Transcript What is PTSD - California State University, Los Angeles

Arousal And Startle
In Maltreated Children With
And Without Posttraumatic
Stress Disorder
Cynthia Perez
Laura Mickes
Danielle Morgan
Veronica Reamon
Dr. Mitchell Eisen
California State University, Los Angeles
What is Posttraumatic Stress
Disorder (PTSD)?

The development of characteristic symptoms
following exposure to an extreme traumatic
stressor.

PTSD can develop when a person has been
exposed to a traumatic event.
Diagnostic and Statistical Manual of Mental Disorders 4th edition text revision.
(2000) American Psychiatric Association.
Diagnostic features of PTSD
Includes 5 Classes of Symptoms
Persistent symptoms of increased arousal
including:
 Difficulty falling or staying asleep
 Irritability or outburst of anger
 Difficulty concentrating
 Hypervigilance
 Exaggerated startle response
Diagnostic and Statistical Manual of Mental Disorders 4th edition text revision.
(2000) American Psychiatric Association
Background

There have been many studies examining
different types of physiological arousal
responses in adults with PTSD.


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Sample: Vietnam Veterans
Physiologic arousal : startle paradigm
Exaggerated startle response has been
studied both in relation to conditioned stimuli,
like trauma-related cues and unconditioned
stimuli, like loud tones.
(Orr, Lasko, Shalev, Pitman, 1995:Shalev, Orr, & Pitman 1997; Shalev et al. 1992;
Metzger, et al. 1999)
Background



There have been many studies examining different types of
physiological arousal responses in adults with PTSD.
 Sample: Vietnam Veterans
 Physiologic arousal : startle paradigm
Exaggerated startle response has been studied both in relation to
conditioned stimuli, like trauma-related cues and unconditioned
stimuli, like loud tones.
Results from these studies show that Vietnam
Veterans with PTSD have elevated resting
heart rates and a higher startle response to
unannounced tones than Veterans without
PTSD.
(Orr, Lasko, Shalev, Pitman, 1995:Shalev, Orr, & Pitman 1997; Shalev et al. 1992; Metzger,
et al. 1999)
Assessing PTSD in Children

There is much disagreement as to how
PTSD is presented in children.

While hyperarousal is seen as one of the
most prominent symptoms in diagnosing
children with PTSD there are NO studies
validating increased arousal in this group.

There is only one study examining children
with PTSD. (Orniz & Pynoos, 1989)
Study of Children with PTSD

Sample: 6 children with PTSD and 6 children
with no PTSD.

Results are inconsistent with findings in the
adult literature.

Namely, that children show lower rates of
arousal and startle.
Study of Children with PTSD


Sample: 6 children with PTSD and 6 children with no PTSD.
Results are inconsistent with findings in the adult literature.
 Namely, that children show lower rates of arousal and startle.

Overall , PTSD is NOT well understood in
children.

Research validating commonly held
assumptions on how PTSD is expressed
in children is desperately needed.
Questions?

Do children with PTSD present the
same way as adults with PTSD?

Do maltreated children with PTSD
present differently from maltreated
children without symptoms of PTSD?
Hypotheses

Children with PTSD will show increased
arousal in a resting state resulting in
larger heart rate levels when compared
to maltreated children without PTSD.

The PTSD group will show a greater
amplitude of startle response when
compared to maltreated children without
PTSD.
Participants

All children were recruited through the Los
Angeles Dependency Court and through
attorney referrals.

Research assistants make daily visits to the
court to recruit children through incoming
faxes: referrals for treatment.

They then contact the CSW, read scripts
approved by the court to the CSW and
caregiver, and finally schedule an
appointment for the child here at CSULA.
Participants

Recruited over 40 children with a verifiable
history of maltreatment


Some children were dropped because they had
serious burns, opted not to participate, or there
were problems with the psychophysiological
monitoring.
Only able to use data for 19 (12 males, 7
females) children.


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Age ranged from 6 – 12 years (M =9.67, SD =
1.88).
11 children with PTSD( 6 males, 5 females)
8 children with no PTSD(6 males, 2 females).
Procedures


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Child assent form
Hearing Test: each
child’s hearing was
assessed before
running startle.
Memory for
Sentences subtest,
from the StanfordBinet Standardize
Intelligence Test
Procedures

Our procedures and equipment for assessing
arousal and startle were identical to those used
by Orr et al. (1995).

Used Coulbourn Lablic Progammable Digital to
Analog Converter

Participants listen to a series of announced and
unannounced tones.

Dependent physiologic measures were the same
as those used by Orr et al. and included Eye blink
(EMG), Skin conductance (SC), and Heart Rate
(HR).
STARTLE PARADIGM



Instructed participants to
wash their hands, arms and
face.
Testing took place in an
isolated room connected
through cables to an adjoining
room in which the
experimental apparatus were
located
We started the startle
paradigm by showing the kids
a video so that they could
relax while we abraded their
skin and hooked up the
electrodes.
STARTLE PARADIGM

We slightly abraded
the children’s skin to
increase the
reliability of readings:
arms (HR) and under
their eye lids (EMG).
STARTLE PARADIGM

Eye blink response
(EMG)

Placed two
electrodes over the
orbicularis oculi
muscle to measure
eye blink response
(EMG).
STARTLE PARADIGM

Skin Conductance
(SC)

Placed two electrodes
over the hypothenar
surface of the
participant’s hand to
measure skin
conductance (SC).
STARTLE PARADIGM
Heart Rate (HR)

Heart rate (HR) was
recorded from the standard
limb electrocardiogram
leads.

We checked readings
by asking the child to
take a deep breath and
scrunch up their face.

We put a Velcro band
lightly around the
child’s wrists.
STARTLE PARADIGM

We placed headphones
on the child and
instructed him or her to sit
still and watch a relaxing
dolphin video while we
gathered resting HR
levels.

Once resting HR levels
were recorded we again
instructed kids to sit still
and keep their eyes open.
STARTLE PARADIGM

Run 15 trials

Startle was measured
by increased heart rate
and skin conductance
when the unannounced
tones were introduced.

Research assistant
monitors the child
through an unobtrusive
video camera.
Additional Testing

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Depression: Child
Depression Inventory (CDIS)
PTSD: Posttraumatic Stress
Structure Interview for
Children (PT-SIC)
Anxiety: State and Trait
Anxiety Inventory for children
(STAIC)
Intelligence: A short form of
the Wechsler Intelligence
Scale for Children 3rd edition
(WISC III)
Results
As you can see there are no differences in resting heart rate between
the groups.
Both groups averaged about 79 beats per minute
Resting HR Means
80
79
78
77
HR
76
Beats per 75
minute 74
73
72
71
70
M = 79.64
SD = 6.52
M = 79.03
SD = 9.78
NO PTSD
PTSD
Group
Resting heart rate scores were averaged during the baseline period.
Series1
t (17) = .165, ns
Results
As you can see there was a difference in the magnitude of startle
response between the groups. The PTSD group had larger startle
responses to the loud tones than the no PTSD group.
Startle HR Response
2.8
2.5
Magnitude of 2.2
HR change 1.9
1.6
1.3
1
M = 2.6
SD = .51
M = 2.2
SD = .71
PTSD
NO PTSD
PTSD
NO PTSD
t (17) = 1.73, p <.05
Group
HR response scores were calculated using the method of Orr et al (1995). We obtained the final score by subtracting pre
and post tone mean hr levels. HR responses were averaged across the 15 tone presentation and a square root
transformation was performed to reduce heteroskedasticity.
Discussion

Our hypothesis that children with PTSD would
show a larger startle response to loud tones than
children without PTSD was supported.

Our findings support clinical assumptions of an
exaggerated startle response in children with
PTSD.

Our study is significant considering there is a
dire need for research with PTSD children.

Future research should continue address the
presentation of PTSD in children.
Arousal And Startle
In Maltreated Children With
And Without Posttraumatic
Stress Disorder
Cynthia Perez
Laura Mickes
Danielle Morgan
Veronica Reamon
Dr. Mitchell Eisen
California State University, Los Angeles