RE: severity of abuse -ADHD

[dick sobsey <dick.sobsey@xxxxxxxxxxx>]

It would be a mistake to think that ADHD has one etiology and it may be a mistake to think that all kids who have symptoms of ADHD have similar brain structure, chemistry, and electrical activity. However, there are two developments that suggest that CHRONICALLY absued children develop some of teh same brain electrical activity associated with ADHD.

First, EEG patterns that are typical of ADHD are being better understood. In essence these kids produce lots of slow waves associated with low levels or arousal and have lots of lttle electrical bursts that are almost like micro seizures.

Second, researchers are beginning to see the effects of chronic exposure to violence on the developing brain. Some but not all of the effects look very much like ADHD. What seems to eb happening is that the mechanism is not typically getting physically damaged by being hit (though that affects lots of kids too). THe mecahnism seems to be that children exposed to extreme stress produce a lot of steroids particularly corisol (the same thing as hydrocortisone. The high levels of cortisol during brain development change the brain physically for the long term. These kids have smaller hypocampi (Critical for memory) expecially on the left side, smaller cortexes,and differences in limbic and brainstem functions (this is where the ADHD comes in).

This research has a lot further to go, but it is beyond the point that it can be totally dismissed.

The earliest work was in the early 1970s. Davies took EEGs on girls who were incest survivors. The reason was that a lot of them exhibited seizures and it was assumed that they were hysterical or pseudo seizures (in other words it was assumed that in spite of having seizures they would have EEGs that were normal). What was found was just the opposite, not only did the incest survivors who had seizures have abnormal EEGs. The incest survivors who didn't have seizures often had abnormal EEGs. At the time, this made no sense, but it it is completely consistent with oday's studies on the effects of trauma.

ADHD, however, is only one of a wide spectrum of disabilities that are associated with abuse. we can now be pretty sure sure that there is a strong association between child abuse and childhood disability. Children with disabilities are about three times as likely to be abused as kids without. Some part, but not all of that association results from abuse causing disability. Another part is caused by increased vulnerability or targeting of kids with disabilities. A third part is caused by other caussal factors, such as substance abusing parents, that increase risk for both. BUT at this stage there is no research thatcan tell us whether the primary causal path of assoction is in one direction or another. Epidemiological studies of childhood disability typically give violence a very small role, less than 1%. This is probably due to methodological problems. My personal bet is that we will see better studies that raise that figure to about 20% in the next two decades. If that turns out to be true, it not only suggests a terrible human cost, it suggests that the economic costs are 100s of billions higher than we now understand.

One final note. There is another equally nasty variation of this. The stress response in women who are victims of domestic violence during pregnancy appears to have drastic effects on resrtiction of blod flow to the uterus. The effects of this on birthweight, etc. are a lot like having the mother smoke a couple of packs of cigarettes every day. It is also likely, though no one has tested it yet, that the chemicals that the mother produces while under intense stress are transferred to the fetus and have developmental effects much like the effects described in kids who are abused.

This means that violence may be disableing children before as well as sfter they are born.

If anyone is interested in reading some research on this. Here is a short bibliography.

Ames, E. (1997) Developmental milestones and intelligence. The development of Romanian orphanage children adopted to Canada. Final Report. Ottawa: National Welfare Grants Program.
Billmire, M.E, & Myers, P.A. (1985). Serious head injury in infants: accident or abuse? Pediatrics , 75, 340-342.
Bonnier, C., Nassogne, M. C., & Evrard, P. (1995). Outcome and prognosis of whiplash shaken infant syndrome; late consequences after a symptom-free interval. Developmental Medicine and Child Neurology, 37(11), 943-956.
Bowker, L. H., Arbitell, M., & McFerron, J. R. (1988). On the relationship between wife beating and child abuse. In K. Yllo & M.
Brandwein, H. (1973). The battered child: A definite and significant factor in mental retardation. Mental Retardation, 11(5), 50-51.
Bremner, J. D. (1999). Does stress damage the brain? Biological Psychiatry, 45(7), 797-805.
Bremner, J. D., Randall, P., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C., Capelli, S., McCarthy, G., Innis, R. B., & Charney, D. S. (1997). Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse--a preliminary report. Biological Psychiatry, 41(1), 23-32.
Brownlee,S. (1996, November 11). The biology of soul murder. U.S. News and World Report, pp. 71-73.
Campbell, J., Torres, S., Ryan, J., King, C., Campbell, D.W., Stallings, R.Y., & Fuchs, S.C. (1999). Physical and nonphysical partner abuse and other risk factors for low birthweight among full term an preterm babies: A multiethnic case-control study. American Journal of Epidemiology, 150(7), 714-726.
Carty, H., & Ratcliffe, J. (1995, February 11). The shaken infant syndrome. BMJ: British Medical Journal, 310 (6976), 344-345.
Davies, R. K. (1978). Incest: some neuropsychiatric findings. International Journal of Psychiatry in Medicine, 9(2), 117-121.
Davies, R. K. (1979). Incest and vulnerable children. Science News, 116, 244-245.
De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., Frustaci, K., & Ryan, N. D. (1999). A.E. Bennett Research Award. Developmental traumatology. Part II: Brain development [see comments]. Biological Psychiatry, 45(10), 1271-1284.
DiScala, C. ,Sege, R., Li, G.H., & Reece, R.M. (2000). Child abuse and unintentional injuries - A 10-year retrospective. Archives Of Pediatrics & Adolescent Medicine,154(1), 16-22.
Edleson, J.L. (1999). the overlap between child maltreatment and woman battering. Violence Against Women, 5(2), 134-154.
Elmer, E., & Gregg, G. S. (1967). Developmental characteristics of abused children., Pediatrics 40(4, Part I.), 596-602.
Ewing-Cobbs, L., Kramer, L., Prasad, M., Canales, D. N., Louis, P. T., Fletcher, J. M., Vollero, H.. Landry, S. H., &Cheung, K. (1998). "Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children." Pediatrics 102(2 Part 1), 300-7.
Fernandez, F.M., & Krueger, P.M. (1999). Domestic violence: Effect on pregnancy outcome. Journal of the American Osteopathic Association, 99(5), 254-256.
Flaherty, E. G., & Weiss, H. (1990). Medical evaluation of abused and neglected children. American Journal on Diseases of Children, 144(3), 330-334.
Fischer, H., & Allasio, D.(1994)Permanently damaged: Long-term follow-up of shaken babies. Clinical Pediatrics, 33(11), 696-698.
Joseph, R. (1999). The neurology of traumatic "dissociative" amnesia: Commentary and literature review. Child Abuse & Neglect, 23(8), 715-727.
Leventhal, J.M., Forsyth, B.W.C., Qi,, K., Johnson, L., Schroeder, D. & Votto, N. (1997). Maltreatment of children born to women who used cocaine during pregnancy: A population-based study. Pediatrics. 100(2), E7.
Lund, A.M. Sandgren G. Knudsen FU. [Shaken baby syndrome]. [Danish] Ugeskrift for Laeger. 160(46):6632-7, 1998 Nov 9. 99043120.
Mansell, S., Sobsey, D., & Moskall, R. (1998) Clinical findings among sexually abused children with and without developmental disabilities, Mental Retardation, 36(1), 12-22.
Muhajarine, N., & D'Arcy, C. (1999). Physical abuse during pregnancy: Prevalence and risk factors. Canadian Medical Association Journal, 160(7), 1007-1011.
Sandgrund, A., Gaines, R. W., & Green, A. H. (1974). Child abuse and mental retardation: A problem of cause and effect. American Journal of Mental Deficiency, 79(3), 327-330.
Scherling, D. (1994). Prenatal cocaine exposure and childhood psychopathology: A developmental analysis. American Journal of Orthopsychiatry, 64, 9-19.
Skeels, H.M., & Dye, H.B.A. (1939) A study of the effects of differential stimulation mentally retarded children. Proceedings & Addresses of the American Association on Mental Deficiency, 44, 114-136.
Sobsey, D. (1994). Violence and abuse in the lives of people with disabilities: The end of silent acceptance? Baltimore: Paul H. Brookes publishing Co.
Spitz, R.A. (1949). The role of ecological factors in emotional development in infancy. Child Development, 20, 145-155.
Sullivan, P.M. & Knutson, J.F. (1998). The association between child maltreatment and disabilities in a hospital-based epidemiological study. Child Abuse and Neglect, 22(4), 271-278.
Sullivan, P.M. & Knutson, J.F. (in press). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse and Neglect,
Teixeira,J.M., Fisk, N.M., & Glover, V. (1999, January 16). Association between maternal anxiety in pregnancy and increased intrauterine artery resistance index. Cohort based study. British Medical Journal, 318(7177), 153-157.

Dick Sobsey, Director
JP Das Developmental Disabilities Centre
University of Alberta
6-123 Education North
Edmonton, Alberta T6G 2G5 Canada
phone: (780) 492-3755
fax: (780) 492-1318
dick.sobsey@ualberta.ca