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

2. Issues?
Conversion disorder
Depressive illness
Trauma

3. “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

4. 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

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

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

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

8. 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

9. 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

10. 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”

11. 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

12. 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

13. 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

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

15. Thank you