We cannot afford to forget that parents have the strongest influence on children’s neurobiological development. Find a child exposed to ACEs and, most certainly, you will find parents who suffered as children. The disorders are easily treatable. Primary care physicians are our best first-line of defense.
Seriously hampered by their symptoms, adults know “something” is wrong; most ask for help if given the opportunity. Without appropriate medical care, adults suffering any of the three syndromes risk turning for relief to alcohol and/or drugs. Much of my clinical work was done in an addiction treatment setting where I was tasked with diagnosing and treating patients unable to achieve sobriety with a 12-Step Program alone.
Listening to adult patients’ stories of childhood, I found most to suffer at least one of three specific neuro-biological syndromes – all resulting from ACEs. Data on the diagnosis and treatment of these syndromes confirms the link diagrammed by the ACE pyramid found on the ACE homepage (www.cdc.gov/ace/). Diagnostic terminology (neurophysiologic rather than behavioral) differs from that of the DSM, which can still be used for coding purposes.
1. Autonomic hyper-reactivity (locus ceruleus activation) Life-threatening fear creates receptors in the locus ceruleus that, when triggered by memory of the experience, cause uncontrollable explosive reactions and/or dissociative symptoms. Men typically react with uncontrollable violent outbursts. Women are more likely to experience panic attacks – debilitating but less frightening to a child. At therapeutic doses one medication, clonidine, fully treats the symptoms, and without side-effects. Diagnostically, a small test-dose of clonidine neurobiologically confirms the clinical diagnosis. Pharmacologic observations and directives can be found by clicking on “clonidine” at http://www.bornforjoy.com/science.html.
2. Pervasive Dysphoria (serotonin-neuron-communication dysfunction) Essentially all adults with life-long bouts of depression grew up afraid to make mistakes. Through play (making mistakes, then learning from them) the developing brain and body maintain physiological connection with the serotonin-mediated neuronal system we experience as instincts (our feelings). The physical, sexual, and emotional symptoms are profound, underlying pain syndromes, compromising marital pleasure, and preventing playful care of children. Fluoxetine is the only medication that treats the disorder without side-effects. Again, a small test-dose confirms a clinical diagnosis. Pharmacologic observations and directives can be found by clicking on “fluoxetine” at http://www.bornforjoy.com/science.html.
3. Profound alienation (frustration intolerance) Children need a firm, loving and guiding, hand to grow up confident adults. Otherwise, they have only primitive animal coping skills to deal with frustration: posturing, threatening, bullying, and violence. Although typically anxious and often “med-seeking,” adult patients find the side effects of all but addictive medications (absolutely contraindicated) intolerable. They need the firm limits of cognitive therapy provided in a group setting. Beyond clonidine and/or fluoxetine (when clinically indicated as above), medication should be avoided.
Effective treatment of these disorders has been limited by pharmaceutical industry financial interest. Good research goes unreported or is undermined; data “proving” the effectiveness of unhelpful medicines is selectively published: dosing guidelines misrepresent pharmacology. 1) Drug company representatives told me told me this (first hand) in private discussion. 2) An editor of the DSM-IV supported the above findings as “right” but vowed never to publicly support them. 3) The research, found “technically sound” by senior editors at both Science and Nature, could not be published. We must understand that corporations are, by law, required to profit their shareholders. The current economy demands most of us make compromises to insure our families’ financial security.
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