Children with trauma are often misdiagnosed with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), mood disorder or a combination of these disorders, because diagnosis can be difficult without knowing about any abuse history. This is what Rea Romero, Ph.D., neuropsychologist, and Brian Ludden, Ed.D., M.S., LMHC, NCC, CCMHC, also noted in their work with Jacob, an 8-year-old boy, who was permanently removed from his mother’s care due to abuse and neglect, possibly including sexual abuse.
They submitted a case study about Jacob that was accepted in late 2016 for a poster presentation at the 2017 American Psychological Association (APA) Convention. Dr. Romero will present the poster of their work on Aug. 5, 2017 in Washington, D.C.
Jacob has a history of erratic mood swings, anger outburst, impulse control, fire-setting, stealing, lying and aggression. Before coming to Keystone Behavioral Pediatrics to work with Dr. Brian and Dr. Rea, Jacob had been given Adderall for two years, with minimal benefit. Prior to receiving a neuropsychological assessment at Keystone, Jacob’s treatment had focused on ADHD and disruptive behaviors.
Jacob’s assessment revealed average to superior cognitive functioning, and academic achievement, visual-spatial skills and language skills also ranged from average to superior. Likewise, other neuropsychological assessments results were at the expected level or well above the expected level.
The assessments did reveal that Jacob has problems with adaptive, emotional and behavioral functioning. Research shows that abuse and neglect can affect neurobehavioral development that is necessary for efficient behavioral/emotional control and regulation. This led Dr. Rea and Dr. Brian to believe that Jacob’s difficulties in emotional and behavioral regulation are related to his history of significant traumas associated with abuse and neglect.
Patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account
While Jacob denied suffering from increased startled response, flashbacks and psychological symptoms, which are usually an indication of posttraumatic stress disorder (PTSD), his emotional and behavioral problems and patterns are indicative of trauma. Jacob also struggles with handling interpersonal relations and maintaining meaningful relationships, also symptoms of trauma.
Currently, Jacob is receiving a combination of individual mental health sessions and family mental health sessions. Dr. Brian and Dr. Rea have focused on helping Jacob improve his communication with his family and on reducing behavioral concerns, anxiety and the impact of persistent thoughts related to traumatic childhood experiences. He has been taught the use of mindfulness meditation, guided visualizations, compartmentalization, diaphragmatic breathing and other adaptive coping skills for managing and reducing his emotional and behavioral issues.
Over the course of six months of treatment, Jacob’s behavior has improved considerably. As a result of ongoing family mental health sessions, Jacob has come to develop a relationship with his biological mother. Jacob should continue to progress through treatment and master the various mindfulness and self-regulating skills that he has learned in treatment.
As a result of this case study, Dr. Rea and Dr. Brian are presenting to conference attendees that patients will receive a better treatment plan and interventions if complete biopsychosocial history is taken into account. Keystone supports Dr. Brian and Dr. Rea’s research efforts and encourages all therapists to engage in research that continues to improve clinical results for the kids we serve.
For Keystone, Dr. Rea is the director of the Trauma & Grief Clinic and co-director of the Neuropsychological Clinic and Educational & Learning Clinic. Dr. Brian is the director of Keystone’s Anxiety & Obsessive Compulsive Disorders Clinic and the Military Transitions Clinic.