Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. I aim to show how contemporary developmental science points us on a path to effective prevention, intervention, and treatment, with the aim of promoting healthy development and wellbeing of all children and families.

Friday, May 13, 2011

Preserve Important Childhood Trauma Treatment Program

In a powerful recent New York Times op ed, Post-Traumatic Childhood, leading trauma researcher Bessel van der Kolk writes about the possible of loss of funding for the National Child Traumatic Stress Network, an organization developed in 2001 to evaluate and develop treatments for traumatized children nationwide. He writes:

Most traumatized children now do not even receive a proper mental health assessment. Moreover, hundreds of thousands of them are numbed by powerful drugs that help control their "bad behavior," but that don't deal with the imprint of terror and helplessness on their minds and brains. Drugs can sedate, but they do not help children deal with trauma - in fact, they may prevent recovery by interfering with learning and the formation of relationships, essential preconditions for becoming functioning adults.
This paragraph brought to mind a particularly distressing case from my previous job as a behavioral pediatrician in a busy small town practice. This eight year old boy(details have been changed to protect privacy) had recently moved to a new foster home in my town and his foster parents brought him to see me to prescribe medication for attention deficit hyperactivity disorder(ADHD), which had been diagnosed by a psychiatrist in another town about 40 minutes away.

This little boy had not only been physically and sexually abused starting at a very young age, but he had been removed from another foster home where he had allegedly sexually assaulted another young child. He was impulsive and distracted in school, symptoms which, according to his new foster mother, were helped by his medication. She wanted me to prescribe the medication because the trip to the psychiatrist was too long. At the time I saw him, he was receiving no other treatment besides monthly visits to the psychiatrist for his medication.

When I resisted, saying in as gentle a way as possible that his problems needed much more intensive intervention than I could offer as a pediatrician, his foster mother was indignant. "But his psychiatrist said I should come to you. It's only to refill the medication, and I just can't drive that far." When I called the psychiatrist, horrified to learn that she had endorsed this plan, she reluctantly agreed to continue seeing the patient, but made it clear that she felt I was just making this foster mother's life more difficult.

I don't know if I made things any better for this boy by insisting that he at least be treated by a trained mental health professional. I spoke with the psychiatrist about the need for more intensive help, but given the lack of resources and lack of motivation, both on the part of the foster mother and psychiatrist, this probably didn't happen. Yet I felt that I could not collude with the system in sedating away this child's symptoms rather than addressing the underlying trauma, the "imprint of terror and helplessness" so eloquently and dramatically described by Dr. van der Kolk.

Soon after this incident I left that job. I had begun to feel increasingly uncomfortable prescribing medication to children in this way. The standard of care for ADHD treatment, where similarly traumatized children are often treated by pediatricians who prescribe medication at visits every 3 months, did not seem right. Instead I am writing to call attention to the problem, as well as developing, within a pediatric practice, an infant mental health program that focuses on prevention.

Many others in the areas of childhood trauma research, as well as the growing discipline of infant mental health, are speaking out about the need for changes in the way we treat these most vulnerable members of our society. I hope that our combined voices will be sufficient to call attention to the problem, and reverse the proposed 70 percent reduction in funding for the National Child Traumatic Stress Network.

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