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Child-Maltreatment-Research-L (CMRL) List Serve

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Welcome to the database of past Child-Maltreatment-Research-L (CMRL) list serve messages (10,000+). The table below contains all past CMRL messages (text only, no attachments) from Nov. 20, 1996 - September 14, 2018 and is updated quarterly.

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Message ID: 8770
Date: 2011-01-05

Author:Carrie Ellis

Subject:Re: Misdiagnosis of ADHD in Abused Children

This is very helpful. Is there a link to your study that abuse experiences were related to an upsurge in traumatic stress symptoms? I would like to use it and be able to cite you correctly. Carrie ________________________________ From: "Chaffin, Mark J. (HSC)" To: Child Maltreatment Researchers Sent: Tue, January 4, 2011 11:05:37 AM Subject: RE: Misdiagnosis of ADHD in Abused Children IMO, the favoring of PTSD over ADHD diagnostically has been an advocacy point for years among some trauma therapists, but one with limited scientific data. Their main concern is that the need for some sort of trauma therapy might be missed. It might be important to remember that the two conditions are not mutually exclusive and children can and often do have both so its not always an either-or proposition. The conditions have different courses. In one of our studies, we found that abuse experiences were clearly related to an upsurge in traumatic stress symptoms, but had little impact on ADHD symptoms, and the combination of two conditions in the same child was not at all uncommon. There also are some clear differences in history and symptoms between the two conditions, so differential diagnosis is quite possible if not always reliable. Sometimes people are on an advocacy agenda with their diagnosis of choice, or may be more familiar with one than the other. I terms of the impact of ADHD medication on children with PTSD, I’m aware of only one controlled study that tested the effect of stimulant medication on things like depression and anxiety among psychiatrically disturbed children with ADHD, and they found no significant negative effect. It was a small sample study. Maybe some of the child and adolescent psychiatrists on the list know of different or other findings, and if so I’d be interested in learning about them. Of course the whole question is complicated by the fact that although stimulants are the main pharmacological treatment for ADHD, there are other classes of medications that can be used as well (e.g. atomoxetine), so just because a child is being treated for ADHD doesn’t automatically mean stimulants. From what studies I’ve seen, stimulants have the largest effect sizes on ADHD symptoms, and the safety record is pretty good, but they are not the only option. Perhaps the bottom-line point here for those ADHD vs. PTSD cases where there are clear elements of both is that there doesn’t seem to be any incompatibility at all between the two first-line treatments for the two comorbid conditions (stimulant medication for ADHD and TF-CBT for PTSD). So, if a child has clear symptoms of both, they can be treated for both. We routinely deliver both treatments to the same child and at least from our clinical observations it doesn’t seem to be a problem in the least. Stimulant meds are very short acting, so its often possible to notice fairly quickly if they are helping with things like paying attention in class, completing school work or performing on a neuropsych task. MC Mark Chaffin, PhD Professor of Pediatrics University of Oklahoma Health Sciences Center P.O. Box 26901 Oklahoma City, OK (405) 271-8858 mark-chaffin@ouhsc.edu This message (including attachments) may contain information that is privileged, confidential or protected from disclosure. If you are not the intended recipient, you are hereby notified that dissemination, disclosure, copying, distribution or use of this message or any information contained in it is strictly prohibited. If you have received this message in error, please immediately notify the sender by reply e-mail and delete this message from your computer. Although we have taken steps to ensure that this e-mail and attachments are free from any virus, we advise that in keeping with good computing practice the recipient should ensure they are actually virus free. From: Carrie Ellis [mailto:carrieellis76@yahoo.com] Sent: Monday, January 03, 2011 12:03 PM Subject: Misdiagnosis of ADHD in Abused Children I am looking for studies on the misdiagnosis of ADHD in abused children. Particularly, the diagnosis of ADHD when the true diagnosis should be PTSD. Also, the consequences of prescribing stimulants to children who have been misdiagnosed. Any ideas are greatly appreciated! Carrie Ellis Policy Research Intern TexProtects

This is very helpful. Is there a link to your study that abuse experiences were related to an upsurge in traumatic stress symptoms? I would like to use it and be able to cite you correctly. Carrie ________________________________ From: "Chaffin, Mark J. (HSC)" To: Child Maltreatment Researchers Sent: Tue, January 4, 2011 11:05:37 AM Subject: RE: Misdiagnosis of ADHD in Abused Children IMO, the favoring of PTSD over ADHD diagnostically has been an advocacy point for years among some trauma therapists, but one with limited scientific data. Their main concern is that the need for some sort of trauma therapy might be missed. It might be important to remember that the two conditions are not mutually exclusive and children can and often do have both so its not always an either-or proposition. The conditions have different courses. In one of our studies, we found that abuse experiences were clearly related to an upsurge in traumatic stress symptoms, but had little impact on ADHD symptoms, and the combination of two conditions in the same child was not at all uncommon. There also are some clear differences in history and symptoms between the two conditions, so differential diagnosis is quite possible if not always reliable. Sometimes people are on an advocacy agenda with their diagnosis of choice, or may be more familiar with one than the other. I terms of the impact of ADHD medication on children with PTSD, I’m aware of only one controlled study that tested the effect of stimulant medication on things like depression and anxiety among psychiatrically disturbed children with ADHD, and they found no significant negative effect. It was a small sample study. Maybe some of the child and adolescent psychiatrists on the list know of different or other findings, and if so I’d be interested in learning about them. Of course the whole question is complicated by the fact that although stimulants are the main pharmacological treatment for ADHD, there are other classes of medications that can be used as well (e.g. atomoxetine), so just because a child is being treated for ADHD doesn’t automatically mean stimulants. From what studies I’ve seen, stimulants have the largest effect sizes on ADHD symptoms, and the safety record is pretty good, but they are not the only option. Perhaps the bottom-line point here for those ADHD vs. PTSD cases where there are clear elements of both is that there doesn’t seem to be any incompatibility at all between the two first-line treatments for the two comorbid conditions (stimulant medication for ADHD and TF-CBT for PTSD). So, if a child has clear symptoms of both, they can be treated for both. We routinely deliver both treatments to the same child and at least from our clinical observations it doesn’t seem to be a problem in the least. Stimulant meds are very short acting, so its often possible to notice fairly quickly if they are helping with things like paying attention in class, completing school work or performing on a neuropsych task. MC Mark Chaffin, PhD Professor of Pediatrics University of Oklahoma Health Sciences Center P.O. Box 26901 Oklahoma City, OK (405) 271-8858 mark-chaffinouhsc.edu This message (including attachments) may contain information that is privileged, confidential or protected from disclosure. If you are not the intended recipient, you are hereby notified that dissemination, disclosure, copying, distribution or use of this message or any information contained in it is strictly prohibited. If you have received this message in error, please immediately notify the sender by reply e-mail and delete this message from your computer. Although we have taken steps to ensure that this e-mail and attachments are free from any virus, we advise that in keeping with good computing practice the recipient should ensure they are actually virus free. From: Carrie Ellis [mailto:carrieellis76yahoo.com] Sent: Monday, January 03, 2011 12:03 PM Subject: Misdiagnosis of ADHD in Abused Children I am looking for studies on the misdiagnosis of ADHD in abused children. Particularly, the diagnosis of ADHD when the true diagnosis should be PTSD. Also, the consequences of prescribing stimulants to children who have been misdiagnosed. Any ideas are greatly appreciated! Carrie Ellis Policy Research Intern TexProtects