperactivity disorder, the family, and child maltreatment.</A>
Database: PsycINFO _____
Record: 11
Title: Psychotherapy with young people in care: Lost and found. Author(s): Hunter, Margaret , Maudsley NHS Trust, England Source: New York, NY, US: Brunner-Routledge, 2001. xiv, 193 pp.
ISBN: 0-415-19190-4 (hardcover)
0-415-19191-2 (paperback) Language: English Key Concepts: psychotherapy; children; adolescents; residential care; foster care; ethical considerations; confidentiality; sexual abuse; ADHD; PTSD; identity crisis; trauma Abstract: (from the cover) Whilst there is wealth of literature on working with children and adolescents, very little focuses on those who are in residential or foster care. This book is a practical guide to working with this group from a psychoanalytic therapeutic perspective. The book examines the issues most relevant to all those working with children and adolescents: (1) the place of psychotherapy in residential/foster care, (2) ethical considerations (e.g. confidentiality and sexual abuse), and (3) particular problems faced by young people (e.g. attention deficit hyperactivity disorder (ADHD), trauma, identity crisis, and posttraumatic stress disorder (PTSD)). (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Adolescent Psychotherapy; *Child Psychotherapy; *Foster Care; *Residential Care Institutions; Attention Deficit Disorder with Hyperactivity; Identity Crisis; Posttraumatic Stress Disorder; Privileged Communication; Sexual Abuse Classification: Psychotherapy & Psychotherapeutic Counseling (3310) Population: Human (10)
Male (30)
Female (40) Age Group: Childhood (birth-12 yrs) (100)
Adolescence (13-17 yrs) (200) Form/Content Type: Book Handbook/Manual (8200) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Authored Book (120); Print Release Date: 20010725 Accession Number: 2001-01563-000
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Database: PsycINFO _____
Record: 12
Title: Attention deficit-hyperactivity disorder and the electroencephalogram. Author(s): Millichap, J. Gordon , Northwestern U Medical School, Children's Memorial Hosp, Div of Neurology, Chicago, IL, US Source: Epilepsy & Behavior , Vol 1(6), Dec 2000. pp. 453. Publisher: United Kingdom: Elsevier Science
Publisher URL: http://www.elsevier.com ISSN: 1525-5050 (Print) Digital Object Identifier: 10.1006/ebeh.2000.0131 Language: English Key Concepts: EEG; ADHD; electroencephalography; attention deficit hyperactivity disorder Abstract: Notes the importance of the EEG in the evaluation of children with attention deficit hyperactivity disorder (ADHD) is frequently neglected in psychiatric studies and symposia. The author believes that an EEG should be obtained in patients with ADHD if there is a personal or family history of seizures, inattentive episodes characterized by excessive "daydreaming" and/or periodic confused states, comorbid episodic, unprovoked temper or rage attacks frequently recurrent headaches, a history of head trauma, encephalitis, or meningitis preceding the onset of ADHD, and abnormalities on neurologic examinations indicative of brain damage or deficit. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder with Hyperactivity; *Electroencephalography Classification: Developmental Disorders & Autism (3250) Population: Human (10) Form/Content Type: Journal Letter (5500) Publication Type: Peer Reviewed Journal (270); Print
Format(s) Available: Print Release Date: 20020508 Accession Number: 2002-02694-010 Number of Citations in Source: 4
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2002-02694-010&db=psyh">Atte ntion deficit-hyperactivity disorder and the electroencephalogram.</A>
Database: PsycINFO _____
Record: 13
Title: Child maltreatment, other trauma exposure and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Author(s): Ford, Julian D. , U Connecticut, School of Medicine, Ctr for the Study of High Utilizers of Health Care, Farmington, CT, US
Racusin, Robert
Ellis, Cynthia G.
Daviss, William B.
Reiser, Jessica
Fleischer, Amy
Thomas, Julie Source: Child Maltreatment: Journal of the American Professional Society on the Abuse of Children , Vol 5(3), Aug 2000. pp. 205-217. Publisher: US: Sage Publications
Publisher URL: http://www.sagepub.com ISSN: 1077-5595 (Print) Language: English Key Concepts: child maltreatment & other trauma & PTSD symptoms, 6-17 yr olds with ADHD & oppositional defiant disorder Abstract: 165 consecutive child psychiatric outpatient admissions (aged 6-17 yrs) with disruptive behavior or adjustment disorders were assessed by validated instruments for trauma exposure and posttraumatic stress disorder (PTSD) symptoms and other psychopathology. Four reliably diagnosed groups were defined in a retrospective case-control design: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), comorbid ADHD-ODD, and adjustment disorder controls. ODD and (although to a lesser extent) ADHD were associated with a history of physical or sexual maltreatment. PTSD symptoms were most severe if (a) ADHD and maltreatment co-occurred or (b) ODD and accident/illness trauma co-occurred. The association between ODD and PTSD Criterion D (hyperarousal/hypervigilance) symptoms remained after controlling for overlapping symptoms, but the association of ADHD with PTSD symptoms was largely due to an overlapping symptom. These findings suggest that screening for maltreatment, other trauma and PTSD symptoms may enhance prevention, treatment and research concerning childhood disruptive behavior disorders. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Child Abuse; *Emotional Trauma; *Hyperkinesis; *Oppositional Defiant Disorder; Posttraumatic Stress Disorder Classification: Psychological Disorders (3210) Population: Human (10)
Male (30)
Female (40)
Outpatient (60) Location: US Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000802 Accession Number: 2000-05031-001
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Database: PsycINFO _____
Record: 14
Title: Stress, trauma, and PTSD in ADHD-diagnosed children: A biopsychosocial perspective. Author(s): Bennett, Edith Allison , California School Of Professional Psychology - Berkeley/Alameda, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(9-B), Apr 2000. pp. 4875. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAI9945881 Language: English Key Concepts: levels of stress & trauma & PTSD, 7-13 yr olds with vs without ADHD Abstract: Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood disorder with increasing prevalence rates that raise questions about overdiagnoses, misdiagnoses, and possible inadequate assessment of primary, comorbid, and differential diagnoses. The present study assumes that other factors influence or coexist with attention deficits: combinations of stresses, difficult life events, trauma history, and trauma symptoms. Stress and trauma, which are often characteristic of children with ADHD, may produce symptoms that present as attentional deficits. Distinguishing between ADHD and behaviors that result from severe stress or trauma poses a challenge for clinicians. Accurate assessment of ADHD and trauma-related attentional problems has important implications for diagnostic practices and treatment. This study investigated levels of stress, trauma, and PTSD in two groups of children ages 7 to 13 in a school district in a large metropolitan area: a group of children with existing ADHD diagnoses and a comparison group of children without ADHD. Participants were 41 children, their mothers, and the children's teachers. The study hypothesized that children with ADHD experience more significant life events, more family stress, more traumatic events, more trauma symptoms, and more PTSD diagnoses than children without ADHD. The procedures included the use of standardized instruments, adapted measures, and interviews. The instruments used were the Behavioral Assessment System for Children Developmental History Form, the Child Behavior Checklist, the Children's Life Events Inventory, the Life Chart, and the Structured Clinical Interview for DSM-IV. Statistical procedures included t tests and nonparametic tests. The results from quantitative analyses suggested that the ADHD group demonstrated more significant life events, more severe events, and more chronic traumas than the comparison group. The ADHD group did not report significantly more family stress, more trauma symptoms, or PTSD diagnoses. Exploratory analyses on demographics and medical history did not indicate significant differences between the groups. Qualitative data suggested some similar features among ADHD-diagnosed children with significant trauma, which included adoption, chronic trauma, difficulty with attachment, and foster home placement. The results underscore the need for further research to distinguish between ADHD and comorbid PTSD, ADHD with trauma features, and attentional problems that are secondary to trauma. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Emotional Trauma; *Hyperkinesis; *Posttraumatic Stress Disorder; *Stress Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print
Format(s) Available: Print Release Date: 20010110 Accession Number: 2000-95006-109
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2000-95006-109&db=psyh">Stre ss, trauma, and PTSD in ADHD-diagnosed children: A biopsychosocial perspective.</A>
Database: PsycINFO _____
Record: 15
Title: Treating ADHD as attachment deficit hyperactivity disorder. Author(s): Ladnier, Randall D. , Family Counseling Ctr of Sarasota County, Inc, Sarasota, FL, US
Massanari, Alice E. Source: Handbook of attachment interventions. Levy, Terry M. (Ed); pp. 27-65. San Diego, CA, US: Academic Press, Inc, 2000. xiv, 289 pp. ISBN: 0-12-445860-2 (paperback) Language: English Key Concepts: ADHD as attachment disorder, implications for family treatment Abstract: (from the chapter) Examines whether there is a causal connection between attachment failure and attention deficit hyperactivity disorder (ADHD), and whether it is possible to create a developmental model, based on attachment theory, that would provide a valid explanation for the origin of ADHD and suggest a treatment plan that could offer a child more than temporary relief from symptoms. The authors examine the effects of childhood trauma on the developing brain, proposing an etiologic model for ADHD based on developmental trauma. They discuss four basic types of bonding breaks (prenatal influences, inattentive caretakers, situational traumas, and faulty parenting), their role in attachment deficits, and problem behavior outcomes. A model for treating the family of a child with ADHD is proposed, and the authors note that whenever possible, the treatment-of-choice for a child diagnosed with ADHD should be family therapy. Other forms of therapy are also discussed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attachment Behavior; *Attention Deficit Disorder; *Childhood Development; *Family Therapy; *Hyperkinesis; Parent Child Relations Classification: Behavior Disorders & Antisocial Behavior (3230)
Group & Family Therapy (3313) Population: Human (10) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20000301 Accession Number: 2000-07048-002 Number of Citations in Source: 36
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Database: PsycINFO _____
Record: 16
Title: Vankien lapsuuden kaltoinkohtelu, kaeytoesongelmat ja aikuisiaen psyykkiset haeirioet trauma--ja kiintymyssuhdeteorian naekoekulmasta. Translated Title: Childhood maltreatment, behavior problems and adult psychiatric disorders: A trauma and attachment theory perspective.
Author(s): Haapasalo, Jaana , U Jyvaeskylae, Dept of Psychology, Jyvaeskylae, Finland Source: Psykologia , Vol 35(1), 2000. pp. 45-57. Publisher: Finland: Psykologia
ISSN: 0355-1067 (Print) Language: English Key Concepts: early childhood maltreatment & childhood behavior problems & adult psychiatric diagnoses, young adult male prisoners Abstract: Examined the relations between early childhood maltreatment, childhood behavior problems, and adult psychiatric diagnoses in 89 young male prisoners. The prevalences of attention deficit hyperactivity disorder (ADHD), depression and substance dependencies and violent criminal convictions in the subgroups in adulthood were also examined. Archival data were used to detect preschool maltreatment experiences and school-age behavior problems, and lifetime criminal records were reviewed. Hierarchical cluster analyses revealed 4 subgroups of offenders: (1) offenders with few childhood behavior problems and less maltreatment experiences, (2) aggressive offenders with predominantly reexperiencing (e.g., bullying, fighting) and avoidance type of problems (e.g., running away, substance abuse) who were physically abused in childhood, (3) offenders with predominantly avoidance type of problems, such as alcohol and drug use, who were neglected in childhood, and (4) multiproblem offenders with multiple activation and reexperiencing type of symptoms who were much abused and neglected in childhood. The adult diagnoses or criminal convictions did not discriminate between the subgroups. A trauma model and attachment theory were used to interpret the functions of childhood behavior problems (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Behavior Problems; *Child Abuse; *Male Criminals; *Mental Disorders; *Prisoners; Early Experience; Patient History; Victimization Classification: Criminal Rehabilitation & Penology (3386) Population: Human (10)
Male (30) Age Group: Adulthood (18 yrs & older) (300)
Young Adulthood (18-29 yrs) (320) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print Release Date: 20000501 Accession Number: 2000-03116-002
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2000-03116-002&db=psyh">Vank ien lapsuuden kaltoinkohtelu, kaeytoesongelmat ja aikuisiaen psyykkiset haeirioet trauma--ja kiintymyssuhdeteorian naekoekulmasta.</A>
Database: PsycINFO _____
Record: 17
Title: Criminal behavior fueled by attention deficit hyperactivity disorder and addiction. Author(s): Richardson, Wendy Source: Science, treatment, and prevention of antisocial behaviors: Application to the criminal justice system. Fishbein, Diana H. (Ed); pp. 18-1-18-15. Kingston, NJ, US: Civic Research Institute, 2000. xiii, 27-25 pp. ISBN: 1-887554-12-2 (hardcover) Language: English Key Concepts: characteristics & diagnosis & treatment & differentiation between ADHD & co-occurring addictions & criminal behavior & antisocial behavior, criminal offenders Abstract: (from the chapter) Describes how the symptoms of attention deficit hyperactivity disorder (ADHD) are manifested in the prison population, as well as the accurate diagnosis, alternative sentencing, and treatment of these conditions. Previous research has shown the influence of neurotransmitters and the dysfunction of the frontal lobes of the ADHD brain. ADHD is characterized by loss of control of attention, impulses, and activity level, and the neurochemical aspects of poor impulse control need to be managed in order to decrease recidivism. There exists an inattentive type of ADHD, and other symptoms include enhanced sensitivity, rage and violence, addiction to high levels of stimulation. ADHD can also be acquired through head trauma. Lack of impulse control that characterized ADHD can also lead to antisocial behavior and disinhibition, and criminals with ADHD are usually unsuccessful due to their attentional problems and impulsivity. Unlike antisocial personality disorder, most people with ADHD are able to express sincere feeling of remorse. Accurate diagnosis of ADHD is the most important part of a comprehensive treatment plan, which includes medication and repatterning. Potential controversy exists with treating alcoholics with ADHD medication, and alternative sentencing for criminals with untreated ADHD is discussed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Addiction; *Antisocial Behavior; *Attention Deficit Disorder; *Crime; *Hyperkinesis; Comorbidity; Criminals; Differential Diagnosis; Treatment Classification: Behavior Disorders & Antisocial Behavior (3230) Population: Human (10) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Chapter (160); Print Release Date: 20000705 Accession Number: 2000-08319-017 Number of Citations in Source: 12
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=2000-08319-017&db=psyh">Crim inal behavior fueled by attention deficit hyperactivity disorder and addiction.</A>
Database: PsycINFO _____
Record: 18
Title: Trauma exposure among children with oppositional defiant disorder and attention deficit-hyperactivity disorder. Author(s): Ford, Julian D. , U Connecticut, School of Medicine, Dept of Psychiatry, Farmington, CT, US
Racusin, Robert
Daviss, William B.
Ellis, Cynthia G.
Thomas, Julie
Rogers, Karen
Reiser, Jessica
Schiffman, Jill
Sengupta, Anjana Source: Journal of Consulting & Clinical Psychology , Vol 67(5), Oct 1999. pp. 786-789.
Journal URL: http://www.apa.org/journals/ccp.html Publisher: US: American Psychological Assn
Publisher URL: http://www.apa.org ISSN: 0022-006X (Print) Digital Object Identifier: 10.1037//0022-006X.67.5.786 Language: English Key Concepts: trauma exposure, 6-17 yr olds with oppositional defiant disorder vs ADHD vs adjustment disorder Abstract: Consecutive admissions to an outpatient child psychiatry clinic diagnosed with oppositional defiant disorder (ODD), attention deficit-hyperactivity disorder (ADHD), or adjustment disorder were assessed for trauma exposure by a structured clinical interview and parent report. Controlling for age, gender, severity of internalizing behavior problems, social competence, family psychopathology, and parent-child relationship quality (assessed by parent report), an ODD diagnosis, with or without comorbid ADHD, was associated with increased likelihood of prior victimization (but not nonvictimization) trauma. ADHD alone was not associated with an increased likelihood of a history of trauma exposure Traumatic victimization contributed uniquely to the prediction of ODD but not ADHD diagnoses. Children in psychiatric treatment who are diagnosed with ODD, but not those diagnosed solely with ADHD, may particularly require evaluation and care for posttraumatic sequelae. (PsycINFO Database Record (c) 2003 APA, all rights reserved)(journal abstract) Subjects: *Adjustment Disorders; *Attention Deficit Disorder; *Emotional Trauma; *Hyperkinesis; *Oppositional Defiant Disorder; Posttraumatic Stress Disorder; Victimization Classification: Psychological & Physical Disorders (3200) Population: Human (10)
Male (30)
Female (40)
Outpatient (60) Location: US Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19991101 Accession Number: 1999-11785-017 Number of Citations in Source: 23
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1999-11785-017&db=psyh">Trau ma exposure among children with oppositional defiant disorder and attention deficit-hyperactivity disorder.</A>
Database: PsycINFO _____
Record: 19
Title: The examination of selected tasks of frontal lobe functioning and subtyping by birth trauma, hereditary, and environmental stress factors in children diagnosed with attention deficit hyperactivity disorder. Author(s): Stiles-Smith, Benita Lynnette , The Fielding Inst, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(3-B), Sep 1999. pp. 1317. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAM9922152 Language: English Key Concepts: birth trauma & heredity & environmental stress, selected tasks of frontal lobe functioning & subtyping, children diagnosed with ADHD Abstract: Diagnosis and treatment of ADHD are often either arduous or simplistic in the absence of an accepted covering theory of the condition. Syndrome paradigms have been forwarded from a range of perspectives, including inherited factors, environmental factors, and neurological factors. Subtyping the syndrome is of current interest in the field. Neuropsychological testing, especially involving the Wisconsin Card Sorting Test, Trail Making Test, and continuous performance testing, has assumed a descriptive role from the perspective of ADHD as a frontal lobe dysfunction. Utilizing these tests, the issue of subtyping via the independent measures of birth trauma, heredity, and life stressors is examined. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Birth Trauma; *Cognitive Processes; *Frontal Lobe; *Genetics; Environmental Stress Classification: Health & Mental Health Treatment & Prevention (3300)
Psychometrics & Statistics & Methodology (2200) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print Release Date: 20000101 Accession Number: 1999-95018-131
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1999-95018-131&db=psyh">The examination of selected tasks of frontal lobe functioning and subtyping by birth trauma, hereditary, and environmental stress factors in children diagnosed with attention deficit hyperactivity disorder.</A>
Database: PsycINFO _____
Record: 20
Title: Antecedents and complications of trauma in boys with ADHD: Findings from a longitudinal study. Author(s): Wozniak, Janet , Massachusetts General Hosp, Pediatric Psychopharmacology Unit, Boston, MA, US
Crawford, Margaret Harding
Biederman, Joseph
Faraone, Stephen V.
Spencer, Thomas J.
Taylor, Andrea
Blier, Heather K. Source: Journal of the American Academy of Child & Adolescent Psychiatry , Vol 38(1), Jan 1999. pp. 48-56.
Journal URL: http://www.jaacap.com/ Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com ISSN: 0890-8567 (Print) Language: English Key Concepts: ADHD & increased risk for trauma or PTSD or trauma-associated psychopathology, 6-17 yr old males Abstract: Examined the relationship between trauma and attention-deficit hyperactivity disorder (ADHD) and evaluated whether ADHD increases the risk for trauma, the risk for posttraumatic stress disorder (PTSD), or the risk for trauma-associated psychopathology. Data from a longitudinal sample of 260 male children and adolescents (aged 6-17 yrs) with and without ADHD were examined. All were evaluated comprehensively with assessments in multiple domains of functioning including systematic assessments of trauma and PTSD. Comparisons were made between traumatized and nontraumatized youths with and without ADHD. No meaningful differences were detected in comparisons between ADHD and control children, either in the rate of trauma exposure or in the development of PTSD. Although trauma was associated with the development of major depression, this effect was independent of ADHD status. In contrast, bipolar disorder at baseline assessment was a significant risk factor for subsequent trauma exposure. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Emotional Trauma; *Posttraumatic Stress Disorder; *Psychopathology; *Risk Analysis; Human Males; Hyperkinesis Classification: Developmental Disorders & Autism (3250) Population: Human (10)
Male (30) Age Group: Childhood (birth-12 yrs) (100)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800)
Longitudinal Study (0850) Publication Type: Peer Reviewed Journal (270); Print Release Date: 19990301 Accession Number: 1999-00128-017
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1999-00128-017&db=psyh">Ante cedents and complications of trauma in boys with ADHD: Findings from a longitudinal study.</A>
Database: PsycINFO _____
Record: 21
Title: Through the eyes of a child: EMDR with children. Author(s): Tinker, Robert H. , Private Practice, Colorado Springs, CO, US
Wilson, Sandra A. Source: New York, NY, US: W. W. Norton & Co, Inc, 1999. xviii, 284 pp. ISBN: 0-393-70287-1 (hardcover) Language: English Key Concepts: use of eye movement desensitization & reprocessing with children who experienced trauma or suffer from specific phobias & with children with other disorders not caused by trauma Abstract: (from the jacket) Explores the use of eye movement desensitization and reprocessing (EMDR) with children and adolescents. The book demystifies the application of EMDR for children, from the first session with the parents to later sessions with children at all developmental stages. The adult protocol is modified so that it can be applied to children as young as two years old (and possibly younger). A system of classification of childhood trauma allows therapists to predict a child's response to EMDR is presented. Myriad cases illustrate the use of EMDR with various traumas. Many examples of simple traumas are presented, including automobile accidents, lightning strikes, bereavement, and specific phobias such as a fear of animals. In addition, cases illustrate success with complex traumas, where aspects of the trauma are ongoing and EMDR becomes part of several possible therapeutic interventions. EMDR is also discussed as an intervention for children who have problems that are not caused by trauma. Case illustrations show how EMDR can be used with children with attention deficit hyperactivity disorder (ADHD), anxiety, depressive, or reactive attachment disorders as well as learning difficulties and somatoform disorders. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Emotional Trauma; *Eye Movement Desensitization Therapy; *Mental Disorders; *Phobias Classification: Specialized Interventions (3350) Population: Human (10) Age Group: Childhood (birth-12 yrs) (100)
Preschool Age (2-5 yrs) (160)
School Age (6-12 yrs) (180)
Adolescence (13-17 yrs) (200) Form/Content Type: Book Reference Work (8400) Intended Audience: Psychology: Professional & Research (PS) Publication Type: Authored Book (120); Print Release Date: 19990401 Accession Number: 1999-02261-000
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1999-02261-000&db=psyh">Thro ugh the eyes of a child: EMDR with children.</A>
Database: PsycINFO _____
Record: 22
Title: A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder. Author(s): Yasik, Anastasia Elizabeth , City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(4-B), Oct 1998. pp. 1873. Publisher: US: Univ Microfilms International
ISSN: 0419-4217 (Print) Order Number: AAM9830778 Language: English Key Concepts: A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder Abstract: This study compared the Wide Range Assessment of Memory and Learning (WRAML) scores of urban youth with PTSD to the WRAML scores of stress-exposed urban youth without PTSD. A total of 131 youths were referred from Bellevue Hospital clinics subsequent to exposure to a variety of traumatic events (e.g., physical assaults, sexual assaults, motor vehicle accidents, fires). Youth with a positive history for child abuse or neglect were excluded. In order to control for the potentially confounding effects of comorbidity, youth meeting criteria for ADHD, conduct disorder, major depression, substance dependence, and schizophrenia were excluded. Similarly, youth with a documented head trauma, use of psychopharmacological agents, or mental retardation were also excluded. This process led to the identification of 16 youth with PTSD and 19 youth without PTSD. Statistical analyses revealed that there were no significant differences between comparison groups with regard to gender, ethnicity, age, and SES. Separate ANOVAs for the four WRAML Index scores were performed. These analyses revealed significant group differences on the General Memory and Verbal Memory Indexes. Youth with PTSD scored significantly lower on the General Memory and Verbal Memory Indexes compared to stress-exposed youth without PTSD. Whereas statistically significant differences were not observed on the Visual Memory and Learning Indexes, clinically significant impairment of these Indexes was observed among youth with PTSD. Finally, three separate MANOVAs were performed to examine for group differences across the WRAML subtests. These analyses failed to reveal significant group differences across the nine WRAML subtests. As such, this study indicates that PTSD is associated with discrete patterns of memory impairment in youth. A discussion of the observed results with reference given to clinical and theoretical implications is presented. Finally, the potential limitations with reference given to implications for future research are addressed. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Early Experience; *Memory; *Posttraumatic Stress Disorder; *Stress Classification: Health & Mental Health Treatment & Prevention (3300) Population: Human (10) Age Group: Adolescence (13-17 yrs) (200) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print Release Date: 19980101 Accession Number: 1998-95020-231
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1998-95020-231&db=psyh">A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder.</A>
Database: PsycINFO _____
Record: 23
Title: Relationship between perinatal complications and attention deficit hyperactivity disorder and other behavioral characteristics. Author(s): Spadafore, Lori Ann , Ball State U, US Source: Dissertation Abstracts International Section A: Humanities & Social Sciences , Vol 58(10-A), Apr 1998. pp. 3836. Publisher: US: Univ Microfilms International
ISSN: 0419-4209 (Print) Order Number: AAM9812081 Language: English Key Concepts: perinatal complications & ADHD & other behavioral characteristics, biological mothers of children with vs without ADHD Abstract: The present study was undertaken to determine the relationship between perinatal complications and subsequent development of Attention Deficit Hyperactivity Disorder (ADHD) and other behavioral characteristics. The biological mothers of 74 children diagnosed with ADHD and 77 children displaying no characteristics of the disorder completed the Maternal Perinatal Scale (MPS), the Behavior Assessment System for Children-Parent Rating Scales (BASC-PRS), and a demographic survey. In addition, the biological mothers of 120 children with no characteristics of ADHD or any other behavior disorders completed only the MPS so that exploratory factor analysis of the MPS could be completed. Following factor analysis, stepwise discriminant analysis of the resulting five factors was utilized to explore the nature of the relationship between such perinatal factors and ADHD. Results of this analysis indicated that emotional factors, or the amount of stress encountered during pregnancy and the degree to which the pregnancy was planned, were the items that maximized the separation between the ADHD and Non-ADHD groups. Additional discrimination between the groups was attributed to the extent of insult or trauma to the developing fetus and the outcome of prior pregnancies. ADHD children were also found to have experienced twice as many behavioral, social, or medical problems, and were more likely to reach developmental milestones with delays. Stepwise discriminant analysis also revealed the Attention Problems and Hyperactivity scales of the BASC-PRS were most significant in differentiating between the ADHD and Non-ADHD subjects. Using the BASC-PRS resulted in approximately 90% of the total sample being correctly classified as ADHD or Non-ADHD. Canonical correlation analysis indicated that emotional factors and the general health of both the mother and the developing fetus were the best predictors of later behavioral patterns reported on the BASC-PRS. (PsycINFO Database Record (c) 2003 APA, all rights reserved) Subjects: *Attention Deficit Disorder; *Hyperkinesis; *Mothers; *Obstetrical Complications; *Perinatal Period; Stress Classification: Educational Psychology (3500)
Health & Mental Health Treatment & Prevention (3300) Population: Human (10)
Female (40) Age Group: Childhood (birth-12 yrs) (100)
Adulthood (18 yrs & older) (300) Form/Content Type: Empirical Study (0800) Publication Type: Dissertation Abstract (350); Print Release Date: 19991101 Accession Number: 1998-95007-091
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Cut and Paste: <A href="http://search.epnet.com/direct.asp?an=1998-95007-091&db=psyh">Rela tionship between perinatal complications and attention deficit hyperactivity disorder and other behavioral characteristics.</A>
Database: PsycINFO _____
Record: 24
Title: A comparative analysis of WISC-III performance of traumatized and non-traumatized children. Author(s): Samet, Mitchell Jay , City U New York, US Source: Dissertation Abstracts International Section A: Humanities & Social Sciences , Vol 58(9-A), Mar 1998. pp. 3419. Publisher: US: Univ Microfilms International |
