Re: Children & PTSD

I'm new and need help. My husband and I adopted our two biological grandsons who both have significant mental health issues. The oldest lives with us and he is 12. The 10 year old lives in the same city as us but in a therapeutic foster home.

Oops. Didn't know that pressing enter would send what I wrote so far. Anyway, the 12 year old has PTSD.

The 12 year old has PTSD (from domestic violence relationship between bio parents), ODD, ADHD, Bipolar disorder, and Intermittent Explosive Disorder. He has been in residential treatment and now home for 7 months. He is now in a day treatment facility and is starting to transition to his home school. That is definitely a step in the right direction. I would say the biggest problem we have is the ODD. We just can't seem to get through to him. We are wits end.

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Abuse of kids is increasing in the United States and may be the most common cause of interpersonal traumas and posttraumatic stress disorder (PTSD) in kids and teens. Developmental Traumatology, the systematic investigation of the psychiatric and psychobiological impact of overwhelming and chronic interpersonal violence (abuse in childhood) on the developing child, is a relatively new area of study that synthesizes knowledge from an array of scientific fields including: developmental psychopathology, developmental neuroscience, and stress and trauma research.

One active area of research involves the effects of abuse and related stressors on major body stress response systems such as the hypothalamic-pituitary-adrenal (HPA) axis, the catecholamine system (the locus ceruleus (LC)- norepinephrine (NE) /sympathetic nervous system (SNS)) and the immune system and the subsequent effects of chronic stress on brain development. To investigate these relationships, researchers at Western Psychiatric Institute and Clinic have begun to gather data using physiological measures to capture changes is the stress response system. To capture changes in brain development, imaging technology is being used, which provides a non-invasive way to examine differences in brain morphology and physiology.

Results from recent research at the Institute's Developmental Traumatology Laboratory suggest that the overwhelming stress of abuse experiences in childhood is associated with alterations of biological stress systems and with adverse influences on brain development.

In one study, 18 prepubertal abused kids with PTSD and non-traumatized kids with DSM-111-R overanxious disorder (N=10) and healthy controls (N=24) underwent 24 hour urine collection for measurements of urinary free cortisol (UFC), a reflection of HPA axis regulation, and urinary catecholarnine excretion. Abused subjects with PTSD excreted significantly greater amounts of UFC and catecholamines than non-abused controls. These biological stress measures correlated positively with duration of the PTSD trauma and symptoms of intrusive thoughts, avoidance, and hyperarousal.

In a second study, 43 abused kids and teens with PTSD and 61 matched controls underwent comprehensive clinical assessments and an anatomical magnetic resonance imaging (MRI) brain scan. Abused subjects with PTSD had 7.0 % smaller intracranial and 8.0% smaller cerebral volumes than matched controls. The total midsagital area of corpus callosum, the major interconnection between the two hemispheres that is broadly conceptualized as facilitating intercortical communication, and the middle and posterior regions of the corpus callosum, were smaller in abused subjects.

In contrast, right, left, and total lateral ventricles were proportionally larger than controls, after adjustment for intracranial volume. Intracranial volume robustly correlated positively with age of onset of PTSD trauma (i.e., smaller brains were associated with earlier onset of trauma) and negatively with duration of abuse. Symptoms of intrusive thoughts, avoidance, hyperarousal and dissociation correlated positively with ventricular volume, and negatively with intracranial volume and total corpus callosurn and regional measures. The decreased hippocampal volume reported in adult PTSD was not found in these subjects.

These data suggest that chronically abused kids with a diagnosis of PTSD manifest alterations of major biological stress systems including adverse influences on brain development. Although based on a cross sectional analysis, and thus causation cannot be proven, these findings are intriguing and may have important social policy and treatment implications. Elucidating the biological sequelae and mechanisms of symptom production in PTSD and associated comorbid psychiatric disorders will pave the way to better clinical and social treatment of abused kids. Accordingly, prospective longitudinal studies in Developmental Traumatology are critical to the effort to develop early interventions to attenuate the psychobiological dysregulation and adverse effects on brain development associated with abuse.

What should be my course of action?

Hi Mark

An update on my situation here with my son. He is living with 2 other people now in a townhouse. A friend of my son's mother signed the lease for him. I asked her not to get involved because we were trying to work with him (using your program) to get him back on track. She told him that if he didn't like it here with us that he could move in with her and her family. So when we were do the program he jumped ship and went there. 3 weeks after being at her place he was looking for his own and needed a an adult to sign the lease, this "lovely women" who say she loves him and wants to adopt him stepped up to the plate. Just before he moved out he was doing drugs with one of her kid and had a bad trip and came running home for help because he was afraid that he was dying. We got him into the crisis/detox centre and the "lovely women" went and got him. A week later he moved to his own place. I know that he is into drugs heavy duty now. My husband is getting weekly calls from him to see if they can do something together, before he wouldn't even go any where with his dad and now he phones to see what they can do together. I am taking your advice keeping my conversation to 30 seconds and no more after he ran out and left the counselling session 3 weeks ago. The counsellor has the attitude that we should just let him run wild and see what happens. How can you as a parent sit back and watch your child destroy himself? He told me that I should continue the counselling session because the warning lights are going off when I was seeing the behaviour change in this kid and I need to resolve what went on in my home as a child. I came from an alcohlic family physically and verbally abusive, both parents and I raised my brother (we are very close, he phones every night to talk to me before he goes to bed). The counsellor told me his kid does drugs, okay is the whole world gone nuts? I thank God that I saw the warning lights going off! The kids living in the townhouse are going to university, it is just a matter of time now I think before they kick his butt to the curb. I think he will have no place to go. Everyone knows what he is up to. If he should ask to come home what should be my course of action? Rehab, not hang around the friends etc. and how do I convince him to want to go to rehab?... How do I get this kid back? Or do they ever come back?

On Monday, I received a call from a mother of one of his old friends named S___. This friend was in jail and is in a halfway house now, he had gotten into a fight and the kid died from the fight and he went to jail. One of the kids in the townhouse that lives with my son hangs around a kid named Jim. Jim saw S___ and told him that my son is going down the wrong road and that nobody can believe what has happened to this kid with so much potential, that it is unbelievable. S___ begged his mother to call me and to see if they can help in any way to get this kid back. S___ has changed his life around and the mother said he doesn't want what happened to him to happen to my son. S___ wants to meet with him soon, my boy always looked up to S___ and copied him ie. dress, mannerisms etc. The mother said she prayed for 2 hours before she called me asking God for strength and that I would be open to talking to her. Do you think that this meeting will help at all? S___ is trying to arrange the meeting with his social worker to sit in on it as well. Any help and insight from you would be greatly appreciated. Hey the program was working until he called her to move in.

Thanks A.

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Hi A.,

Re: If he should ask to come home what should be my course of action?

You'll want to draft a behavioral contract that stipulates (a) the house rules and (b) the consequences for violating each house rule. Be very specific. Click Here for more info on contracts.

Re: Do you think that this meeting will help at all?

I don't know. It's worth a shot though.

Mark

Online Parent Support

I know I'm too soft!

Thank you Mark for contacting me, I am trying very hard to do as you say, and most of the time I'm doing really well but i know I'm too soft!

My eldest daughter isn't really naughty, its just the stuff that comes out of her mouth, she does not swear, its just the disrespect and her telling me when she is going to do something. She asked me this weekend if she could go on a sleep over i said no because of the way she had acted shouting and arguing.

She was really upset and really didn't think she had done anything wrong. how do i make her see that she is doing wrong? …also she has ADHD but very mild …there is no reasoning with her.

Many thanks M.

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Hi M.,

The strategy that applies here is the one entitled “When You Want Something From Your Kid” (online version – session #3). In this case, you want her to accept a consequence for her choice to shout and argue.

Let me know if you need any clarification after reviewing the strategy listed above.

Mark

Online Parent Support

Teens & Tiredness

Hi Mark,

K's current problems are - bad sleep patterns, and not spending enough time on his study (in fact, almost no time).

Given the success of using the program for his other behaviours (still ups and downs, but he has actually modified his behaviour because of this program), I would like to state these rules & consequences:

1. No sleeping after school (or during the day on weekends). Consequence - phone disabled for 24 hours.

2. At least 1.5 hrs of study per night - in a way that is transparent. that is, when I look in on him, he should be entirely open about what homework he is doing. If he doesn't do enough time, or refuses to tell me what he is doing - Consequence - phone disabled for 24 hrs.

He had a blood test to rule out a medical cause for his tiredness (we get the results in a couple of days) - obviously if there is medical issue and the doctor says he needs more rest, I wouldn't have this rule, but I am confident that won't be the case, and I would like to have clear plan and clear expectations starting from next week.


Click here for my response...

Son is angry, failing in school, & refusing to go to school...

My son is always angry. He hates school and his grades are falling, He does not want to go to school …he is in grade 10. He is angry all the time. What can I do?

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Hi G.,

Re: …grades are failing.

This is covered in the eBook [online version]. Please look for the section entitled “Read these Emails from Exasperated Parents” …then scroll to the bottom where we discuss poor academic performance.

Re: …does not want to go to school.

School refusal is equally common among boys and girls and is most likely to occur between age 5 to 11. Incidence of school refusal is highest when schools reopen after summer.

School refusal is defined as the behavior of resisting or refusing to attend a specific class or to stay in school for an entire day. Such school refusal may be accompanied by one or more of the following behaviors: complaints about stomach pain, headache, or nausea before or during school; crying before and during school; frequent visits to the school nurse; temper tantrums; specific fears; anxiety or sadness.

Truants otherwise tend to be compliant, well-behaved, and academically smart kids. Unlike truants, they stay home only with their moms & dads' knowledge. Generally, they have a close relationship with one or both moms & dads. Overall, they are good kids. So the question arises why does a youngster who wants to comply with the moms & dads' wishes and be good, drive them nuts in the morning when it's time to get ready for school?

Kids refuse to go to school for a reason, and we moms & dads should determine what that reason is.

Some kids refuse to go to school because they are overly anxious. Some may have specific fears or concerns regarding teachers, peers, or some other aspects of the school setting. Others may consciously or unconsciously worry, not about the school as such, but about being away from home. Some overanxious kids are afraid to sleep on their own, insist on having lights on in their room at night, and have nightmares about their safety or the safety of their moms & dads.

Kids who are overanxious about something at school or home need to be gradually exposed to the situation they want to avoid. Offer them emotional support and encouragement. They need to develop better means to cope with situations that provoke anxiety.

Truants tend to feel that others see them in a negative way. They become unduly self-conscious and avoid social situations in which they fear others may criticize them or make fun of them behind their back. Some have negative and troublesome relationships with their peers, and are, perhaps, teased by mischievous kids or harassed by a bully.

For kids who refuse to go to school in order to avoid a difficult social encounter, teach them effective social behaviors such as, learning to say "no" assertively, seeking help from adults, and making new friends. Seek help from school authorities if there is a genuine concern for the safety of your youngster.

In some cases, school refusal starts out with kids experiencing discomfort in the school setting, but as time goes on, they develop a liking for staying home. It dawns on them how much more fun it is to stay home than to go to school and do the "boring stuff." For example, when "Jake is allowed to stay home, he stays in bed for longer hours, plays with toys or watches TV, and gets to visit his grandparents during the day. If I were Jake, I sure would like to stay home day after day, wouldn't you?

Don't make staying home more rewarding than going to school. Eliminate or reduce all incentives for staying home. On the contrary, attach rewards and incentives to going to school and staying there throughout the school hours.

Some teens suddenly become reluctant to go to school because of an appearance and self-esteem problem, or social "image" problem prompted by a school rumor or being let down by a friend. They need appropriate skills and parental support to deal with such situations. Openness in communication and closeness with moms & dads can be really helpful.

Some kids are clinically depressed and experience significant difficulty in getting up and getting out of bed in the morning. Kids who are clinically depressed or who suffer from an anxiety disorder need professional help. Some medications cause sluggishness and may make it difficult for a youngster to be alert and active in morning. In such event, consult your doc.

Having investigated the possible causes and offered your support as a parent, you may have to "push" your youngster out to school. You may have to learn to ignore the tantrums, complaints, and the pleading to "let me stay home just for today."

Mark Hutten, M.A.

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