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TREATING TRAUMATIZED CHILDREN : CLINICAL IMPLICATIONS OF THE PSYCHOBIOLOGY OF PTSD

There is growing evidence that child maltreatment and Posttraumatic Stress Disorder (PTSD) result in numerous neurobiological alterations in children and adolescents, including abnormalities in brain structure and functioning. This article reviews several psychobiological systems with regard to their functioning under normal stress and in the presence of PTSD, with a focus on recent research findings in children and adolescents, and the implications these findings have on clinical intervention for traumatized children. The importance of early identification and treatment of traumatized children and the need to empirically evaluate psychopharmacological interventions for childhood PTSD are discussed in detail. Research and policy priorities are also addressed. Treating Traumatized Children: Clinical Implications of the Psychobiology of PTSD Judith A. Cohen, M.D., James M. Perel, Ph.D., Michael D. DeBellis, M.D., M.P.H., Matthew J. Friedman, M.D., Ph.D., and Frank W. Putnam, M.D. Introduction Recent research has greatly increased our understanding of the psychobiological changes that accompany Posttraumatic Stress Disorder (PTSD). While most of this research has been conducted with adults, there are a growing number of studies that have examined these outcomes in traumatized children. This new research has made it clear that PTSD is a particularly complex disorder, which involves many different physiologic systems. This is not surprising if we consider that the very survival of living organisms depends on their ability to cope with and adapt to stress. Thus, the human species has evolved to maintain homeostasis (stability of bodily functions)in the face of a wide variety of stressors. These include environmental stressors such as changes in temperature or food availability, internal biological stressors such as childbearing, aging or illness, and external threats such as natural disasters or the presence of predators. Under most circumstances, human beings utilize exquisitely complex and fine-tuned mechanisms to adjust to these and other stressors. However, there is a limit to the amount of stress that any organism can adapt to while maintaining homeostasis. Beyond that point, the very psychobiological mechanisms that typically allow us to function well under stress, may act in ways that contribute to, maintain, or even cause disease (Selye, 1973). Thus, children who have experienced severe stressors may develop PTSD or other illnesses which indicate that the person’s stress adaptation systems have been acutely or chronically overwhelmed. Having an understanding of how these systems typically respond to stress,