Editor’s Note: This is the second installment of a five-part series. Read the first article HERE.
BY DEBBIE PAGE
Most adult mental health and substance use disorders have their roots in unresolved or undiagnosed concerns that can be effectively addressed in childhood, according to Kimberly Siegrist, a certified pediatric nurse practitioner.
Sharing her advanced training in child and adolescent developmental and behavioral medicine and her 30 years of experience working with children and adolescents at the recent DACI In The Know event, Siegrist said that untreated and undiagnosed childhood conditions might lead to substance use disorder.
A shocking 66 percent of children experience trauma by age 16, with 80 percent experiencing trauma by age 18.
After defining trauma as a scary or upsetting thing that happened to the child or that that child has witnessed, Siegrist said a treatment professional’s the first step is to ask the parents if anything like this has happened to them or the child.
Children present past traumatic experiences in a variety of ways, including exaggerated negative beliefs, low interest in activities, inability to experience positive emotions, detachment or estrangement, agitation and anger, anxiety, and attention problems.
Children who have experienced trauma are often misdiagnosed with ADHD, she said.
Their feelings of fear and helplessness, increased agitation, irritability, and recklessness from the trauma often result in difficulty concentrating and learning in school, distraction, poor listening skills, disorganization, hyperactivity, restlessness, and difficulty sleeping, which are all associated with ADHD.
Children experiencing the effects of trauma who are given ADHD medicine will see little benefit because the true root of their behaviors was not diagnosed or treated.
Frequently, ADHD medication will instead cause increased agitation and aggression.
Children with undiagnosed and untreated mental health or developmental disorders, such as ADHD, depression, anxiety, conduct disorder, and autism spectrum, are anywhere from two to five times more likely to develop substance use disorder in adulthood.
To change this trajectory, early diagnosis and ongoing behavioral therapies, appropriate medication, supportive parenting, structured environments, resiliency training, positive mentoring and support, and using community resources are essential steps.
PRENATAL EXPOSURE TO DRUGS AND ALCOHOL
Prenatal exposure to alcohol and a variety drugs can also have a permanent and significant effect on children’s mental health and development.
Siegrist shared a number of disturbing statistics:
♦ About 8 percent of U.S. births are affected by prenatal exposure to illegal drugs. In North Carolina, 57 percent of child-bearing age women report using alcohol even when trying to get pregnant, with 7 percent saying they continue to drink during their pregnancy.
♦ In North Carolina in 2020, just over eight in 1,000 newborns were diagnosed with neonatal abstinent syndrome, the withdrawal from opioids or other addictive substances that the baby experienced in the womb.
Symptoms include irritability, feeding issues, and tremors, which are treated with supportive care and medication to ease withdrawal symptoms.
Research indicates that cognitive functioning and emotional regulation problems seem to be highly associated with prenatal exposure to drugs and alcohol. In the N.C. prison system, the rate of inmates’ prenatal exposure is 19 times higher than the general population.
♦ Children affected with fetal alcohol spectrum disorders, which are often misdiagnosed as ADHD, autism, or other mental health issues, have a median age of 12 for entrance into the juvenile justice system.
♦ An estimated 23,000 to 30,000 babies are born each year in the United States with prenatal exposure to either methamphetamine or cocaine. These substances affect normal brain development and birthweight and result in later behavioral and mental health disorders as well as impulse control and decision-making issues.
♦ An estimated 25 to 50 percent of these children will develop substance disorder later in their lives.
Siegrist emphasized that maternal blame and shame have no place in treatment process, which will only distract from the parent’s recovery effort.
The mother’s ingestion of alcohol, tobacco, opioids, marijuana, caffeine, and stimulants can affect the baby’s physical and brain development, later appearing in behavioral, IQ, and physical issues.
Treatment should promote skill building with early behavioral therapy to manage the children’s decision-making and mood regulation. Building the skills of parents and caregivers to care for the child is also important.
♦ In 2014, 25,908 infants born in the U.S. had prenatal opioid exposure, causing structural brain changes that disrupt the normal development of the parts of the brain that regulate mood, behavior, and addiction. These children often show learning, behavior, and attention problems.
The children are often misdiagnosed with ADHD or autism because the symptoms can be similar, but these children will not respond to the prescribed medications and therapies because of the misdiagnosis.
Medical professionals must get an accurate prenatal and childhood history to avoid this misdiagnosis, Siegrist said.
Research indicates that approximately 50 to 90 percent of children exposed to opioids during pregnancy may develop a substance disorder during their teen or adult years.
♦ New studies are also looking at prenatal exposure to fentanyl, which can result in physical birth defects, abnormal, brain development, developmental delays, learning issues, and sensory processing problems, as well as a 50 to 90 percent risk of developing a substance use disorder in adolescence or adulthood.
FETAL ALCOHOL SYNDROME
Siegrist also emphasized that there is no safe time to drink alcohol during pregnancy because the unborn child does not have a mature liver to process the alcohol that crosses into the placenta and lingers in amniotic fluid.
This physical immaturity leaves the fetus exposed to the alcohol much longer than the mother experiences elevated blood-alcohol levels.
An estimated one in seven pregnant women in the United States reported drinking alcohol during pregnancy, with about one in 20 reporting binge drinking in the past 30 days.
Because of this maternal alcohol usage during pregnancy, an estimated one in 20 school children in the United States may have fetal alcohol syndrome disorder (FASD).
This disorder affects the child’s facial development as well as harming their brain development and functioning, resulting in problems in sensory, attention, reasoning, language, memory, behavior regulation, motor skills, adaptiveness, social skills, and academic achievement.
Children with FASD may have delayed speech and below average reading levels, and require living skill assistance. They may also have difficulties with abstract concepts of money and time, delayed social skills, social maturity, and impulse control.
An estimated one-quarter of adopted and foster children are suspected to have FASD. People with this disorder are also disproportionately represented in the criminal justice system.
People with fatal alcohol syndrome disorder can experience lifelong issues because there is not a cure. However, research shows that early intervention and treatment can improve a child’s development and reduce the risk of later substance use disorder and behavioral difficulties.
Barriers exist in making an accurate FASD diagnosis, including lack of documentation and reporting, poor prenatal care, and the mother not admitting to substance use during pregnancy because of her shame.
FASD is sometimes diagnosed as autism because of overlapping symptoms. However, there are some key differences because those with FASD have better social skills and eye contact, develop advanced language skills as they grow, are able to relate to others, and are able to share enjoyment and laughter.
Siegrist said that honesty about prenatal exposure to substance misuse is crucial to start early interventions to overcome the inherited genetic vulnerabilities that increase the risk of developing future substance use disorder.
These genetic factors can interact with environmental factors, including social economic status, the level of parent involvement, exposure to trauma, and the availability of support systems. Improving these environmental factors can help mitigate the children’s risks.
Parents or caregivers must receive the skills, training, and support needed to help provide the best environment possible for the child to overcome their prenatal exposure issues. Because these children do not always respond as expected to medications as a result of their prenatal exposure, any treatment medications must be monitored closely.