Child psychiatrist Helgo Bruening: Some children may need more freedom

Hilgo Bruining, 49, is a child psychiatrist, but he started out as a pediatrician and at that time was surprised by his lack of interest in the brains of children with a chronic, congenital disease. He says, “For example, in children with cystic fibrosis, everything was focused on reducing the damage to the lungs. Not much was done about the fact that these children became mentally exhausted and often had their head so tired that they were no longer able to study” . Conversely, note that children who do not have a congenital disease can go through the most terrible things – accidents, cancer – without a mental breakdown. Bruining: “It prompted me to ask what resilience looks like from a neurobiological standpoint and why one child might have more than another.”

He recently became a professor at the Amsterdam UMC, specializing in neurobiological developmental disorders – autism, ADHD – and in his speech upon accepting his chair he said that children with such a disorder always had other disorders. Epilepsy, migraines, allergies, infections, abdominal pain, and metabolic diseases. He said: It is no accident. These disorders are related to each other, and may have the same cause.

He also said that children with severe developmental disabilities receive inadequate support, while children with mild behavioral problems are often diagnosed too easily and treated too much. In the 1970s, 1 in 1,000 children was diagnosed with autism spectrum disorder, now 1 in 50 to 100. The numbers are higher for ADHD.

We talk about him at his home in Amsterdam – North, two days after his inaugural lecture. The table is full of gifts, and the parcel conductor brings more gifts during the conversation. Bruening says he learned from his father – a pediatrician who specializes in pediatric diabetes – that medicine is a “watching game”. Be sharp and precise. Don’t take anything for granted. When he was training to be a child psychiatrist at UMC Utrecht, he was surprised that children with completely different behavioral and learning problems and yet received the same diagnosis. “Whether they are gifted kids who, due to their hypersensitivity to stimuli, beat their heads against the wall all day in a darkened room, or gifted kids who actually do well except for social communication – they all have autism spectrum disorder. What good is that? I also found it strange That the diagnosis determines what to do and prescribe, not the individual problems and circumstances of the child.”

It’s all on Ritalin.

And if it worked, or seemed to work, the diagnosis was confirmed. At the time”—around 2005—”we mainly focused on genetics in the research, and we thought that would solve the mystery, and indeed gene mutations that disrupt social development were found, but did your children have anything to do with this symptom?” It did not lead to new treatments. We noticed that stimulus processing was different in children with autism spectrum disorder and wondered if this couldn’t be made more tangible and if you could check that for each child.”

As long as you leave an autistic child alone, she says, you don’t have to worry.

The problem mainly lies in the interaction with the environment, which is very intense, very complex, and sometimes even frightening. It triggers something in these children that prevents them from learning or behaving socially. How did this happen?”

Children with severe developmental disabilities do not receive adequate help

The brain is not a “blank sheet” of information from birth, Bruening says. The greater part of the brain, 95 percent, is occupied by the automatic activity that directs the organs and makes possible mental functions: thinking and doing, emotional experience. Before birth, the structure of this entire system is built – 100 billion neurons, each in contact with tens of thousands of other neurons – and after birth it must begin to interact with the environment. “From that moment on, the neurons should also be able to get inhibited,” Bruening says. “If the brain allows all the stimuli to get through, it will be chaos. The stimulus balance needs to be stabilized around birth, so that the right amount of information can flow to the right place in the brain at The right time.”

This is where things can go wrong?

“Anything can go wrong with the whole project, but this shift from build to action is essential. The crucial moment is just before birth, when a strong and sudden drop in chloride concentration occurs in neurons and inhibition becomes possible. The oxytocin released during birth also reduces chloride. This shift in chloride is characteristic of most animal species. It is one of the best-proven concepts in neurobiology and teaches us that this stimulus balance must also be established in time, so that the baby is able to learn to process stimuli after birth.”

Why could this transformation fail?

“Genetic predisposition, premature birth, smoking, alcohol, chronic maternal stress, trauma – all of this appears to be a cause of a brain that is not sufficiently inhibited. So you see that different types of disturbances in brain development can have the same effect: a child who learns to respond appropriately. less for the environment.

And why are there other disorders, too?

“Yes, how does that happen. What is nature trying to tell us if developmental disorders in the brain are almost always associated with them? Why is there such a clear overlap between autism and epilepsy? And why do so many children with autism problems have a febrile seizure? No Neurologists see it that way yet, but I think it must be related. Then metabolic disorders. In children with such a disorder, a genetic abnormality can completely disrupt the metabolism, often affecting the brain as well. You can Thinking with all these disturbances that the balance in the body is upset and the effect of that can be seen everywhere.”

Children with mild behavioral problems are often diagnosed very easily and often treated

Following the example of Danish theoretical physicist Per Buck and Amsterdam neurophysicist Klaus Linknecker Hansen, Helgo Bruening considers the brain to be a complex system that organizes itself in a balance between order and disorder. Nature is filled with such systems – weather, flocks of starlings, genetics, oceans – and Bear Buck in 1987 proved that they are governed by universal laws. And all of them have their own mechanisms for maintaining balance. “Brain activity consumes a great deal of energy, 20 to 30 percent of what is available, at rest, and when illness, stress or a busy environment places more demands on the brain and demands more energy, this can be at the expense of motivational balance,” Bruening says. What I see a lot in the doctor’s office: a child who is very tired and can do nothing. He is easily annoyed, there are problems with concentration and sleep, and everything is excessive.”

If a child does not have any other conditions, does he not have autism or ADHD?

“In mild cases, that is really the question. I see them a lot, children without delays in language, speech or motor skills at a young age, without a stressful family history, without other disorders. In this case, there is really no reason to assume there is a developmental disorder. You must then dare to tell the parents that stimulus sensitivity can also be a psychological phenomenon, a part of personality. The child can simply be a little more sensitive, more sensitive, and therefore often more artistic. If he also suffers from some Dyslexia and was in a competitive school, he may have symptoms similar to those of autism or ADHD. If you’re going to treat this child, you’re doing it wrong in two ways. Treatment won’t help and you’re ignoring this child’s needs. It can have a disastrous effect. Stimulants” – Ritalin and similar drugs – do not work, strangely enough, more stimulants, or other types are given, and in these cases often lead to serious side effects. Sometimes antipsychotics are added against angry moods, neurochemically the analogue of stimulants, q You are completely confusing the brain. You’re making a psychopath for a kid who isn’t.”

Can you objectively diagnose a developmental disorder such as autism or ADHD?

“We have set up the N=You Knowledge Center at Emma Children’s Hospital for this purpose, along with youth care. We do not start from the diagnosis, but we investigate how each child has developed and what are the problems in everyday life. We investigate using an electroencephalogram, an electroencephalogram of the brain, whether it is associated with processing perturbed stimulus. If so, the next question is of course what causes this. It could be in the metabolism process or there is a genetic mutation for signal transduction in the brain. We see the latter in about 30 percent of children with serious disorders.”

You give children with a defective stimulant medication drugs that concentrate chloride.

“Bumetanide, actually a water pill that lowers blood pressure and can also lower the concentration of chloride in brain cells. It’s subtle effects, but we’re seeing kids for whom the world suddenly opens up. They can be a little more cautious. They have a less angry mood. Or less intense.”

So, can the postpartum stimulus balance still be adjusted by mimicking this shift in the chordae?

“Partially. The chance of helping decreases with age. You can also use other means to improve the balance of stimulation. I dare say that in some children the assistance dog has an effect on the processing of the stimulus. It is still a matter of kitchen table psychology, but I think: less stress for the child, And a less tired mind.”

Can Postpartum Stress Cause Brain Development Disorder?

“I think so, biologically. If you expose mice to severe stress, they will see disturbances in the stimulus balance. The brain has relatively few ways of responding. It usually is: something is not going well here, and I need certain areas reduce† Do not waste power on unbalanced networks.”

You said in your opening lecture that children’s brains can be overburdened with games, social media, and pressure to perform.

“For many children, this may be a good thing for some children, and for others it is very stressful. My point is that not all of these factors are now included in the diagnosis. In mild cases, there will certainly be an overdiagnosis, but it also appears that There is a real increase in processing self-shaped stimulus without hypersensitivity, epilepsy, or other explanatory factors. And I wouldn’t be surprised if children who have grown up in the world play a role in this.”

And then?

Then it often becomes child psychiatry. The child is uncontrollable, the parents are in a daze and the school demands that the child be given medicine. I don’t care to blame, that’s how the system works. Schools must meet the standards, and children must go along with them. What is the message of these children’s behavior? You have to think about it. If they don’t have a developmental disability, what will help? Not giving pills or diagnoses, but that’s what often happens. They suppress the disturbances and then the conclusion is: You see, it’s ADHD after all. We’re doing a lot of damage with that.”

What is the message of the behavior of these children?

“That some children may need more physical and mental freedom. You should move more with their temperament and not put them in a rigid educational system. And if the behavior stems from educational neglect, you should do something about it.”

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