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Message ID: 8805
Date: 2011-02-01

Author:Joan Crowley

Subject:Re: Misdiagnosis of ADHD in Abused Children

I have often thought that the most important source of psychological services for abused children is the school, especially since the passage of the IDEA (Individuals with Disabilities Education Act). I know that the psychological unit for the local school district has grown substantially over the past 20 years. The psychologists and diagnosticians are often the only services parents can afford. They need to get the message that any child who is struggling needs to be evaluated for exposure to violence. Most will not be abused, fortunately, but the issue needs to be explored in any comprehensive care plan. Jody Crowley Department of Criminal Justice New Mexico State University On Jan 29, 2011, at 5:20 PM, cecox wrote: > Maybe in theory. > For most practitioners a diagnosis of PTSD or more accurately, > Traumatic > Sress Syndrome (ongoing, chronic exposure), would not occur to them. > They > see the most obvious symptoms and go straight to ADHD because it is > such a > popular diagnosis and they are so highly influenced by the > pharmaceutical > industry. If you ask them if it could be PTSD instead, they would > probably > argue against it because they are also influenced by the traditional > diagnostic criteria for PTSD being EVENT-based and including > "threatened > death or serious injury, or a threat to physical integrity". Living > in a > home with adults behaving in a threatening or disturbing and > unpredictable > manner on a daily basis can produce the same symptoms but is > commonly not > considered. Also there is a prejudice that the symptoms would > present as > primarily psychological, e.g., depression and anxiety, not so much > cognitive, physiological and behavioral symptoms. The glucocorticoids > released in distressing situations exert effects on > neurotransmitter/neuroendicrine functioning (the hypothalamus- > pituitary > axis, amygdala, hippocampus), impair the functioning of the prefrontal > cortex, affect behavior, learning and memory. Stimulants can seem to > help > with symptoms of depression and inability to concentrate in PTSD, > however > the prescribing of them is misguided because they are hard on the > adrenal > glands which can have long term affects on the ability of the adrenal > glands to produce normal levels of cortisol and also chemically > alter brain > and endocrine function in a way that can lead to permanent problems. > Especially in childhood when the brain is still developing. There > needs to > be greater awareness of the possibility of PTSD in children, even in > apparently "normal" families, and also education about natural ways to > address the symptoms rather than using drugs. All conscientious > pediatricians and people working with children and victims of family > violence should take it upon themselves to read the Handbook of PTSD > and > related literature to familiarize themselves with underlying > physiological > processes involved in PTSD. Then they will be more likely to > recognize it > and treat it effectively. > > Those are very good questions that you raise Carrie. Unfortunately > you will > probably not find much in the way of research and get a lot of these > "uh- > let's not go there" type of responses. > > Christine Cox > > > On Wed, 5 Jan 2011 19:07:52 -0500, "Dr. Bruce Borkosky, Psy.D PA" > wrote: >> Any diagnosis of ADHD must have ruled out all other possible causes >> of > the >> behaviors. >> Bruce Borkosky >> >> On Mon, Jan 3, 2011 at 1:02 PM, Carrie Ellis >> wrote: >> >>> 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 >>> >>> >

I have often thought that the most important source of psychological services for abused children is the school, especially since the passage of the IDEA (Individuals with Disabilities Education Act). I know that the psychological unit for the local school district has grown substantially over the past 20 years. The psychologists and diagnosticians are often the only services parents can afford. They need to get the message that any child who is struggling needs to be evaluated for exposure to violence. Most will not be abused, fortunately, but the issue needs to be explored in any comprehensive care plan. Jody Crowley Department of Criminal Justice New Mexico State University On Jan 29, 2011, at 5:20 PM, cecox wrote: > Maybe in theory. > For most practitioners a diagnosis of PTSD or more accurately, > Traumatic > Sress Syndrome (ongoing, chronic exposure), would not occur to them. > They > see the most obvious symptoms and go straight to ADHD because it is > such a > popular diagnosis and they are so highly influenced by the > pharmaceutical > industry. If you ask them if it could be PTSD instead, they would > probably > argue against it because they are also influenced by the traditional > diagnostic criteria for PTSD being EVENT-based and including > "threatened > death or serious injury, or a threat to physical integrity". Living > in a > home with adults behaving in a threatening or disturbing and > unpredictable > manner on a daily basis can produce the same symptoms but is > commonly not > considered. Also there is a prejudice that the symptoms would > present as > primarily psychological, e.g., depression and anxiety, not so much > cognitive, physiological and behavioral symptoms. The glucocorticoids > released in distressing situations exert effects on > neurotransmitter/neuroendicrine functioning (the hypothalamus- > pituitary > axis, amygdala, hippocampus), impair the functioning of the prefrontal > cortex, affect behavior, learning and memory. Stimulants can seem to > help > with symptoms of depression and inability to concentrate in PTSD, > however > the prescribing of them is misguided because they are hard on the > adrenal > glands which can have long term affects on the ability of the adrenal > glands to produce normal levels of cortisol and also chemically > alter brain > and endocrine function in a way that can lead to permanent problems. > Especially in childhood when the brain is still developing. There > needs to > be greater awareness of the possibility of PTSD in children, even in > apparently "normal" families, and also education about natural ways to > address the symptoms rather than using drugs. All conscientious > pediatricians and people working with children and victims of family > violence should take it upon themselves to read the Handbook of PTSD > and > related literature to familiarize themselves with underlying > physiological > processes involved in PTSD. Then they will be more likely to > recognize it > and treat it effectively. > > Those are very good questions that you raise Carrie. Unfortunately > you will > probably not find much in the way of research and get a lot of these > "uh- > let's not go there" type of responses. > > Christine Cox > > > On Wed, 5 Jan 2011 19:07:52 -0500, "Dr. Bruce Borkosky, Psy.D PA" > wrote: >> Any diagnosis of ADHD must have ruled out all other possible causes >> of > the >> behaviors. >> Bruce Borkosky >> >> On Mon, Jan 3, 2011 at 1:02 PM, Carrie Ellis >> wrote: >> >>> 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 >>> >>> >