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Notes from the International Trauma Conference
June 29, 2011
One of the biggest health stories of our time is the dramatic increase in the diagnosis of childhood mental illness. In a recent article in the New York Review of Books, Marcia Angell notes that the prevalence of "junior bipolar disorder" jumped forty-fold between 1993 and 2004, and that 10 percent of ten-year old boys now take medication for ADHD. Children who come from poverty and broken homes are one of the most medicated groups in our country.
We lack a sound understanding of the long-term effects of childhood psychotropic medication. Children routinely receive drugs that were only FDA-approved for use among adults. And many of the diagnoses now given to children, including bipolar disorder, PTSD and depression, were originally developed for adult patients.
A group of researchers, doctors and social workers is taking a different approach to childhood mental illness. Every year this group gathers to discuss the latest research and treatment options in their field. Last month, I headed up to Boston to catch a day of this event, the International Trauma Conference.
The International Trauma Conference is part of the burgeoning field of ‘neurosociology'-the study of how society and the environment shape brain development. Neurosociology is particularly important for understanding the mental health of babies and young children, who depend on consistent, loving care for their brains to develop normally.
Developmental Trauma Disorder
The conference was hosted by the Trauma Center at the Justice Resource Institute, a research and treatment center in Boston. Its founder is Bessel van der Kolk, a lanky and charismatic psychiatrist from Holland. Dr. van der Kolk is an outspoken proponent of a new diagnostic category for abused and neglected children, called Developmental Trauma Disorder, or DTD.
DTD is based on the theory that early childhood experiences literally shape the brain-and therefore the mind, behavior and personality of children into adulthood. Birth to age three is the peak time for the development of neural networks, and as with any natural system in flux, these networks are deeply sensitive to outside influence.
DTD researchers think that when young children experience ongoing chaos, fear and abuse in their lives-what researchers call traumatic stress-these neural networks are profoundly affected. The brain of a child who is chronically abused or neglected is wired for survival above all else. For a child with developmental trauma, learning and socio-emotional development typically fall behind.
Developmental trauma manifests in different ways. Some children may become extremely withdrawn and non-responsive; others are angry and violent. They often end up with an array of diagnoses and medications. Studies show that between 13 and 52 percent of children in foster care are on psychotropic medication.
As van der Kolk said in an unscripted moment, "Our diagnostic system is a total fraud."
The Challenge of Treatment
While the connection between nurture and brain development is fairly intuitive, treating developmental trauma requires major creativity in the context of our health system. Dr. Bruce Perry, a senior fellow at the Child Trauma Academy in Houston, pointed out that an hour-long weekly sit-down with a therapist does little to modify established patterns of brain function. In the brain, change happens in milliseconds, and effective interventions should be short, repetitive and daily.
"The key to effective change," said Perry, "is to make interventions resonant with biology."
In a plenary session, Perry laid out his vision for a mental health diagnostic system that uses physiological cues to understand what's going on in the brain. His center developed a system called "neurosequential therapy" to pinpoint the best therapeutic interventions for traumatized children, many of them in foster care. The treatment team combines interviews, observation and a child's history to understand how trauma has affected the various regions of each child's brain.
"We know how the brain organizes, and when," Perry said. "If we know when trauma happened and what protective factors were in place, we can know how the brain was affected."
Next Steps & Story Ideas
The conference had a familiar format to anyone who has attended a medical get-together: the cavernous conference space, the breakout sessions, the scramble for lunch. Conspicuously absent, however, were any signs of the pharmaceutical industry. Instead, breakout sessions included primers on talk therapy, theater, yoga, massage and meditation. Such interventions may not be recognized by insurance companies, van der Kolk argued, but there is growing scientific evidence that they work.
It will be interesting to see how this particular field fares in the larger psychiatric community. The latest edition of the profession's diagnostic manual, the DSM-5, is currently under review and is set to be published in May 2013. DTD researchers hope that the diagnosis will be recognized in the manual. The Justice Resource Institute is organizing a series of clinical field trials in eight sites-Anchorage, Chicago, Hartford, Houston, Massachusetts, New York City, Philadelphia and Southern Michigan-to bolster the case. Preliminary results will be out in November 2011.
Any reporter interested in health, neuroscience or child welfare will find ample opportunity for stories in this field.
Photo credit: D. Sharon Pruitt via Flickr