PTSD: Identifying trauma risk in small children early after an accident

Small children also suffer from post-traumatic stress disorders (PTSD) after a serious accident. With the aid of a new test, children with an increased risk can already be identified in the space of a few days.

The test devised by scientists from the University of Zurich and the University Children's Hospital Zurich helps to treat traumatized small children at an early stage.

Accidents also traumatize small children. Around one in ten children still suffers from a post-traumatic stress disorder a year after a road accident or burn injury, reliving aspects of the traumatic experience in the form of flashbacks or nightmares.

In doing so, young children keep replaying the stressful memories while avoiding anything that might remind them of the accident in any way.

As a result of this constant alertness to threatening memories, the children can develop sleeping disorders, concentration problems or aggressive behaviour.

Assessing the risk of illness accurately
Researchers from the University of Zurich and the University Children's Hospital Zurich have now devised and evaluated a systematic questionnaire, which can be used to identify pre-school children with an increased risk of long-term post-traumatic disorders within a few days of an accident.

Markus Landolt

For the first time, it is now possible for first responders such as pediatricians, nursing staff or emergency psychologists to assess small children accurately with regard to their risk of illness.

"Children with an increased risk can thus be identified early and referred to an emergency psychologist for treatment," explains Professor Markus Landolt.

This prevents an acute stress response from developing into chronic mental illness that causes the child to suffer and spells a lengthy and expensive course of treatment.

For the study, Professor Landolt's doctoral student Didier Kramer interviewed a total of 134 parents of two to six-year-old children seven days after a road accident or burn injury.

Didier Kramer

The screening instrument used comprised 21 questions on changes in the child's behavior after the accident and recorded a high degree of accuracy: 85 percent of the children examined who suffered from a post-traumatic stress disorder after six months had already been identified correctly a week after the accident with the aid of the questionnaire.

Markus Landolt is now planning an app for Smartphones in collaboration with IT scientists: "This app will enable the screening to be conducted even more easily and quickly, and above all implemented broadly."

More information: Didier N. Kramer, Matthias B. Hertli, & Markus A. Landolt. Evaluation of an early risk screener for PTSD in preschool children after accidental injury. Pediatrics journal. September 23, 2013. DOI: 10.1542/peds.2013-0713

Study finds child abuse and stunted brain development connection

A small team of researchers has found that various forms of child abuse can lead to stunted development in certain regions of the brain. The research carried out by Martin Teicher, Carl Anderson and Ann Polcari, all working in the Boston area, relied on questionnaires.

MRI brain scans were used to determine that certain parts of the hippocampus, all known to be sensitive to stress, were up to six percent smaller in adults who as children had been sexually, verbally or physically abused. The team has published their results in the Proceedings of the National Academy of Sciences.

The three areas affected: the cornu ammonis, the dentate gyrus and the subiculum, all located in the hippocampus, are known to be vulnerable to stress which leads to less cell development than would normally occur in the absence of abuse.

To test the relationship between brain development and childhood abuse, the research team enlisted a group of otherwise healthy adult volunteers: 73 men and 120 women, all between the ages of 18 and 25.

All were given questionnaires that delved into their childhood, specifically addressing issues of verbal, mental and physical abuse and other types of stresses such as the death of someone close to them or problems between parents.

All were also given brain scans using an MRI machine. The team then compared the answers given on the questionnaires to the possibly impacted areas in the hippocampus of each volunteer. In so doing, they found that the brain regions under study were 5.8 to 6.5 percent smaller than average for those that reported such childhood stresses.

The researchers suggest that smaller brain regions due to childhood stress may help explain the abnormally high levels of mental illness (depression, bi-polarism, anxiety, etc.) seen in adults who have endured abuse as children and why so many wind up with drug dependency problems.

They also noted that one of the regions impacted, the subiculum, serves as a relay, moving information in and out of the hippocampus, which can have a direct impact on dopamine production. Those with reduced volume have been found to have problems with drug addiction and in some cases develop schizophrenia.

The researchers believe that increased stress leads to higher levels of the hormone cortisol, which in turn can slow or even stop the growth of new neurons in the brain which can result in permanently stunting certain brain regions.

The researchers are hoping their results will further highlight the damage that is done when children are subjected to adverse living conditions, leading perhaps to earlier interventions and possibly a means for developing treatments that may aid in preventing the stunting of brain regions, thus helping to pave the way for a better quality of life for those that have been abused as children.

More information: Childhood maltreatment is associated with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum, PNAS, Published online before print February 13, 2012, doi: 10.1073/pnas.1115396109

Abstract
Childhood maltreatment or abuse is a major risk factor for mood, anxiety, substance abuse, psychotic, and personality disorders, and it is associated with reduced adult hippocampal volume, particularly on the left side.

Translational studies show that the key consequences of stress exposure on the hippocampus are suppression of neurogenesis in the dentate gyrus (DG) and dendritic remodeling in the cornu ammonis (CA), particularly the CA3 subfield.

The hypothesis that maltreatment is associated with volume reductions in 3-T MRI subfields containing the DG and CA3 was assessed and made practical by newly released automatic segmentation routines for FreeSurfer.

The sample consisted of 193 unmedicated right-handed subjects (38% male, 21.9 ± 2.1 y of age) selected from the community.

Maltreatment was quantified using the Adverse Childhood Experience study and Childhood Trauma Questionnaire scores.

The strongest associations between maltreatment and volume were observed in the left CA2-CA3 and CA4-DG subfields, and were not mediated by histories of major depression or posttraumatic stress disorder.

Comparing subjects with high vs. low scores on the Childhood Trauma Questionnaire and Adverse Childhood Experience study showed an average volume reduction of 6.3% and 6.1% in the left CA2-CA3 and CA4-DG, respectively.

Volume reductions in the CA1 and fimbria were 44% and 60% smaller than in the CA2-CA3. Interestingly, maltreatment was associated with 4.2% and 4.3% reductions in the left presubiculum and subiculum, respectively.

These findings support the hypothesis that exposure to early stress in humans, as in other animals, affects hippocampal subfield development.

New theory links depression to chronic brain inflammation

Chronic depression may be an adaptive, reparative neurobiological process gone wrong, say two University of California, San Diego School of Medicine researchers, positing in a new theory that the debilitating mental state originates from more ancient mechanisms used by the body to deal with physical injury, such as pain, tissue repair and convalescent behaviour.

In a paper published in the September online edition of Neuroscience and Biobehavioral Review, Athina Markou, PhD, professor of psychiatry, and Karen Wager-Smith, a post-doctoral researcher, integrate evidence from diverse clinical, biological and behavioural studies to create a novel theory they hope will lead to a shift in thinking about depression.

“In contrast to other biological theories of depression, we started with a slightly different question,” said Wager-Smith. “Other theories address the question: ‘What is malfunctioning in depression?’ We took a step back and asked the question: ‘What is the biology of the proper function of the depressive response?’

Once we had a theoretical model for the biology of a well-functioning depressive response, it helped make sense of all the myriad differences between depressed and non-depressed subjects that the biomedical approach has painstakingly amassed.”

According to the new theory, severe stress and adverse life events, such as losing a job or family member, prompt neurobiological processes that physically alter the brain. Neurons change shape and connections.

Some die, but others sprout as the brain rewires itself. This neural remodeling employs basic wound-healing mechanisms, which means it can be painful and occasionally incapacitating, even when it’s going well.

“It’s necessary and normal so that an individual can adapt, change behavior and deal with altered circumstances,” Markou said. Real problems occur only “when these restructuring processes go into overdrive, beyond what is necessary and adaptive, and for longer periods of time than needed. Then depression becomes pathological.”

The theory extends findings made by other researchers that the neurobiological substrates of physical and emotional pain overlap. Just as the body’s repair mechanisms for physical injury can sometimes result in chronic pain and inflammation, so too can the response to psychological trauma, resulting in chronic depression.

Markou and Wager-Smith argue that existing, conflicting views about depression actually describe different aspects of the same phenomenon. Psychoanalytic and sociological theories refer to the psychological transformation that occurs during a productive depressive episode.

Biomedical theories relate to the neural remodeling that underlies this psychological change. And neurodegenerative theories account for remodeling malfunctions.

“The big question, of course, is why aren’t all people affected the same way,” said Markou. “Why do some people deal effectively with stress, but others perpetuate a pathological state? This is an interesting question for future research.”

To read more follow this link ......New theory links depression to chronic brain inflammation | Science Blog

6 Things You Need to Childproof

1. The floor.
I heard a child safety expert recommending that you regularly "take a trip around your home on your hands and knees," so you can "see it like a child." She very rightly says that you must check for;

• concealed paper clips (they hide in all sorts of places),
• strings, ties, and blind cords hanging at neck level,
• wood splinters in the hardwood,
• exposed or unprotected electrical outlets,
• power cords that can be pulled to bring a lamp down,
• tablecloths, napkins and stray hanging drapery that can be pulled down,
• nails, tacks and jagged things in carpet seams,
• seasonal hazards (pumpkin laanterns, easter eggs, Xmas tree decorations etc.)
• other (because the list of potential hazards is endless)

Also, best not to let your neighbours catch you doing this too often, they might get the wrong idea about how you spend your days and dressing up in a furry animal costume to do this doesn't help either, believe me.

2. The baby gate.
Never use spring-loaded baby gates at the top of stairs. You know those ones that are simply jammed between the wall and the stair post by a couple of springs and blind faith. They might hold back a crawling baby at ground level, but a determined toddler on his feet will soon push it over and down will come baby, baby gate and all. Wall-mounted gates are essential.

3. The fireplace.
Don't just block access to the fireplace to prevent serious burns and to foil attempts to escape by climbing up the chimney; the next most likely hazard is to the head via the hard, sharp hearthstone in front of the fireplace.

As children transition from crawling to walking to running, they fall a lot and it is essential that there are only soft things to bang their heads on. Fence off any hazards that will damage soft bones. A hearth gate can keep children away from the entire hazardous fireplace area and give you some peace of mind.

4. The television.
More than 15,000 kids are injured or crushed each year by falling furniture and most of those are caused by falling television sets. Children are naturally drawn to the bright lights of a TV. So, secure yours to the wall or the back of your entertainment center, especially those new smart flat-panel TVs, which tip very easily.

At this time of year you may also consider the Xmas tree as a hazard for small children. It is equally attractive to them as the TV and has so many things on it that they can grasp, prior to bringing it down on themselves.

5. The cat.
Cats and children are a constant source of amusement and disasters, sometimes one following on quickly from the other. Scampering and exploring felines can and do, step on toddlers while they are trying to sleep. So, if you own a cat, keep it out of the bedroom, away from the child and invest in a crib tent.

6. Yourself.
Toddlers are programmed to watch, learn and imitate what you do. So, don't let your child see you operate the baby gate, or because they will copy you. Likewise, if they see you step over the gate, they'll try to climb it, too.

Remember: A well-childproofed house is not a good baby-sitter. Constant adult supervision is the only way to prevent injury or at least greatly reduce the likelihood of injury.