Posttraumatic stress disorder in children

The adult posttraumatic stress disorder or PTSD is now a well-accepted condition, which was first observed among Vietnam War veterans. Now I think there is another form of PTSD—the fetal posttraumatic stress disorder.

This condition occurs during pregnancy. At a time when we think that the fetus is well-protected inside the mother’s womb, silently and invisibly environmental toxic chemicals and substances are invading its fragile brain. And during this time, too, the fetus is affected by the mother’s diet and, more importantly, her emotions and stress.

During the first 10 to 18 weeks of gestation of the fetus, the brain is actively growing by the billions of individual neurons. By the end of the 18th week all brain cells that a newborn will have are completely formed, and they have reached their predetermined locations. This is the first major event in the formation of the brain.

The second big event in fetal brain development is the elaboration of cortical connections, the growth of the axons and dentritic arms that transport information from one neuron to another. This is called synaptogenesis. This all happens from the second trimester of gestation and after birth.

During these two stages, the brain growth is vulnerable to exposure from toxic neurochemical substances.

About 40 years ago when I started my pediatric practice in Bangor, Maine, in the United States, I don’t remember seeing many children afflicted with autism, ADHD (attention deficit hyperactivity disorder), OCD (obsessive-compulsive disorder), and bipolar disorder.

Now, about 5 to 10 percent of school children are diagnosed to have ADHD. In the United States, one in every 50 children is found to have autism; in the Philippines, the rate is 1:500. Four decades ago, autism was rarely recognized in a physician’s office.

The No. 1 cause, I think, of many of our children’s behavioral and school difficulties is significant stress during pregnancy. The other is failure of pregnant mothers to consume enough food with DHA, an omega-3 fatty acid.

In my nursery rounds in Maine, I noticed that about 30-40 percent of mothers who just delivered a baby had a history of depression, drug or sexual abuse, suicide attempts, or methadone use.

How can stress during pregnancy cause chronic mental disabilities in children? Research findings in the United States, Canada, Israel, Japan, France, and other countries have shown that when a pregnant mother is chronically stressed, her cortisol level, the stress hormone, goes up in her blood. Then it goes to the placenta and ultimately circulates in the fetal brain.

Exposure by the fetal brain to high levels of cortisol causes language delay, cognitive difficulties, and neuropsychiatric disorders in children. Researchers call this “prenatal programming.”

In lab tests, six pregnant rhesus monkeys were exposed to unpredictable noise and were repeatedly removed from their cages during mid- to late gestation. Another set of six pregnant monkeys were not disturbed in their cages. Those monkeys whose mothers were prenatally stressed later showed abnormal social behaviors like mutual clinging and less social behavior.

In January 1998, there was an ice storm in Quebec, Canada. Hundreds of pregnant women were exposed to the hardships associated with power failure. From this group of mothers, 58 toddlers were investigated at two years old. Members of the Douglas Hospital Research Centre found that the low general intellectual and language abilities of the toddlers were the result of the stressful events that their mothers experienced during the ice storm, a natural disaster. The researchers also found that the higher the level of stress and the earlier it was experienced during pregnancy, the lower were the cognitive and language abilities of the toddlers.

The other factor that contributes to some of the behavioral and cognitive disabilities of many children is the failure of pregnant mothers to take enough DHA, the fatty acid needed by the fetal brain for optimal growth. During fetal brain development, about 60 percent of the energy required for brain cell growth comes from DHA.

When I interviewed mothers with children with autism or ADHD, eight out of 10 said they did not eat fish because of fear of mercury.

Trina, a teacher, had a typical first child who did well in school. There was no family history of autism. Her first pregnancy was happy and without any complication. In her second pregnancy, she became a principal. She neither ate fish nor took DHA supplements. During that time, she had severe job-related stress because of management and personnel disputes which she took personally. She delivered a son who was suspected to be blind at six months old. At two, he could not speak any clear words or complete a sentence. The boy is autistic.

Leonardo Leonidas, MD,  retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1986 graduate of the UP College of Medicine. He authored the eBook “How to Raise A Happy, Smart Child” (https://www.amazon.com/dp/B005UZGCMA).