September 1, 1999
Psychiatric Times.
No. 9
Developmental Traumatology: Neurobiological Development in Maltreated Children With PTSD
Michael D. DeBellis, M.D.
Dr. DeBellis is assistant professor of psychiatry at University of Pittsburgh Medical Center, where he also directs the Developmental Traumatology Laboratory at Western Psychiatric Institute and Clinic. He is the recipient of the 1998 A.E. Bennett Research Award for Original Research in Clinical Science from the Society of Biological Psychiatry.
In contrast, the right, left and total lateral ventricles were proportionally larger in the PTSD subjects than in 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 negatively with intracranial volume and total corpus callosum and regional measures. The decreased hippocampal volumes reported in adults with PTSD were not found in these subjects (DeBellis et al., 1999b).
In the developing brain, catecholaminergic neurotransmitters and steroid hormones are known to modulate the developmental processes of neuronal migration, differentiation and synaptic proliferation, and may affect overall brain development. (For a review of this topic, see DeBellis et al., 1999b-Ed.) These data suggest that chronically maltreated children with a diagnosis of PTSD manifest alterations of major biological stress systems, including adverse influences on brain development. Although causation cannot be proven because these findings were based on a cross-sectional analysis, the data are intriguing and may have important social policy and treatment implications.
For example, intracranial volume increases steadily until 10 years of age with 75% of adult brain weight occurring by 2 years of age (Carmichael, 1990). Near completion of adult intracranial volume has occurred by 5 years of age (Pfefferbaum et al., 1994). Thus, the availability of community educational and supportive programs targeting children under 5 years of age who are at risk for traumatic experiences is extremely important as a primary preventive measure.
Psychopharmacological treatments for PTSD that dampen the activity of the major biological stress systems (DeBellis, 1997; Perry, 1994), in conjunction with psychotherapy and social skills training, may provide an effective treatment strategy for maltreated children who suffer from PTSD. Treatments may prevent the secondary long-term adverse psychobiological consequences of traumatic stress in these patients.
Caring for children who have suffered prior maltreatment offers unique challenges. Elucidating the biological sequelae and mechanisms of symptom production in PTSD and associated comorbid psychiatric disorders will pave the way for better clinical and social treatment of abused children. Accordingly, prospective longitudinal studies in developmental traumatology are critical to this development of early interventions to attenuate the psychobiological dysregulation and adverse effects on brain development that are associated with maltreatment.
References
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DeBellis MD (1997), Posttraumatic stress disorder and acute stress disorder. In: Handbook of Prevention and Treatment with Children and Adolescents: Intervention in the Real World Context, Ammerman RT, Hersen M, eds. New York: John Wiley & Sons Inc., pp 455-494.
DeBellis MD, Baum AS, Birmaher B et al. (1999a), A.E. Bennett Research Award. Developmental traumatology. Part I: Biological stress systems. Biol Psychiatry 45(10):1259-1270 [comments].
DeBellis MD, Keshavan MS, Clark DB et al. (1999b), A.E. Bennett Research Award. Developmental traumatology. Part II: Brain development. Biol Psychiatry 45(10):1271-1284 [comments].
DeBellis MD, Putnam FW (1994), The psychobiology of childhood maltreatment. Child and Adolescent Psychiatric Clinics of North America 3:663-677.
Perry BD (1994), Neurobiological sequelae of childhood trauma: PTSD in children. In: Catecholamine Function in Posttraumatic Stress Disorder: Emerging Concepts, Murburg MM, ed. Washington, D.C.: American Psychiatric Press Inc., pp 233-255.
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