Case Discussion Effects of trauma in children and adolescents Dr Ayesha Minhas

Issues? Conversion disorder Depressive illness Trauma

“Pseudo seizures”/ “Non epileptic or Psychogenic seizures” Diagnosis (1) Nothing beats a good History (2) Planter response immediately after the fit (3) video EEG monitoring (4) measurement of serum prolactin Included under Conversion disorder

Conversion Disorder Motor Symptoms: Weakness or paralysis Abnormal movements e.g tremor Gait abnormalities Sensory Symptoms: Loss of sensation, vision, hearing ‘Seizures’ with ‘impaired consciousness’ Episodes of unresponsiveness like syncope

“The sorrow which has no vent in tears may make other organs weep” Henry Maudsley

Pathophysiology ‘Repressed emotions’ converted into ‘somatic symptoms’ Closely related to psychic trauma

Proposed mechanism of Conversion Traumatic experiences Repressed from conscious memory Nervous excitation Conversion

Trauma in children and adolescents One in four children experiences a significant traumatic event before reaching adulthood domestic, community, or school violence disasters vehicular or other accidents medical traumas war, terrorism the traumatic death of significant others child abuse

Single-blow trauma, such as vehicle accident - Memories fully elaborated, ruminate over details Multiple and repeated traumas, such as covert sexual abuse by a relative -Spotty memories/amnesia with aspects of denial, psychic numbing, dissociation

WHO Definition “Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect and commercial exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity”

Childhood trauma effects brain architecture Childhood Trauma causes disruption in early brain development and immune systems Limbic irritability Deficient development of the cerebral cortex and the hippocampus Deficient left-right hemisphere integration due to underdevelopment of the corpus callosum

Effects of trauma Increased risk for mental health problems Post traumatic stress called the “rheumatic fever” of child psychiatry Conversion/Dissociation Somatoform disorder Depression Panic disorder with agoraphobia Strongly associated with childhood abuse is Borderline personality disorder PTSD 20% of all adolescent suicide attempts due to CSA

Prevention ! Management Manage Anxiety Help child gain insight into unconscious conflicts Discourage illness-related behaviors, and help develop coping mechanisms Build ‘self-esteem’ and ‘promote assertiveness’ Family work to improve communication with family

Sometimes adults say, “They're too young to understand” However young children are affected by traumatic events even though they may not understand !

Thank you