Child abuse and autonomic nervous system hyporesponsivity among psychiatrically impaired children.

OBJECTIVE

Sexually or physically abused children are at risk for neurobiological dysregulation as well as for internalizing and disruptive behavior disorders. Stress-related autonomic nervous system (ANS) down-regulation has been proposed as a sequela of abuse and was investigated in the present study.

METHODS

Child Protective Services documented incidents of abuse were recorded for children in a sample of 262 pediatric psychiatric inpatients, as well as demographic, physical and intellectual functioning, and diagnostic and medication prescription data. Before and after a mildly stressful blood draw, noninvasive assessments of ANS activity were obtained.

RESULTS

Controlling for all other variables in logistic regression analyses, a history of physical abuse (45% overall prevalence) was associated with poststressor ANS hyporesponsivity (i.e., heart rate deceleration).

CONCLUSIONS

Results suggest that a history of physical (but not sexual) abuse is associated with stressor-related ANS down-regulation in psychiatrically impaired children and adolescents.

PRACTICE IMPLICATIONS: Stressor-related autonomic hyporesponsivity secondary to physical abuse may contribute to the impairment of severely emotionally disturbed children. Differential diagnosis of psychiatrically impaired children should include identification of those who have a history of physical abuse, and their treatment should address stressor-related hyporeactivity.