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Message ID: 8841
Date: 2011-03-29

Author:Penny Priest

Subject:Re: Misdiagnosis of ADHD in Abused Children

I think this is a really interesting question. I'm a clinical psychologist working in a Community Mental Health Team in the UK. I'm just finishing a lit review on working with men who have experienced childhood family violence - looking at evidence for long term effects and also systemic interventions. I chose this topic because I started to notice how many of the men I work with have experienced and/or witnessed family violence in childhood. Many of their presenting problems fit with the Trauma Symtoms Inventory and I can imagine if they were children now, a fair few might attract the diagnosis of ADHD, with the underlying problems being ignored. Sorry this doesn't really help much with your quest, though, Carrie. Best wishes Dr Penny Priest ----- Original Message ----- From: "cecox" To: "Child Maltreatment Researchers" Sent: Monday, March 28, 2011 2:48 AM Subject: RE: Misdiagnosis of ADHD in Abused Children > Rosemary- I believe I was referring to Handbook of PTSD: Science and > Practice > Matthew J. Friedman MD PhD (Editor), Terence M. Keane PhD (Editor), > Patricia A. Resick PhD (Editor) > http://www.amazon.com/Handbook-PTSD-Matthew-Friedman-PhD/dp/1593854730 > > Christine > > On Sun, 30 Jan 2011 11:11:40 -0500, "Rosemary Caolo" > wrote: >> Hello all- >> Having worked in the field of child welfare and in community mental > health >> and private practice with victims of physical/sexual abuse I could not >> agree >> more. My dissertation was a case study of a client and the ramifications > of >> ongoing CSA. I am currently teaching theory and practice to graduate >> social >> work students (many who currently work in child welfare and foster care) >> and >> would be interested in the name of the Handbook of PTSD you reference. I >> have multiple texts on trauma and PTSD but am always looking for > worthwhile >> material. >> Thanks so much for your help- >> Rosemary Caolo, PhD, LCSW >> >> -----Original Message----- >> From: bounce-7824398-11755120@list.cornell.edu >> [mailto:bounce-7824398-11755120@list.cornell.edu] On Behalf Of cecox >> Sent: Saturday, January 29, 2011 7:21 PM >> To: Child Maltreatment Researchers >> Subject: Re: Misdiagnosis of ADHD in Abused Children >> >> 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 >>>> >>>> >> >> No virus found in this incoming message. >> Checked by AVG - www.avg.com >> Version: 9.0.872 / Virus Database: 271.1.1/3412 - Release Date: 01/30/11 >> 02:34:00 > >

I think this is a really interesting question. I'm a clinical psychologist working in a Community Mental Health Team in the UK. I'm just finishing a lit review on working with men who have experienced childhood family violence - looking at evidence for long term effects and also systemic interventions. I chose this topic because I started to notice how many of the men I work with have experienced and/or witnessed family violence in childhood. Many of their presenting problems fit with the Trauma Symtoms Inventory and I can imagine if they were children now, a fair few might attract the diagnosis of ADHD, with the underlying problems being ignored. Sorry this doesn't really help much with your quest, though, Carrie. Best wishes Dr Penny Priest ----- Original Message ----- From: "cecox" To: "Child Maltreatment Researchers" Sent: Monday, March 28, 2011 2:48 AM Subject: RE: Misdiagnosis of ADHD in Abused Children > Rosemary- I believe I was referring to Handbook of PTSD: Science and > Practice > Matthew J. Friedman MD PhD (Editor), Terence M. Keane PhD (Editor), > Patricia A. Resick PhD (Editor) > http://www.amazon.com/Handbook-PTSD-Matthew-Friedman-PhD/dp/1593854730 > > Christine > > On Sun, 30 Jan 2011 11:11:40 -0500, "Rosemary Caolo" > wrote: >> Hello all- >> Having worked in the field of child welfare and in community mental > health >> and private practice with victims of physical/sexual abuse I could not >> agree >> more. My dissertation was a case study of a client and the ramifications > of >> ongoing CSA. I am currently teaching theory and practice to graduate >> social >> work students (many who currently work in child welfare and foster care) >> and >> would be interested in the name of the Handbook of PTSD you reference. I >> have multiple texts on trauma and PTSD but am always looking for > worthwhile >> material. >> Thanks so much for your help- >> Rosemary Caolo, PhD, LCSW >> >> -----Original Message----- >> From: bounce-7824398-11755120list.cornell.edu >> [mailto:bounce-7824398-11755120list.cornell.edu] On Behalf Of cecox >> Sent: Saturday, January 29, 2011 7:21 PM >> To: Child Maltreatment Researchers >> Subject: Re: Misdiagnosis of ADHD in Abused Children >> >> 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 >>>> >>>> >> >> No virus found in this incoming message. >> Checked by AVG - www.avg.com >> Version: 9.0.872 / Virus Database: 271.1.1/3412 - Release Date: 01/30/11 >> 02:34:00 > >