Published online March 1, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 509-516 (doi:10.1542/peds.2006-2028)
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ARTICLE

Stress Predicts Brain Changes in Children: A Pilot Longitudinal Study on Youth Stress, Posttraumatic Stress Disorder, and the Hippocampus

Victor G. Carrion, MDa, Carl F. Weems, PhDb and Allan L. Reiss, MDa

a Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
b Department of Psychology, University of New Orleans, New Orleans, Louisiana

OBJECTIVE. Does stress damage the brain? Studies of adults with posttraumatic stress disorder have demonstrated smaller hippocampal volumes when compared with the volumes of adults with no posttraumatic stress disorder. Studies of children with posttraumatic stress disorder have not replicated the smaller hippocampal findings in adults, which suggests that smaller hippocampal volume may be caused by neurodevelopmental experiences with stress. Animal research has demonstrated that the glucocorticoids secreted during stress can be neurotoxic to the hippocampus, but this has not been empirically demonstrated in human samples. We hypothesized that cortisol volumes would predict hippocampal volume reduction in patients with posttraumatic symptoms.

PATIENTS AND METHODS. We report data from a pilot longitudinal study of children (n = 15) with history of maltreatment who underwent clinical evaluation for posttraumatic stress disorder, cortisol, and neuroimaging.

RESULTS. Posttraumatic stress disorder symptoms and cortisol at baseline predicted hippocampal reduction over an ensuing 12- to 18-month interval.

CONCLUSIONS. Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus. Additional studies seem to be warranted.

Key Words: stress • child maltreatment • cortisol • MRI • hippocampus

Abbreviations: PTSD—posttraumatic stress disorder • DSM-IV—Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • CAPS-CA—Clinician-Administered PTSD Scale for Children and Adolescents • CSF—cerebrospinal fluid • HPA—hypothalamic-pituitary-adrenal

Accepted Oct 23, 2006.




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