There is growing evidence that child maltreatment and posttraumatic stress disorder 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 posttraumatic stress disorder, 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 posttraumatic stress disorder are discussed in detail. Research and policy priorities are also addressed.
American Academy of Child and Adolescent Psychiatry Legislative Action Alert
. (2001). Representative Stark introduces graduate medical education bill for shortage specialties. Retrieved from www.aacap.org
2.
American Medical Association
. (2001). Graduate medical education directory 2001-2002. Chicago: Author.
3.
Angold, A.
, Erkanli, A., Egger, H. L., & Costello, E. J. (2000). Stimulant treatment for children: A community perspective. Journal of the Academy of Child and Adolescent Psychiatry, 39, 975-984.
4.
Baker, D. G.
, West, S. A., Orth, D. N., Hill, K. K., Nicholson, W. E., Ekhator, N. N., et al. (1997). Cerebrospinal fluid and plasma beta endorphin in combat veterans with post-traumatic stress disorder. Psychoneuroendocrinology, 22, 517-529.
5.
Benson, H.
, & Klipper, M. Z. (2000). The relaxation response. Cambridge, MA: Harvard University Press.
6.
Bentley, P. J.
(1985). Endocrine pharmacology. New York: Cambridge University Press.
7.
Bonne, O.
, Brundes, D., Gilboa, A., Gomori, J. M., Shenton, M. E., Pitman, R. K., et al. (2001). Longitudinal MRI study of hippocampal volume in trauma survivors with PTSD. American Journal of Psychiatry, 158, 1248-1251.
8.
Brady, K.
(2001, May). Gender differences in PTSD. Paper presented at the 154th annual meeting of the American Psychiatric Association, New Orleans, LA.
9.
Bremner, J. D.
, Narayan, M., Staib, L., Southwick, S. M., McGlashan, T., & Charney, D. S. (1999). Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. American Journal of Psychiatry, 156, 1787-1795.
10.
Bremner, J. D.
, Randall, P., Scott, T. M., & Bronen, R. A. (1995). MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. American Journal of Psychiatry, 152, 973-981.
11.
Bremner, J. D.
, Randall, P., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C., et al. (1997). Magnetic resonance imaging-based measurement of hippocampal volume in post-traumatic stress disorder related to childhood physical and sexual abuse—a preliminary report. Biological Psychiatry, 41, 23-32.
12.
Bremner, J. D.
, Scott, T. M., Delaney, R. C., Southwick, S. M., Mason, J. W., Johnson, D. R., et al. (1993). Deficits in short-term memory in posttraumatic stress disorder. American Journal of Psychiatry, 150, 1015-1019.
13.
California Task Force Guidelines for Treatment of Child Trauma Victims
. (2001). California victims of crime program. Unpublished manuscript.
14.
Campbell, M.
, Anderson, L. T., Small, A. M., Adams, P., Gonzalez, N. M., & Ernst, M. (1993). Naltrexone in autistic children: Behavioral symptoms and attentional learning. Journal of the American Academy of Child and Adolescent Psychiatry, 32(6), 1283-1291.
15.
Chambers, R. A.
, Bremner, J. D., Moghaddam, B., Southwick, S. M., Charney, D. S., & Krystal, J. H. (1999). Glutamate and PTSD: Toward a psychobiology of dissociation. Seminars in Clinical Neuropsychiatry, 4(4), 274-281.
16.
Charney, D. S.
(2001, May 5-10). The neurobiology of mood disorders. Program and abstracts of 154th annual meeting of the American Psychiatric Association, New Orleans, LA, Industry Symposium 5B.
17.
Cohen, J. A.
, Berliner, L., & Mannarino, A. P. (2000). Treatment of traumatized children: A review and synthesis. Journal of Trauma, Violence & Abuse, 1(1), 29-46.
18.
Cohen, J. A.
, Berliner, L., & March, J. S. (2000). Guidelines for treatment of PTSD: Treatment of children and adolescents. Journal of Traumatic Stress, 13, 566-568.
19.
Cohen, J. A.
, & Mannarino, A. P. (1993). A treatment model for sexually abused preschoolers. Journal of Interpersonal Violence, 8(1), 115-131.
20.
Cohen, J. A.
, Mannarino, A. P., & Rogal, S. S. (2001). Treatment practices for childhood PTSD. Child Abuse and Neglect, 25, 123-125.
21.
DeBellis, M. D.
(in press). The neurobiology of PTSD across the life cycle. In J. C. Soares & S. Gershon (Eds.), The handbook of medical psychiatry. New York: Marcel Dekker.
22.
DeBellis, M. D.
, Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A. M., et al. (1999). Developmental traumatology part I: Biological stress systems. Biological Psychiatry, 45, 1259-1270.
23.
DeBellis, M. D.
, Burke, L., Trickett, P. K., & Putnam, F. W. (1996). Antinuclear antibodies and thyroid function in sexually abused girls. Journal of Traumatic Stress Studies, 9, 369-378.
24.
DeBellis, M. D.
, Chrousos, G. P., Dorn, L. D., Burke, L., Helmers, K., Kling, M. A., et al. (1994). Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls. Journal of Clinical Endocrinology and Metabolism, 78, 249-255.
25.
DeBellis, M. D.
, Clark, D. B., Beers, S. R., Soloff, P. H., Boring, A. M., Hall, J., et al. (2000). Hippocampal volume in adolescent-onset alcohol use disorder. American Journal of Psychiatry, 157, 737-744.
26.
DeBellis, M. D.
, Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., et al. (1999). Developmental traumatology part II: Brain development. Biological Psychiatry, 45, 1271-1284.
27.
DeBellis, M. D.
, Keshavan, M. S., & Harenski, K. A. (2001). Case study: Anterior cingulate N-acetylaspartate concentrations during treatment of a maltreated child with PTSD. Journal of Child and Adolescent Psychopharmacology, 11, 311-316.
28.
DeBellis, M. D.
, Keshavan, M. S., Spencer, S., & Hall, J. (2000). N-acetylaspartate concentration in the anterior cingulate of maltreated children with PTSD. American Journal of Psychiatry, 157, 1175-1177.
29.
DeBellis, M. D.
, Lefter, L., Trickett, P. K., & Putnam, F. W. (1994). Urinary catecholamine excretion in sexually abused girls. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 320-327.
30.
DeBellis, M. D.
, & Putnam, F. W. (1994). The psychobiology of childhood maltreatment. Child and Adolescent Psychiatric Clinics of North America, 3(4), 663-678.
31.
Deblinger, E.
, & Heflin, A. H. (1996). Treating sexually abused children and their non-offending parents: A cognitive behavioral approach. Thousand Oaks, CA: Sage.
32.
Deutch, A. Y.
, & Young, C. D. (1995). A model of the stress-induced activation of prefrontal cortical dopamine systems: Coping and the development of PTSD. In M. J. Friedman, D. S. Charney, & A. Y. Deutch (Eds.), Neurobiological and clinical consequences of stress: From normal adaptation to post-traumatic stress disorder (pp. 163-176). Philadelphia: Lippencott-Raven.
33.
Eichenbaum, H.
, & Cohen, N. J. (2001). From conditioning to conscious recollection: Memory systems of the brain. Oxford, UK: Oxford University Press.
34.
Famularo, R.
, Kinscherff, R., & Fenton, T. (1988). Propranolol treatment for childhood posttraumatic stress disorder, acute type: A pilot study. American Journal on Disabled Children, 142, 1244-1247.
35.
Foa, E. B., Davidson, R. T., & Frances, A. (Eds.). (1999). Expert consensus guideline series: Treatment of posttraumatic stress disorder [Special issue]. Journal of Clinical Psychiatry, 60(16).
36.
Frazer, A.
(1997). Pharmacology of antidepressants. Journal of Clinical Psychopharmacology, 17(Suppl. 2), 2S-18S.
37.
Friedman, M. J.
, Davidson, J.R.T., Mellman, T. A., & Southwick, S. M. (2000). Pharmacotherapy. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatment for PTSD (pp. 84-105). New York: Guilford.
38.
Friedman, M. J.
, & Schnurr, P. P. (1995). The relationship between trauma, posttraumatic stress disorder, and physical health. In M. J. Friedman, D. S. Charney, & A. Y. Deutch (Eds.), Neurobiological and clinical consequences of stress: From normal adaptation to posttraumatic stress disorder (pp. 507-524). Philadelphia: Lippencott-Raven.
39.
Goenjian, A. K.
, Yehuda, R., Pynoos, R. S., Steinberg, A. M., Tashjian, M., Yang, R. K., et al. (1996). Basal cortisol, dexamethasone suppression of cortisol, and MHPG in adolescents after the 1988 earthquake in Armenia. American Journal of Psychiatry, 153, 929-934.
40.
Harmon, R. J.
, & Riggs, P. D. (1996). Clinical perspectives: Clonidine for posttraumatic stress disorder in pre-school children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1247-1249.
41.
Hart, J.
, Gunnar, M., & Cicchetti, D. (1996). Altered neuroendocrine activity in maltreated children related to symptoms of depression. Development and Psychopathology, 8, 201-214.
42.
Herman, B. H.
, Hammock, M. K., Egan, J., Arthur-Smith, A., Chatoor, I., & Werner, A. (1989). Role of opioid peptides in self-injurious behavior: Dissociation fromautonomic nervous system functioning. Developmental Pharmacologic Therapeutics, 12(1), 81-89.
43.
Horrigan, J. P.
, & Barnhill, L. J. (1999). Risperidone and PTSD in boys. Journal of Neuropsychiatry and Clinical Neurosciences, 11, 126-127.
44.
Kaufman, J.
(1991). Depressive disorders in maltreated children. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 257-265.
45.
Kaufman, J.
, Birmaher, B., Perel, J., Dahl, R. E., Moreci, P., Nelson, B., et al. (1997). The corticotropin-releasing hormone challenge in depressed abused, depressed nonabused, and normal control children. Biological Psychiatry, 42, 669-679.
46.
Knight, R. T.
, Grabowecky, M. F., & Scabini, D. (1995). Role of human prefrontal cortex in attention control. Advances in Neurology, 66, 21-34.
47.
Lemieux, A. M.
, & Coe, C. L. (1995). Abuse-related posttraumatic stress disorder: Evidence for chronic neuroendocrine activation in women. Psychosomatic Medicine, 57, 105-115.
48.
Liberzon, I.
, Taylor, S. F., Amdur, R., Jung, T. D., Chamberlain, K. R., Minoshima, S., et al. (1999). Brain activation in PTSD in response to trauma-related stimuli. Biological Psychiatry, 48, 817-826.
49.
MacLeod, J.
, & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child mal-treatment: A meta-analytic review. Child Abuse & Neglect, 24(9), 1127-1149.
50.
March, J. S.
, Amaya-Jackson, L., Murray, M. C., & Schulte, A. (1998). Cognitive-behavioral psychotherapy for children and adolescents with PTSD after a single incident stressor. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 585-593.
51.
Moradi, A. R.
, Doost, H.T.N., Taghavi, M. R., Yule, W., & Dalgleish, T. (1999). Everyday memory deficits in children and adolescents with PTSD: Performance on the Rivermead Behavioural Memory Test. Journal of Child Psychology and Psychiatry, 40, 357-361.
52.
Moradi, A. R.
, Taghaiv, M. R., Neshat-Doost, H. T., Yule, W. Y., Dalgleish, T. (2000). Memory bias for emotional information in children and adolescents with posttraumatic stress disorder: A preliminary study. Journal of Anxiety Disorders, 14, 521-534.
53.
Nester, E. J.
, & Duman, R. S. (2001, May 5-10). Healing the depressed brain: Piqual transduction and neural plasticity. Program and abstracts of the 154th annual meeting of the American Psychiatric Association, New Orleans, LA, Industry Symposium 5D.
54.
Perry, B. D.
(1994). Neurobiological sequelae of childhood trauma: PTSD in children. In M. M. Murburg (Ed.), Catecholamine function in posttraumatic stress disorder: Emerging concepts (pp. 223-255). Washington, DC: American Psychiatric Press.
55.
Pitman, P. K.
, van der Kolk, B. A., Orr, S. P., & Greenberg, M. S. (1990). Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder. Archives of General Psychiatry, 47, 541-544.
56.
Rasmussen, A.
, & Friedman, M. (in press). The neurobiology of PTSD in women. In R. Kimering, P. C. Ouimette, J. Wolfe (Eds.), Gender and PTSD: Clinical, research, and program level applications. New York: Guilford.
57.
Rauch, S. L.
, Whalen, P. J., Shin, L. M., McInerney, S. C., Macklin, M. L., Lasko, N. B., et al. (2000). Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study. Biological Psychiatry, 47, 769-776.
58.
Sallee, F. R.
, Nesbitt, L., Dougherty, D., Hilal, R., Nandagopal, V. S., & Sethuraman, G. (1995). Lymphocyte glucocorticoid receptor: Predictor of sertraline response in adolescent Major Depressive Disorder (MDD). Psychopharmacology Bulletin, 31(2), 339-345.
59.
Saxe, G.
, Stoddard, F., Courtney, D., Cunningham, K., Chawla, N., Sheridan, R., et al. (2001). Relationship between acute morphine and the course of PTSD in children with burns. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 915-921.
60.
Seifritz, E.
, Baumann, P., Muller, M. J., Annen, O., Amey, M., Hemmeter, U., et al. (1996). Neuroendocrine effects of a 20 mg. citalopram infusion in healthy males. Neuropsychopharmacology, 14, 253-263.
61.
Selye, H.
(1973). Homeostatis and heterostatis. Perspectives in biology and medicine. Biology and Medicine, 16, 441-445.
62.
Shin, L. M.
, McNally, R. J., Kosslyn, S. M., Thompson, W. L., Rauch, S. L., Alpert, N. M., et al. (1999). Regional cerebral blood flow during script-imagery in childhood sexual abuse-related PTSD: APET investigation. American Journal of Psychiatry, 156, 575-584.
63.
Southwick, S. M.
, Krystal, J. H., Bremner, J. D., Morgan, C. A., Nicolaou, A. L., Nagy, L. M., et al. (1997). Noradrenergic and serotonergic function in PTSD. Archives of General Psychiatry, 54, 749-758.
64.
Spivak, B.
, Vered, Y., Graff, E., Blum, I., Mester, R., & Weizman, A. (1999). Low platelet-poor plasma concentrations of serotonin in patients with combat-related posttraumatic stress disorder. Biological Psychiatry, 45, 840-845.
65.
Steiner, H.
, Garcia, I. G., & Matthews, G. (1997). PTSD in incarcerated juvenile delinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 36(3), 357-365.
66.
Yehuda, R.
(1999). Linking the neuroendocrinology of PTSD with recent neuroanatomical findings. Seminars in Clinical Neuropsychiatry, 4(4), 256-265.
67.
Yehuda, R.
, Giller, E. L., Southwick, S. M., Lowy, M. T., & Mason, J. W. (1991). HPA dysfunction in PTSD. Biological Psychiatry, 30, 1031-1048.
68.
Zito, J. M.
, Safer, D. J., dosReis, S., Magder, L. S., Gardner, J. F., & Zarin, D. A. (1999). Psychotherapeutic medication problems for youth with attention deficit/hyperactivity disorder. Archives of Pediatric and Adolescent Medicine153, 1257-1263.
69.
Cohen, J. A.
, Berliner, L., & Mannarino, A. P. (2000). Treatment of traumatized children: A review and synthesis. Journal of Trauma, Violence & Abuse, 1(1), 29-46.
70.
DeBellis, M. D.
, Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A. M., et al. (1996). Developmental traumatology part I: Biological stress system. Biological Psychiatry, 45, 1259-1270.
71.
DeBellis, M. D.
, Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., et al. (1996). Developmental traumatology part II: Brain development. Biological Psychiatry, 45, 1271-1284.
72.
DeBellis, M. D.
, Keshavan, M.S., & Harenski, K.A. (2001). Case study: Anterior cingulate N-acetylaspartate concentrations during treatment of a maltreated child with PTSD. Journal of Child and Adolescent Psychopharmacology, 11, 311-316.
73.
Friedman, M. J.
, Davidson, J.R.T., Mellman, T. A., & Southwick, S. M. (2000). Pharmacotherapy. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatment for PTSD (pp. 84-105). New York: Guilford.
